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Ethical drugs, unethical practices

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by Geewananda Gunawardana, Ph.D.

Ensuring the quality, safety, and efficacy of pharmaceuticals requires a high level of constant vigilance. A good example is the four deaths caused by contaminated eye drops in the USA last May despite the well-regulated and best prepared monitoring of the drug supply by the US Food and Drug Administration. Unfortunately, the consumers in places where regulations as well as their implementations fall short of ideals can fall victims much more frequently: A World health Organization (WHO) report finds that about 10% of the world’s drug supply is either subpar or fake. Global deaths among children alone due to subpar drugs is over 150 thousand annually while the economic cost is estimated to be about US $ 200 billion.

While loss of life is a tragedy, the failure to ensure the quality of medicinal products can have far reaching and long-lasting consequences of much larger magnitude. The emergence of drug resistant infections and parasitic diseases and genetic disorders due to subpar drugs will only come to light in the long run.

To get some idea about the vulnerability of pharmaceuticals, it is important to know the way the regulatory process works. Almost 90% of the new drug development takes place in North America and Europe. The rest is divided among Japan and Israel. India and China, leaders in generic drug manufacture, are only beginning to enter this field through collaboration with American and European pharmaceutical companies. When a drug is invented, the inventor obtains a patent, which is an exclusive right to market it for 20 years. However, a patent only keeps the competition away, and it does not give the authority to market the drug, which must be obtained from the regulatory agency of the respective country.

To get the marketing authority, a vast amount of data must be produced showing efficacy, safety, and manufacturability of the drug. This process takes 10 to 12 years on average and over US $ 1.5 billion in R&D costs. As the development takes up to 8 to 10 years, the actual patent life left when it goes to market is reduced to 10 to 12 years, during which time the company must recoup all the costs and make a profit. A drug marketed under patent is known as a brand name drug. These initial R&D costs make the brand name drugs expensive.

The manufacturer of the brand name drug must follow all the current good manufacturing practices (cGMP) as specified by the regulatory agency of the marketed countries. The International Conference on Harmonisation (ICH) has standardised these guidelines and are followed by the major pharmaceutical manufacturing countries. Adherence to the cGMP regulations assures the identity, strength, quality, and purity of drug products by requiring that manufacturers of medications adequately control manufacturing operations.

The consequences of failing to meet guidance can be harsh. For example, the UK based Glaxo Smith Kline was fined US$ 3 billion in 2012, the highest in history for cGMP violations. The brand name drug manufacturers avoid taking any risks as the stakes are very high. There are some companies that were forced to shut down for failing to follow cGMP. A common problem with brand name drugs is the manufacture of counterfeit drugs sold in small markets despite the best efforts of the patent owner to avoid such piracy. The commitment to quality and the stringent regulatory vigilance makes brand name drugs less susceptible for quality issues.

Once the patent expires, anyone with the right capabilities can manufacture the drug and seek marketing authorisation in selected countries. These drugs are referred to as generic drugs. Since the generic manufacturers do not have to bear the billion-dollar R&D costs, they can afford to lower the price. The competition for market share also drastically reduces the cost of generic drugs, often by over 80% of the original price. The costs can be further reduced by moving the manufacturing into places where the labor and operating costs are lower and occupational safety and environmental regulations are lax or lacking altogether. The affordability and wide availability are the beneficial outcomes of generic drugs. For example, 91% of the drugs prescribed in the USA in 2022 were generic drugs. Except for a rare event, the US drug supply remains safe and reliable, mainly thanks to the diligence of the US Food and Drug Administration.

The bulk of these cost-effective generic drugs are destined for low- and middle-income countries. Unfortunately, that is where the troubles begin. The WHO has formulated international regulatory standards to ensure the safety and efficacy of the drugs in places where ICH guidance is not implemented. They also have a program for pre-qualification of drug manufacturing facilities when requested. While international organisations require WHO prequalification for drug purchases, individual governments can follow their own regulations. Knowing the presence of potential buyers who are willing to forgo cGMP requirements, some manufacturers tend to ignore the need for costly qualification or certification programms. This practice is also encouraged by the premise on the buyers’ side that testing alone can ensure the quality of drugs. However, the truth is that failing to follow cGMP can lead to unintended release of subpar drugs to markets even if the standard testing procedures are followed.

Two processes where this can happen easily are sterilisation and achieving content uniformity. Failure to ensure that every single unit of the drug, be it a pill or a vial of many thousands manufactured, is compliant could result in subpar drugs reaching the market. In the case of uneven sterilisation, microbial contamination can occur as was seen with eye drops. Failure to ensure uniformity can result in drug units containing either higher or lower doses than shown on the label.

Most of the generic drugs are manufactured in Asia. Drug manufacturing is a multistep process conducted in multiple locations under varying levels of regulatory control. A routine drug manufacture can have the following basic steps: procurement of raw materials, synthesis of starting materials and/or intermediates, synthesis of the active pharmaceutical ingredient (API), procurement of excipients, and formulation of the API into the drug product – capsule, tablet, syrup etc. This can vary for biologics such as vaccines and recombinant proteins etc., which make up only about 2% of all drugs used. In either case, at every step, the product must be stored in proper containers under the right conditions as determined based on its stability to prevent degradation and contamination.

Except for biologics, almost all drugs are produced by chemical synthesis. A small portion are either plant or microbial origin. The generic drug manufacturers come up with alternate synthetic routes that are cost effective. This creates a major problem: Any synthetic process generates impurities or side products in addition to the desired product. These impurities could have unknown properties, including toxicity, and must be removed or kept to a minimum using various purification steps. The processes and analytical methods used for this purpose by the brand name manufacturer are optimized to monitor and control any impurities specific to the raw materials, starting materials, and excipients they used. However, if the generic manufacturers introduce any changes, the standard quality control methods may not work, and undesired impurities will end up in the drug causing potential adverse events. Another potential problem, particularly in the warm and humid tropics, is microbial contamination, as happened with eye drops when handling and storage conditions are deviated.

With complicated supply chains, it is very difficult for the drug purchaser to track if all processes used in the manufacture of the drug were conducted under cGMP. Either they do not have the wherewithal or have no impetus altogether as happens when questionable drug procurement methods are followed. There are other ways the purity of drugs can be compromised. All drugs have a limited lifetime as specified by the expiration date. The expiration date is set assuming the storage of the drug under certain conditions and in designated containers. Any deviation, which can happen easily when transported between tropical locations, the drug can degrade reducing the potency or efficacy and introducing impurities. Without proper cGMP, it is not possible to know if such deviations have occurred.

If the drug is degraded, the desired therapeutic effect may not be achieved. In addition to that, in the case of antimicrobial and antiparasitic drugs, the administration of lower doses can lead to the development of drug resistant varieties. Infections caused by resistant organisms can be difficult, and sometimes impossible, to treat. Antimicrobial resistance is an urgent global public health threat that killed around 1.27 million people worldwide in 2019. If not controlled, this could render the current anti-infective drugs virtually useless and makes it one of the world’s most urgent public health problems.

The impurities or contaminants in drugs can have numerous undesired results including death. The deaths of 66 children in Gambia last year caused by taking contaminated cough syrup, imported from India, is just one example. A serious problem is contamination with genotoxic compounds. If not detected promptly, the consequences would not be known for many generations. The genotoxic impurities can be harmful when present in as low as parts per million amounts in the drug. The analytical techniques for detecting such low amounts require specific instruments not readily available in most laboratories. Recently, a whole family of hypertension drugs were found to contain genotoxic impurities and were withdrawn from the US markets.

These are the problems that can arise under normal operating procedures, and fortunately, the ones that can be eliminated if proper cGMP are observed. To worsen things, there are added problems that go beyond manufacture and cGMP. Unscrupulous drug companies and corrupt administrations contribute to the problem by knowingly allowing substandard drugs into healthcare systems with total disregard for life and limb. Pharmaceutical industry is notorious for its “gift” system for buying or prescribing their drugs. In one reported incident, a company sold 45 years’ worth of antibiotics to a developing country when the shelf life of the drug is only 2 years. Unloading drugs that are nearing expiration or not suitable for their own countries into low-income countries is a common practice.

The subpar drug related adverse events are predictable but also preventable. Generic drugs in general are safe and effective as international organizations have provided the means to ensure their safety and efficacy. Every step from the supply of starting materials to the dispensing of the drug to the patient must be controlled according to the guidance to receive the full benefits of drugs and avoid adversities. Sri Lanka has incorporated most of those rules and regulations to their own. However, their complete implementation remains questionable. Purchasing drugs without knowing its complete history is inviting trouble. Neglecting to do so puts future generations at risk in addition to wasting hard-earned foreign exchange.



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Closing the Book: Fair regulation of gambling – V

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by Prof. C. A. Saliya

Over the past four weeks, this column has taken you to a casino floor on the Colombo waterfront, a card game under an awning, a trading app glowing in a teenager’s bedroom, and a racecourse where the numbers on the board are quietly rigged in the house’s favour before the horses even reach the starting gate. Four completely different worlds. Four completely different sets of laws governing them. And, underneath every single one, the exact same machine.

It’s worth stating that machine plainly, one final time, because it’s the thread that has run through this entire series: every form of gambling we’ve examined has a built-in mathematical edge that belongs to the operator, not the player. Every one of them puts real effort into making that edge feel invisible, by calling itself a sport, a tradition, an investment, or simply harmless fun. And every one of them has a shadow version, an informal or offshore tier, that exists specifically to serve the customers the legal, licensed version either can’t reach or won’t touch.

Once you see that pattern, you can’t really unsee it. A casino’s house edge, a bookmaker’s overround, a trading platform’s spread, and the quiet certainty that whoever’s running the neighbourhood’s illegal numbers game isn’t doing it as a charity, they’re all the same idea, wearing different clothes.

Sri Lanka’s moment of choice

Which brings us to the reason this series exists right now, rather than five years ago or five years from now: Sri Lanka is in the middle of the biggest overhaul of its gambling laws in more than a century. A new Bill, gazetted under President Anura Kumara Dissanayake, would scrap three separate, ageing pieces of legislation, the ordinances covering horse racing, general gambling, and casinos, the oldest dating back to 1889, and replace them with a single Gambling Regulatory Authority responsible for the entire industry, from a Colombo casino table to an online betting app.

That’s a genuinely significant moment, and it deserves to be judged fairly, against the three failures we’ve traced through this series rather than against vague hopes or fears. So, let’s do that, one at a time.

Does it close the gap between licensed gambling and everyone else’s gambling? Almost certainly not, and, as we argued in Part 2, it probably shouldn’t try. A modern regulator built to license casinos and tax betting operators has no realistic way of prosecuting a card game at a funeral house. That gap between “gambling the wealthy do” and “gambling everyone else does” is older than the Republic itself, and one new law was never going to close it. The more honest question for policymakers isn’t how to stamp out Buruwa, it’s whether the country should keep spending any enforcement energy at all pretending it might, when that energy could go toward the tier of the industry that actually causes measurable financial harm.

Does it bring trading apps and offshore forex platforms under the same protective umbrella as gambling? No, and this is the new law’s single biggest blind spot, exactly as we laid out in Part 3. A 19-year-old can lose their entire savings to a leveraged CFD trade with none of the protections that would apply if they’d lost the same money at a licensed casino table: no mandatory age verification built for gambling-style harm, no loss limits, no cooling-off period, no self-exclusion register. The new Gambling Regulatory Authority, as currently designed, has no jurisdiction over any of it, because these products are still classified as financial services rather than gambling, a distinction that matters enormously on paper and barely at all to the person who actually loses the money.

Does it strengthen the fight against unlicensed offshore operators? Here, genuine credit is due. The new law’s Digital Gambling License, requiring both local and offshore online operators to hold a Sri Lankan licence before taking bets from Sri Lankan customers, is a real and overdue step, arguably the single most useful thing in the entire Bill. Whether it can actually be enforced against operators sitting on servers in another country, outside Sri Lankan jurisdiction, is a separate and much harder question. But as a statement of intent, it’s the clearest sign yet that the government understands where the real money, and the real modern risk, has moved to.

What the rest of the world is trying

Sri Lanka isn’t figuring any of this out alone, and it’s worth glancing at how others are handling the same puzzle. Britain’s Gambling Commission is one of the world’s most established regulators, and it is currently under real political pressure over gambling advertising and whether operators do enough to check that customers can actually afford their losses, a reminder that even a mature, well-resourced regulator never really finishes the job. Curaçao, a small Caribbean territory, built its reputation on issuing gambling licences fast and cheap, which sounds appealing until you realise it’s also a cautionary tale about what happens when a “race to the bottom” on licensing standards leaves consumers with almost no real protection at all. And the United Arab Emirates offers the opposite lesson: a country that spent decades as one of the strictest gambling-ban states in the world, now in the process of building a licensed casino and betting industry from scratch, precisely because its leaders concluded that a controlled, visible industry was easier to manage, and tax, than an invisible one they could never fully suppress anyway.

Sri Lanka’s new law sits somewhere between those examples: more ambitious than Curaçao’s light-touch approach, less mature than Britain’s decades-old framework, and facing the same fundamental question the UAE has just decided for itself, is it better to chase an activity underground, or bring it into the light where it can at least be taxed, measured, and, where necessary, restrained?

What no law can fix

It’s worth being honest about the limits of regulation, too, because this series has tried throughout not to oversell what any single law can achieve. No Gambling Regulatory Authority, however well designed, is going to stop a family playing Buruwa at a funeral house, and it probably shouldn’t try to. Some forms of gambling are so deeply woven into ordinary social life that treating them as a policing problem wastes effort that would be far better spent where the actual harm is concentrated: online, on trading apps, at unlicensed operators reaching people through their phones at two in the morning, far from any awning or family gathering.

A closing word, not a closing bet

If there’s one thing worth taking away from five weeks of this column, it isn’t a tip for the next race, or a warning to delete your trading app, though there’s a case for both. It’s simply this: understanding how the house edge works, in a casino, at a card table, on a trading screen, or at the bookmaker’s window, doesn’t make you better at winning. Nothing does, reliably, over the long run; that’s what “house edge” means. What it does is make you a harder person to fool, which, in an industry built almost entirely on making its edge feel invisible, might be the only real advantage a player ever gets.

The most dangerous bet in this entire series was never really a bet at all. It was assuming that because a game wears a suit, or a silk shirt, or a family blessing, it doesn’t have a house. It always does. The only real choice any of us has is whether we walk in with our eyes open.

This concludes our five-part Out of the Box series on the business of gambling. If you or someone you know is struggling with gambling-related harm, please seek support from a qualified counsellor or helpline in your area.

(Prof. C. A. Saliya, is a charted accountant, academic, researcher and former banker. He is the author of SAMAJA GAVESHAKAYA and Springer Publication DOING SOCIAL RESEARCH. He can be contacted at saliya.ca@gmail.com. The views expressed in this article are his own and do not necessarily represent those of the organisations with which he is affiliated.)

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Why Sri Lanka needs an Inclusive Civic Nationalism – urgently

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Maitreyi Ramakrishnan

by Sasanka Perera
(The writer is on X as @sasmester)

The frenzied online actions of thousands of Sri Lankans responding to the Canadian actress, Maitreyi Ramakrishnan, calling herself an Eelam Tamil and opting not to identify herself with Sri Lanka has gone viral.  Many of these were ‘Sinhalas’ from the country and the diaspora. An equal number of people spoke in support of the actress too, most being diasporic and local Tamils. Much of the latter was driven by a sense of online-Eelam nationalism. The liberal-woke types from Lanka claimed the Canadian actress as our own despite Ramakrishnan having made it very clear she does not want to be identified as such.  The first two of these expressions are clear examples of ways in which nationalism should not manifest, usually as a divisive and exclusionary force. The liberal third expression is simply silly, irrelevant and sad. This said, I have never considered nationalism as useless or dangerous if it can be intelligently and inclusively fashioned to serve the nation. This is very different from my friends in the Sri Lankan Left, who have generally rejected all forms of nationalism.

However, one must be mindful that across the globe nationalism has long walked a dangerous tightrope. Too often, its supporters in different countries have defined the nation through an exclusionary lens, drawing narrow circles around who ‘truly’ belongs and pushing minority communities to the periphery. Two very dangerous ongoing manifestations are epitomised by the virulent US and Israeli nationalisms espoused by Donald Trump and Benjamin Netanyahu. Consequences of their toxic rhetoric have gone beyond their national borders to impact the entire world.  In Sri Lanka, this global malaise has found a localised anchoring as exemplified by the online explosion of competing ethnic nationalisms referred to at the beginning of this essay.

For decades, dominant political narratives have cast nationalism mostly in majoritarian and ethno-cultural and religious terms, overtly or subtly privileging the Sinhala identity. In doing so, this version has mostly alienated Tamil, Muslim, Burgher, and other communities, transforming a concept that should have ideally unified the people of the nation into a wedge that drives them apart. These other communities also have on their own come up with similarly competitive, exclusionary and at times, virulent forms of ethnoreligious natalisms.

But this is not how Sri Lankan nationalism emerged, at least among the elites, in the early years prior to independence. It was far more inclusive and inclusionary than we can fathom today. Compounding the present exclusionary trend is a more cynical phenomenon. That is the weaponization of identity by woefully unethical political interests. In the hands of many political parties and at present, among the fractured and irrelevant political opposition, nationalism in Sri Lanka has been reduced to crude, emotional rhetoric. Or to put it more clearly, it has been turned into a tool of convenience hauled out during election cycles or in times of existential political crisis to secure votes and support through divisive and chauvinistic mobilization. This phenomenon is clearly visible among Sinhala, Tamil and Muslim-dominated political parties.

This brand of nationalism is both offensive and counterproductive, even though many nationalisms in the world today work precisely like this.  Such a negative, virulent and exclusionary nationalism only offers hollow slogans while failing to address the fundamental socio-economic realities and existential crises reaching across international borders that ordinary citizens must face regardless of whether they speak Sinhala or Tamil. It thrives on stoking fear rather than building state capacity or national pride.

To break this cycle, Sri Lanka must self-consciously move toward an inclusive civic nationalism. In my mind, this reimagined identity must necessarily encompass all Sri Lankans across ethnic, linguistic, and religious boundaries. This is the kind of nationalism that did exist among the elites prior to independence and also reemerged decisively during the public protests of the aragalaya.  But I am unsure of its continuity, although it is clear the present government has not offered any ammunition to build a divisive and exclusionary nationalism within the country as in the past. Such inclusive civic nationalism however, does not manifest in the government’s dealings with other nations where the more dominant streak is an unfathomable sense of servility.

Crucially, this new civic nationalism must operate purely on behalf of the sovereign state and its national interest, refusing to use ethnicity or religion as filters for patriotism.  It should also be a driver for our national interest when dealing with other countries –– big or small. When a citizen contributes to the economy, pays taxes, or defends the rule of law, their right to the nation is absolute. True nationalism respects diversity not as a concession, but as the very bedrock of the nation’s strength.

An inclusive nationalism, however, is not merely a domestic moral imperative; it is a geopolitical necessity as well. In an era where small nations are increasingly caught in the crosshairs of great power competition, Sri Lanka cannot afford to be internally fractured.

We have seen ample evidence of how external pressures can sideline our interests — whether through lopsided economic leverage, geopolitical arm-twisting, or diplomatic overreach by regional and global powers like India and China. Particularly this international dimension of nationalism has not seriously been discussed in Sri Lanka and it is hardly an integral part in our negotiations with other nations.

There has been continuous diplomatic pressure and policy lobbying, driven by long-term Indian security and political interests, to construct a physical road and rail link along with power and energy connections between India and Sri Lanka. While Indian proponents and their many Sri Lankan cohorts pitch this purely through an economic lens of trade and tourism, many Sri Lankans view it with deep apprehension. But this apprehension is hardly articulated in any sensible way in any sensible forum including in national politics. It is almost a whisper, albeit a widespread one. Beyond environmental vulnerabilities in the fragile Palk Strait ecosystem, there is a legitimate fear that an open land corridor would strip away Sri Lanka’s natural island strategic defence as well as its identity itself. It risks opening up the country to asymmetric socio-political pressures more than it endures at present, potential demographic and migration imbalances, and tighter economic subjugation by its massive neighbor, effectively transforming Sri Lanka into an easily accessible periphery of the Indian mainland. Besides, a physical link is not an absolute necessity for connectivity.

The Chinese situation is no different. Over the past two decades, aggressive infrastructure financing by Chinese state-owned banks have led Sri Lanka into high-cost commercial debt, culminating in the 2022 economic collapse and the infamous 99-year lease of the Hambantota Port to a Chinese joint venture. This highlights how a weak, fragmented state can be reduced to the role of a pawn in a ‘debt-trap’ or broader Indo-Pacific great power rivalry. When national leaders prioritise short-term political survival or personal patronage networks and wealth accumulation over national interest, critical sovereign assets are compromised, turning parts of Sri Lankan territory into strategic flashpoints for foreign powers. This has already happened in Sri Lanka.

An inclusive Sri Lankan nationalism ensures that decisions on sovereignty and borders as well as the value of national economic assets are evaluated from the standpoint of all citizens and only in the national interest –– not forced through by a locally powerful government with a compliant international relations outlook susceptible to external lobbying. A unified nation can objectively weigh economic connectivity against strategic vulnerability without internal or regional factions weaponizing the issue for sectarian advantage.

In my mind, an inclusive, civic nationalism establishes a firm, non-negotiable doctrine: no foreign power, whether Eastern or Western, regional or global, is permitted to compromise Sri Lanka’s territorial integrity or economic sovereignty. It ensures the country’s national interest and long-term survival are carefully aligned to the economic independence of the nation, ensuring that future governments maintain transparency, resist predatory lending, and treat national assets as sacred public trusts rather than bargaining chips. This does not mean the closure of opportunities for overseas investments. Rather, it means those investments would be based on transparency, on equal grounds and with equal benefits based on similar rules and conditions as those operational in the very countries we deal with.

When a nation is internally divided along ethnic and religious lines or is submissive in the way it deals with the world, it is inherently weak, vulnerable to external manipulation, and ill-equipped to negotiate fiercely.

A unified, inclusive Sri Lanka, backed by a nationalism rooted in collective strength and an inclusive sense of national pride rather than narrow exclusion, can stand its ground. Only then can we speak with one voice to defend our sovereignty, protect our economic assets, and chart an independent course in the Indian Ocean and the world.

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Eastern University and the making of a culture of peace

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by Jehan Perera

There is an important change in the way peace is being understood in Sri Lanka. The notion that peacebuilding is not simply the responsibility of governments, politicians and peace organisations, but is also a responsibility of educational institutions, appears to be permeating the consciousness of at least a section of the academic community. This was visible on International Peace Day at an event held at Eastern University by the Faculty of Health-Care Sciences. The event was unusual not least because the medical and nursing faculty of the university had decided that peacebuilding was relevant to its academic and professional responsibilities.

Peacebuilding has too often been treated as something undertaken after conflict, when the fighting has stopped and the immediate task is to rebuild relationships between communities. But peace cannot be sustained by governments and peace organisations alone. If it is to become long lasting, the values and practices of peace have to become part of the institutions through which a society educates its younger generations. Universities and other educational institutions are therefore important to peacebuilding. They are among the places where the foundations of a culture of peace can either be built or neglected.

The experience of the Faculty of Health-Care Sciences at Eastern University provides a practical example of what this can mean. Led by its Dean, Prof Thillainathan Sathaananthan, the faculty organised an event which went beyond the ordinary academic scope of a medical faculty. University academics are experts in writing project proposals and applying for research grants. On this occasion, the members of the Faculty of Health-Care Sciences used those skills to apply for a UNESCO grant that they won to conduct an International Peace Day event. The significance lies less in the Rs 200,000 grant than in the decision to use the university’s institutional capacity and resources to invest in peacebuilding. The event at Eastern University needs to be understood as more than a successful university programme. It represents a possible paradigm shift in peace thinking.

Institutional Commitment

The Peace Day event obtained the support of the university administration, including Vice Chancellor Prof P Peratheepan, and reached out to secondary schools in the vicinity to mobilise their attendance. The event itself was meticulously organised. There were cultural items including traditional and modern dance and song in the three languages, performed by combinations of solo, duet and multiple singers, dancers and actors drawn in part from nearby secondary schools. There was a panel discussion by senior academics on the general theme of peacebuilding and how to prepare for it. A discussion among the students followed, where each student spoke on behalf of a religion that was not theirs. This is significant because peacebuilding cannot remain an idea discussed by specialists at conferences. It has to become part of the way institutions educate and prepare people for life in a plural society.

The Faculty of Health-Care Sciences at Eastern University has provided a model through its Peace Medicine course modules that were introduced to the curricular as a compulsory core course over 10 years ago. Two senior academics, Dr Kuveriel Eliyas Karunakaran and Dr Thillainathan Sathaananthan, have written a book on “Peace Medicine- A Health Care Concern” that was published five years ago. Its Peace Medicine Module integrates principles of medical ethics, compassion, equity, social justice and community engagement into health education and practice. In his introduction, former Vice Chancellor of Eastern University, Prof T Jayasingam noted “This book is an introduction to a theme which had already been operating in the Faculty of Health Care Sciences as a course.”

Doctors, nurses and health workers know better than anyone the harm that war and violence does. They are the people who treat the wounds and trauma that violence leaves behind. In a hospital, a patient is not asked what their religion or ethnicity is before they are treated. Health care is one of the places where peace is practised every day. The Faculty has therefore found a way of connecting its professional responsibilities with the wider social responsibility of peacebuilding. The question is whether this experience can be replicated throughout the country, at universities and at other educational institutions, so that peacebuilding becomes part of the consciousness of education itself. If that happens on a sufficient scale, it can begin to generate a culture of peace that becomes increasingly difficult to reverse.

Local Action

The Eastern University event corresponded closely to the United Nations theme for this year’s International Day of Peace, “Invest in Peace – For Everyone, Everywhere, Every Day”, which honours the “everyday architects of peace”, people driving local action, laying the groundwork for stability and building lasting peace from the ground up. The emphasis on investment is important. An investment means that something is put in: time, courage and resources. There is no more violent conflict in Sri Lanka today. But the absence of war does not automatically produce a culture of peace. The factors that fed the country’s conflict have not disappeared from the world. Racism, corruption and the violation of laws and human rights are the raw materials of conflict. So too are unresolved grievances, discrimination and the failure to recognise the suffering of others.

A country that does not deal with its past does not escape it. The past can return in the next generation. This is why the experience of Eastern University needs to be replicated countrywide, both at universities and at other educational institutions. The objective should not be to turn every academic discipline into peace studies. Rather, peacebuilding needs to become part of the consciousness of education itself. Eastern University shows that a medical faculty can develop Peace Medicine. A law faculty can examine the relationship between justice, rights and peace. Faculties of education can prepare teachers to work in diverse communities, while the humanities and social sciences can examine the different narratives through which communities understand their histories. Every institution can find its own way of making peacebuilding relevant to what it teaches.

Sri Lanka has had many declarations, pledges and programmes in the past. What matters is whether these produce changes in behaviour and institutional practice. Peacebuilding requires confronting difficult issues rather than avoiding them. It requires respect for different identities, but also engagement across those identities. It requires dealing with grievances in the present while also addressing unresolved issues from the past. It requires truth, accountability, reparations and guarantees of non-recurrence. It requires people to learn that the rights of another community do not diminish their own rights. The International Peace Day event at Eastern University was evidence of a change in the way at least some academics in a part of the country deeply affected by war are thinking about their responsibilities. Peace needs to be invested in and the most important investment will be in the minds of those who will inherit the future.

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