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Reflections on a contemporary European tragedy
  1. Iain B McInnes1,2,
  2. Annamaria Iagnocco3,
  3. Daniel Aletaha4,
  4. Xenofon Baraliakos5,
  5. Johannes WJ Bijlsma6,
  6. Elsa F Mateus7,
  7. Zoltan Szekanecz8,
  8. Theodora P M Vliet Vlieland9,
  9. Josef S Smolen10
  1. 1 MVLS College Office, University of Glasgow, Glasgow, UK
  2. 2 Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
  3. 3 Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy
  4. 4 Department of Rheumatology, Medical University of Vienna, Vienna, Austria
  5. 5 Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Herne, Germany
  6. 6 Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
  7. 7 Portuguese League Against Rheumatic Diseases (LPCDR), Lisbon, Portugal
  8. 8 Department of Rheumatology, University of Debrecen Medical Center, Debrecen, Hungary
  9. 9 Orthopaedics, Rehabilitation and Physical Therapy, J11, Leiden University Medical Center, Leiden, The Netherlands
  10. 10 Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
  1. Correspondence to Professor Josef S Smolen, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria; josef.smolen.ard{at}

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"No valuable talent exists without the following qualities: 1. Compassion for the oppressed; 2. Love for the good; 3. Hate against evil; 4. Courage, to express the compassion for the oppressed, the love for the good, the hate against evil loudly and unambiguously" 1

One year ago, reflecting on the impact of COVID-19, the influenza pandemic in 1918–1920 was prominent in our thoughts noting that it cost more lives than the first World War.2 However, the World War I was just one of the many disruptions to peace that occurred in Europe during the 20th century. Many more lives were lost in the course of the World War II; people and families were annihilated in the misguided name of a reprehensible ideology, or sacrificed by necessity to retain freedom of thought and expression!

In 2021, the shocking number of 122 300 000 victims of European violence during the 20th century was shown in an exhibition at the Jewish Museum Hohenems, a city in Vorarlberg in the federal republic of Austria. ‘Numbers are mathematical objects, objects of measuring thought, but behind this number, the abstract quantity of 122 300 000, are hidden concrete characters, human lives… (The) European history of violence claimed more than 122 million lives on European soil or through the actions of European powers on non-European soil. A number that is not imaginable, not comprehensible, just abstract. From this monstrosity, this one hundred years of European history of violence, the European project of peace emerged’.3

We imagined a more civilised era in this new century but are sadly disappointed in the first two decades in numerous war-torn regions around the globe. Yet Europe was considered a bastion of peace, stability and prosperity. Now, moving towards the middle of 21st century (during a pandemic that has already caused ~6.5 million deaths through March),4 we witness the instigation of a new war within our European continent, whereby an aggressive leadership sends troops to invade a neighbouring, sovereign and democratic country; where the intruder’s youth is sent to kill others, and where that leadership does not hesitate to send their own youths to their deaths. People die from vicious modern weaponry; thousands are wounded; millions lose their homes and become refugees from a war imposed on them; buildings and cities are destroyed; homes, where people lived in peace, nurseries, schools, universities, libraries and hospitals transformed into rubble and ashes. For what possible ideology can such inhumanity be justified?

So please pause for a minute on the many hundred millions of people who mourned their loved ones in the 20th century—parents, wives, husbands, children, brothers, sisters, grandparents. What agonising, unfathomable aggression seeks to start wars, to kill people and to let one’s own people be killed? Consider the millions of wounded persons and the devastation of homes and towns, and infrastructure that had to be rebuilt. Consider the irrevocable loss of cultural heritage. What cruelty, what barbarism! For nothing but dysfunctional ideologies! Now this, hic et nunc. Why cannot modern mankind disprove Hegel’s conclusion ‘that nations and governments have never learnt anything from history, or acted on any lessons they might have drawn from it’?5

The rheumatology community looks on in horror and weeps. Horror rendered in the cruellest contrast by our fond recollection of the VIII Ukrainian National Congress of Rheumatology, including a EULAR Cooperation with National Societies programme (EULAR ECONS), held in October 2021 in Kyiv, organised by Iuliia Biliavska and others from Volodymyr Kovalenko’s Department, together with the EULAR president, Annamaria Iagnocco. Should the international rheumatology community speak of this horror? It is for politicians, political analysts and historians to make political statements. It is for international courts to make judgement on adherence or otherwise to international laws. But, we believe that medical organisations such as EULAR and medical journals such as ARD should demand respect of human rights. The Universal Declaration of Human Rights makes very clear statements: ‘Whereas recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world… Now, therefore, The General Assembly, proclaims this Universal Declaration of Human Rights as a common standard of achievement for all peoples and all nations, to the end that every individual and every organ of society, keeping this Declaration constantly in mind, Article 1—All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood. Article 2—Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind,… Article 3—Everyone has the right to life, liberty and security of person….’6

People suffer not only from the direct consequences of war, but also from contemporary loss of diagnostic and therapeutic opportunities and as the long-term implications of their physical and psychological privations impose later in life. Our feelings are with the Ukrainian people, with the patients and those who care and seek to care for them, now and in the times to come. Accordingly, we recognise that we as EULAR, an alliance of kindred medical, health professional and patient spirits, have a duty of care to support and sustain our Ukrainian colleagues now and in the times to come.

We call for an immediate ceasefire in Ukraine, for the sake of humanity, for the sake of that population and for the sake of Ukrainian patients and their healthcare providers—by corollary, we call on our Russian medical colleagues to mediate for peace.

Peace has been at the centre of the European project3 and peace is fundamental to the remarkable achievements of humanity manifest beautifully in culture, science and modern medicine. Peace across Europe and the world is instrumental for the well-being of mankind in general, but especially for the benefit of our patients. ‘Primum non nocere’

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  • Contributors All authors contributed to the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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