Introduction

… social policy is the academic setting where big processes and powers, grand concepts and theories come together with the constitution and lived experience of personal lives. (Clarke, 2004: 147) Social policy has a distinctive capacity to offer a new and insightful narrative about the political dynamics of the Middle East, and indeed to highlight the possibilities of positive social action that have so far remained under-represented in the mainstream social policy and development studies literatures. Broadly speaking, social policy is concerned with the protection or promotion of human well-being. But, while there is common consensus both in academia and policy circles that the main goal of social policy are general social welfare, the debate, and indeed, the history of social policy is much more about how social welfare is defined, achieved and measured. This is an important lesson when we consider social policy in the context of the Middle East.

For clarification, the geography of the Middle East in this essay includes countries in the Middle East and North Africa, which according to Henry and Springborg (Globalization and the Politics of Development in the Middle East, p. 8) extends 'from Morocco to Turkey along the southern and eastern shores of the Mediterranean and as far east as Iran and south to Sudan, Saudi Arabia and Yemen'. The region has a population of half a billion, which is Muslim in the majority, but as the seat of the world's three largest monotheistic religions, it continues to have substantial Christian and Jewish populations.

The books reviewed here consist more or less of the entire collection of recent English-language book publications dealing with social policy in the Middle East. Though modest in number, they cover a broad range of angles on the subject, which point to the dynamic nature of the actors and issues involved.

This essay takes up the story of social policy in the Middle East where the books reviewed have left off. To this end, it represents a revised history of social policy in the region that will present arguments drawn from a variety of new developments in the social policy literature, namely: cultural studies and the dynamics of the policy process, the resurgence of civil society and the voluntary sector in light of the challenges posed by neoliberalism to participative democracy, new currents of thinking in social care that emphasize informality and personalization, old histories of social welfare based on accounts of religious and voluntary welfare organizations that stress the moral purpose of social policy, new lessons that can be learnt from the great strides in social development achieved by East and South East Asian states as diverse as Singapore, North Korea and the Indian state of Kerala.

Based on this discursive background, the essay will argue that there is still room for manoeuvre in the Middle Eastern context starting from the simple premise that social policy in the region can build upon the positive social action that already exists there. Linked to this simple premise is a more controversial one: religious welfare organizations, particularly Islamic ones (because they are the most widespread and active in the region), are doing important social welfare work in the region. It should be noted that while not all of these organizations are political in the work they do, many are acting as a political voice not only for disenfranchized populations but also for the middle classes.

It is apt to make clear from the start that discussion of religious welfare in this essay is driven neither by ideology nor by nostalgia for a pre-colonial past. Rather, it is based on an earnest enquiry into the realities of social action in the Middle East. Indeed, there is a well-established vein of argument in the development studies literature that advocates local solutions to local problems [START_REF] Hall | Social Policy for Development[END_REF] and it is this principle that informs part of the rationale here. This essay will be made up of two argumentatively opposing sections. The first will highlight the key insights about Middle Eastern social policy that the books reviewed offer. The second section will supplement and in some senses challenge section one by offering a revised reading of both the theoretical conception of social policy that emerges from the books and the analytical approach that is used in them to discuss social policy in the region.

Key Insights From the Review Books: The Political Economy of Social Policy and the Failure of Middle Eastern Welfare States

The books reviewed here offer a broad perspective on the history, and present dynamics of Middle Eastern social policy. They encompass: the political economy of social policy in country case studies (Social Policy in the Middle East; Globalization and the Politics of Development in the Middle East); theological and philosophical discussion of human well-being in Islam (Reason, Freedom and Democracy in Islam, Essential Writings of Abdolkarim Soroush; Islam and Social Policy); the politics and history of wealth inequalities in the region (El-Ghonemy, 1998; Globalization and the Politics of Development in the Middle East); Islamic political movements which provide social welfare services [START_REF] Clarke | Changing Welfare, Changing State: New Directions in Social Policy[END_REF]Islamic Activism); the application of Islamic principles to some policy sectors, including health, finance and human rights (Islam and the Everyday World; Islam and Social Policy): and finally, the gender dimension of social policy in the region (Social Policy in the Middle East; and chapter on Iran by V. Moghadam in Gender and Social Policy in a Global Context).

The main general comment about the books to mention here is that they primarily describe policies that have failed or which have been successful. Analytically, some of them offer suggestions about what the way forward might be for social policy in the region, but none of them offers a comprehensive analysis of the interaction between the different social forces shap-ing social policy in the region (state, market, voluntary or informal sectorincluding the family) or a systematic study of the basis of possible future social action.

This section briefly highlights the main themes that emerge from each of these texts. Based on this, it will offer an assessment of the gaps that remain in the discussion of social policy in the region, and what may be a fruitful way forward for the development of social policy as a subject of research and practical application.

INTERNATIONAL INTERVENTION

Social policy in the Middle East has been most influenced by international intervention, for example, opening up to the European-dominated economy since the 17th century through colonization and mandate rule, which set particular political and economic structures in motion; and since the 1980s, economic reform under the pressure of globalization and structural adjustment programmes led mainly by international development agencies such as the International Monetary Fund (IMF) and World Bank. In all these instances, the groups that have taken control for state social policy have been mainly local elites made up of tribal, religious or ethnic leaders and wealthy merchants whose privileged status during mandate rule and afterwards marginalized the interest of a primarily rural agricultural population. The increasing market-orientation of Middle Eastern economies and the privatization programmes they underwent under the present influence of globalization and international development actors has further retrenched the role of the state as principle provider of social services and employer in the public sector. (2003) and Clark (Islam, Charity and Activism) all describe how the states in Middle Eastern countries have failed or are failing to develop effective democratic institutions that can ensure representative government and political participation for all citizens. Whether over-sized and coercive (such as Egypt and Saudi Arabia) or weak and dysfunctional (such as Sudan and Lebanon), states are rife with corruption and the embezzlement of public funds. State social provisioning is especially hard hit because of several factors such as: (1) the misallocation of resources and the prioritization of military spending over key social sectors such as health and education; (2) the narrow economic focus of public policy, which hinges social progress on economic prosperity; (3) the dominance of minority factions in Middle Eastern countries dating back to the colonial era; (4) political insecurity and military conflict, with the protraction of the Arab-Israeli conflict; (5) high levels of state indebtedness, which have taken away funds from social welfare services; (6) the introduction of structural adjustment programmes and the increasing privatization programmes, which have reduced the role of the state further as provider of social services and public sector jobs.

The resulting social ills of unemployment, wealth polarization, and even undernourishment need to be addressed through the reform of public policy and state legislation, in the areas of labour laws for example.

CLASSIFICATION OF SOCIAL POLICY: RENTIER, RESIDUAL, NEO-PATRIMONIAL State social policy is residual in character and is primarily focused on the provision of social safety nets and the reintegration of marginalized groups into society. The most comprehensive employment-based insurance goes to urban public sector workers, particularly those who are unionized, with the best protection going to the army and security forces. At the heart of this residual social policy are key conceptual blockages, namely the overly economic focus of public policy and a corresponding lack of importance accorded to the social. A significant example of this residual or piecemeal approach to social policy is highlighted by the Egypt case study in Karshenas and Moghadam (Gender and Social Policy in a Global Context) where since the 1990s, the state has not been able to cut back on key consumer subsidies, as it has wished, due to the outbreak of violent public protest.

Related to this is the characterization of Middle Eastern states as 'Rentier' meaning that their primary source of revenue is from natural resources such as oil and natural gas. This is particularly the case for the oil-rich countries in the Gulf, as well as Iran, Iraq and Algeria. The over-reliance on oil revenues has meant that some states were able to provide social welfare and social insurance services to citizens during the oil boom era of the 1960s-1980s without having to tax citizens on the basis of their civic membership of the nation. The easy access to capital and the sudden overnight affluence brought about by the oil windfall in the region is depicted as a curse by El-Ghonemy (1998) since it has directly undermined the structures of social citizenship and the need to develop the productive capacity of the local population, due to the over-reliance on foreign labour.

The third classification is of social policy as neo-patrimonial due to the persistence of gender discrimination. Islamic family planning laws, female illiteracy and labour legislation impede women from free participation in the labour market and from equal political rights to men. The persistence of the family as a key social unit in society and the main locus of social care also impinges upon gender equality.

THE POLITICIZATION OF SOCIAL POLICY: CLIENTELISM AND POLITICAL LEGITIMIZATION OF RULING ELITES

Another major factor hampering social policy is the politicization of welfare and the instrumental use of social policy by the state to gain power and political legitimacy. Some authors argue that this is a historical factor as well, for example the introduction of social benefits to workers and employment guarantees to university graduates in Iran and Egypt in the 1950s/1960s were motivated by the need to win the support of the working classes in the postcolonial states, and were not based on a civic discourse of social citizenship. Today, social benefits are channelled though clientelist networks, which link ruling governments to their supporters. Thus, social policy today in the Middle East lacks a sense of its own legitimacy.

SOCIAL POLICY AS WEALTH REDISTRIBUTION AND THE PROVISION OF BASIC NEEDS

The major challenges that the authors describe for social welfare provisioning are less about the long-term structures of democratic participation and a share in decision-making by society, and more about the urgent measures of wealth redistribution, income transfers, provision of basic needs and ensuring the basic support systems of survival. When measures of human well-being are discussed in some of the books, it is in the developmental/survival terms of child morality, female literacy, sanitation and housing. At the heart of social policy, then, are key challenges of basic economic and social development. This gives the desired purpose and definition of social policy by the authors a particular focus on economic productivity, inherent in female labour participation, creating more employment opportunities, reducing indebtedness, reforming property rights and the Islamic laws that dominate inheritance and family planning. This is not to say that social policies in the past did not bring about improvements in society in the Middle East. The authors argue that the immediate post-independence era in the 1940s and subsequently the oil-boom era, which lasted until the 1980s, saw rapid social transformation of the region with enormous improvements in education and health, as well as rapid urban transformation. But these gains were rapidly lost, as states became more authoritarian in character and failed to develop adequate economic policies.

BREAKDOWN OF STATE/SOCIETY RELATIONS

State and society in the Middle East are 'detached' from each other, indeed, relations between the two reach competition or violent hostility. The sense of social unrest is exacerbated further by the common notion within society that the state should take more responsibility for the welfare of citizens and that the latter have the rights and entitlement over the state to be provided with social services. A main area of contention is basic consumer subsidies, particularly food, where the local population has mounted riots to protest against their withdrawal, for example in Egypt.

Competition between state and societal groups over the public sphere is most acutely expressed in the rise of Islamic groups in the Middle East, with are providing vital public and social services, and thus challenging the state not only as a provider of welfare but as a modern secular institution of government. Some of these groups are well-known political groups such as the Muslim Brotherhood (Egypt) and Hamas (Palestinian Territories) but others are more local and less political, such as the Islah Charitable Society in Yemen or the Mustafa Mahmood Health Clinic in Egypt (Islam, Charity and Activism).

Otherwise, the general impression arising from the books is that poor populations have not organized politically around the issues that affect them. Save for a few examples, such as the establishment of rotating funds among poor populations in Egypt, the poor just get on with trying to survive by finding ways, quite often illegal, to access vital public services. The only successful mobilizing force for the poor (and disgruntled middle classes) appears to be Islam.

ISLAM AND SOCIAL POLICY

All the authors recognize the influence of Islam on social policy. Islam (like Judaism and Christianity) is described as an important cultural influence on inheritance laws as well as family planning. In this sense, Islam is considered to perpetuate wealth and gender inequalities, although the authors differ in that some argue that women do have rights to property and to work or do have a say in family planning.

Islam is also discussed in terms of its welfare institutions such as waqf (religious endowments) and zakat (an obligatory 2.5% tax levied on assets). These are also considered at a practical level in the countries that apply them. In all cases, the authors acknowledge that zakat had acted as a hugely important source of poverty-alleviation for the poor and that waqf played a key role in the socio-economic development of the Middle East in the last few centuries prior to colonization. Some authors examine the application of Islamic principles in particular public policy areas such as health, finance and economy and human rights legislation. Here, it is argued that Islamic economics remains underdeveloped but in the health sector for example, some countries such as Iran have been able to make substantial improvements to primary care thanks to the influence of Islamic principles in Iran after the revolution.

Islamic values are also important as an activating force for social groups and movements in society to engage in public and social service provisioning -as mentioned above. In Egypt, Yemen and Jordan for example, Islamic movements or Islamic charity organizations use social welfare to challenge the basis of the secular modern state, and/or to protect the political status of the professional classes through the provision of employment opportunities and social networks. In the case of political Islamic groups, contributions in the book edited by Wiktorowicz (Islamic Activism) depict organizations such as Hamas in Palestine as social movements that have developed locally and are now supported by a comprehensive institutional basis of which the provision of social welfare and public services is a vital component. In these cases, Islam is depicted as the only remaining platform for political contestation and struggle for social justice in the Middle East.

SYNTHESIS: THE WELFARE STATE AS A PARTICULAR CULTURAL SETTLEMENT?

The earlier discussion suggests that where social policy and the Middle Eastern state are discussed, the books reviewed confirm an account that we might perhaps have expected of the region. In the book by Karshenas and Moghadam, the main recommendation put forward is for the state to develop democratic, developmental and socially inclusive policies. El-Ghonemy (1998) also emphasizes the resolution of political and armed conflicts in the region. There is a strong plea for Middle Eastern states to acknowledge the centrality of social analysis in public policy and for the need to devise a new social vision for their societies. But the authors do not explain where we are to start. Instead, they end with an offer of the conventional wisdom of socially inclusive democracy and development.

The author of the Egypt case study in Social Policy in the Middle East argues that it was the particular combination of conditions present in Western Europe (inherited socialist values, liberal democratic structures, capitalist accumulation) that made possible the social settlement between labour and the state. This is the ideal of social democracy.

But I argue here what does this say about the possibilities of social action in other contexts? Is there an implicit suggestion that there is an inherently cultural quality to the welfare state or to social policy solutions more broadly? Surely, these questions would undermine the prescribed conventional wisdom of socially inclusive democracy plus development equals social policy?

Societal Action and the Ethics of Welfare: Re-reading the History of Social Policy in the Middle East

This essay will now take an argumentative turn in order to supplement, and in some cases challenge the account of social policy in the Middle East that we find in the books reviewed. To this end, this section will explore the implications of four key themes.

First, I consider a more populist version of social welfare, inspired by the development studies literature and historical accounts of citizenship in the region; second, I address the limits of political economy and the potential of culture for analysing social policy; third, I consider the new trend in the literature on the voluntary sector and civil society that is gaining ground in Western Europe as a way to revive participative democracy; finally, I conclude with the question of religious welfare and faith-based organizations that have re-emerged with force in American and British social policy. This leads to my final redefinition of social policy as a fundamentally ethical endeavour centred upon what it means to be human.

POPULIST/SOCIAL MOVEMENTS AS ONE POSSIBILITY OF POSITIVE SOCIAL ACTION

In the Western social policy literature, populism has acquired a bad reputation for its association with conservatism and traditionalism, which can incite exclusionary or anti-immigrant sentiment (Hall and Midgely, 2004). However, populism may help us better understand the dynamic of social policy in the Middle East, not just during and after the colonial era but also with respect to the current involvement of Islamic social movements in social welfare in the region. Indeed, Hall and Midgely (2004) argue that populist approaches to social change have had a long history and a substantial record of achievements in the developing countries of the South. The works of Paolo Freire in Brazil, popular social movements in India and Latin America, and the expansion of social services in Argentina under President Juan Peron in the1960s were all inspired by forms of populism that had the strength to attract the 'people' around a sense of common identity (Hall and Midgely, 2004). Indeed, recent recognition of the success of social policy in the 'tiger' economies of East Asia acknowledges the influence of traditional Confucian values and the objectives of nation-building and political legitimization that have underpinned them [START_REF] Walker | East Asian Welfare Regimes in Transition, From Confucianism to Globalisation[END_REF].

The discussion of populism here is not based on nostalgia for an Islamic society or on a romantic vision of local people. Rather, it is based on the simple premise of what is happening on the ground to people's ordinary lives in the Middle East and where effective social action is taking place.

Taking a historical look, [START_REF] Thompson | Colonial Citizens: Republican Rights, Paternal Privilege, and Gender in French Syria and Lebanon[END_REF] documents how during mandate rule in Lebanon and Syria, populist movements flourished particularly in 1942-3. Along with the women's movement, which was very active at the time, and the communist movement, populist movements played an active role in challenging the authorities of the mandate, and in defining the terms of their subsequent citizenship by demanding the establishment of key political and social rights. [START_REF] Thompson | Colonial Citizens: Republican Rights, Paternal Privilege, and Gender in French Syria and Lebanon[END_REF] denotes these movements as 'subaltern' because they were in conflict with the colonial rulers and the local elites whose alliances with colonial rulers protected their privilege and powers. It was through the combined efforts of these movements that the semblance of a welfare state based on citizenship rights was established in Lebanon and Syria in the post-independence era.

In the contemporary context, Jaber (1997), [START_REF] Shadid | Legacy of the Prophet: Despots, Democrats and the New Politics of Islam[END_REF] and Wiktorowicz (Islamic Activism) argue that Islamic groups such as Hamas in the Palestinian Territories, the Virtue Party in Turkey (previously Refah), the Muslim Brotherhood in Egypt and Hizbullah in Lebanon have taken their social welfare role very seriously and are offering a real social agenda for large populations in their countries, many of whom come from the poor segments of society. While some of these organizations appear notorious, they pose serious questions about the future of social policy in the region and more significantly, the enduring role of religious welfare organizations, with Islamic organizations at their helm.

To this extent, [START_REF] Shadid | Legacy of the Prophet: Despots, Democrats and the New Politics of Islam[END_REF] argues that such organizations have a real sense of social obligation and are not driven primarily by political motives of selfinterest. They see their social welfare work as an expression of their solidarity with deprived members of their population. To this end, [START_REF] Shadid | Legacy of the Prophet: Despots, Democrats and the New Politics of Islam[END_REF] advocates formal political support of these organizations, based on a culturally-sensitive analysis that places Islam at the heart of social policy in the region.

CULTURE AND SOCIAL POLICY [START_REF] Clarke | Changing Welfare, Changing State: New Directions in Social Policy[END_REF] makes an insightful argument about the connection between culture and social policy: the understanding of what is happening to the welfare state has to start with how we think about it. According to [START_REF] Clarke | Changing Welfare, Changing State: New Directions in Social Policy[END_REF], culture means the 'politics of articulation', or put in a simpler way, it is the study of how social actors interact and enter into conflict with each other in order to define or indeed control the environment they live in. This can bring important insights to how social policy works, particularly as policy making itself is a complex process and has as much to do with the actors involved in making the decisions as with its actual content [START_REF] Hudson | Learning Lessons from Policy Experience[END_REF]. In this sense, Clarke (2004: 154) describes the welfare state as a combination of 'institutionalised formations (apparatuses, policies, practices) and political-cultural imaginaries (symbolizing unities, solidarities and exclusions)'.

Based on this analysis, [START_REF] Clarke | Changing Welfare, Changing State: New Directions in Social Policy[END_REF] arrives at the conclusion that in Britain, for example, what we are witnessing in fact is not the end of welfare but simply a process of destabilization and change whereby a new national welfare settlement will eventually emerge. For, from a cultural perspective, at the heart of the conflict over welfare and its meaning is the definition of nationhood and the construction of the 'people' in a nation as citizens.

Thus, while the political-economic analysis of social policy in the Middle East that is presented in the review books can help us understand how states have succeeded or failed to redistribute wealth in their countries, it misses the way in which the social order was itself negotiated and how states were also exercising influence on the national formations and symbols of identity among their populations. Indeed, a cultural analysis would suggest that political conflict over welfare and its association to nation-building in the Middle East is part and parcel of the nature of social policy, since a social settlement is a particular negotiation arrived at by various conflicting groups.

To this end, [START_REF] Thompson | Colonial Citizens: Republican Rights, Paternal Privilege, and Gender in French Syria and Lebanon[END_REF] study of Lebanon and Syria in the 1940s is instructive as she argues that the movements struggling for state recognition and welfare services (women's, communist and populist/religious movements) did so by using the same terms of reference of the colonial ruler against whom they were struggling.

To summarize, then, what does this mean for our reading of social policy in the Middle East? The history of the welfare state cannot be understood in a linear form that imposes a rational and objectivist approach to the study of social policy. Instead, as Clarke argues (2004: 5), our reading of history needs to be 'conjunctural', in that it should be sensitive to the variety of forces that come into play in order to produce a particular event or definition of a concept. For our present purpose, this would mean supplementing the historical account of social policy from the point of view of the state, which is portrayed in the books reviewed through an analysis of the multiplicity of social actors and the polysemy of the concept of welfare itself. This is based on recognizing social policy as a discourse and as an anthropological phenomenon.

The gender dimension of this kind of analysis has been well demonstrated by [START_REF] Thompson | Colonial Citizens: Republican Rights, Paternal Privilege, and Gender in French Syria and Lebanon[END_REF] historical analysis of the social movements that flourished in the 1940s in Lebanon and Syria. [START_REF] Thompson | Colonial Citizens: Republican Rights, Paternal Privilege, and Gender in French Syria and Lebanon[END_REF] argues that the civic order that was established was not equitable in part because of the threat to paternal privilege that was perceived at the time which women eventually gave in to, thereby giving more weight to the pull between social/political rights for colonized people and the paternal/class privilege of the ruling elites. This shaped the final course of citizenship. This confirms [START_REF] Clarke | Changing Welfare, Changing State: New Directions in Social Policy[END_REF] argument that social categories such as race, gender and class are not mutually exclusive but intermingle and constitute each other to form a larger formation of the nation.

Society in the Middle East, then, may not be as passive as our authors depict. For the significance of the politics of articulation suggests that power struggles do not end in subjection and dominance but in accommodation and negotiation. This offers the possibility of finding new solutions to the status quo.

THE VOLUNTARY SECTOR AND THE SEARCH FOR A NEW WELFARE ETHIC

There is a new generation of thinking in the social policy literature which is actively addressing the challenge of exploring how social policy and human well-being might look like beyond the strict borders of the welfare state -at least in the western context. This literature comes under many names: the mixed economy of welfare or welfare pluralism [START_REF] Powell | The Mixed Economy of Welfare and the Social Division of Welfare[END_REF], the voluntary sector [START_REF] Milligan | Contemporary Landscapes of Welfare: The "Voluntary Turn"?[END_REF], the third sector or third way [START_REF] Powell | The Mixed Economy of Welfare and the Social Division of Welfare[END_REF], civil society [START_REF] Powell | The Mixed Economy of Welfare and the Social Division of Welfare[END_REF], social capital [START_REF] Milligan | Contemporary Landscapes of Welfare: The "Voluntary Turn"?[END_REF]. Recalling Gøsta Esping-Andersen's statement that social policy, welfare states and welfare regimes are not the same, M. Powell (2007: 6) notes: 'social policy can exist without welfare states … social policy predates welfare states'.

The key argument here is that the state, market and voluntary/informal sector have always combined in different ways to deliver, finance and devise social services [START_REF] Powell | The Mixed Economy of Welfare and the Social Division of Welfare[END_REF]. Thus, it is not so much the role of non-state actors that has increased in the western context but their visibility to social policy thinkers and makers in recent times. This visibility has been brought about by the changing fortunes of the 'classic welfare state', which has come under fiscal and political pressure from the advancement of the neoliberal agenda and the subsequent demise of the traditional nation-state, inherent in the need to accommodate the rise of new interest groups.

Discussion of the apparent virtues of the voluntary sector has been split between the left and right. Conservatives, who discourage state involvement in social welfare anyway on both moral and fiscal grounds favour the reinstitution of old mutuals that were destroyed by the welfare state [START_REF] Powell | The Mixed Economy of Welfare and the Social Division of Welfare[END_REF]. On the left, the concern is more about preserving the quality of participative democracy and social citizenship in light of the argument that only the state can guarantee equality. This has served to focus attention on the meaning of 'the social' in order to maintain the basic principles of social welfare. It is noteworthy, that Karshenas and Moghadam (Social Policy in the Middle East) argue for the need to make social analysis more central in public policy and to not just focus on political economy, yet no clear definition of the social is presented. [START_REF] Clarke | Changing Welfare, Changing State: New Directions in Social Policy[END_REF][START_REF] Powell | The Politics of Civil Society[END_REF] also discuss the meaning of the social in a challenging way that can shed light on the situation of the Middle East. [START_REF] Clarke | Changing Welfare, Changing State: New Directions in Social Policy[END_REF] argues that while the social continues to be the site of contestation between various actors in society over social inequalities, it has now acquired a new dynamic thanks to the neoliberal agenda. In this sense, the 'social' has become depoliticized and largely driven by economic concerns, as inherent in New Labour's welfare to work ethos. On the other hand, F. Powell (2007) argues that the inability of the welfare state to accommodate new welfare constituencies has made the notion of the social defunct and what matters more is 'active' citizenship as opposed to social citizenship.

These concerns reflect a deep debate in the western social policy context about the nature of participative democracy and an apparent crisis of associational culture brought on by the individualism of neoliberalism. F. Powell (2007) argues for the development of civic virtue through the flourishing of civil society institutions. This also echoes New Labour's concern to deal with welfare reform and to develop social capital [START_REF] Powell | The Politics of Civil Society[END_REF]. With reference to faith-based organizations, F. Powell (2007) cites Habermas who argues that democracy does not have inherent within it all the ingredients to allow its effective functioning and that Europe needs to reconcile with its religious heritage.

Added to this is an increasing concern with human dignity in social welfare [START_REF] Chan | Human Dignity and Welfare Systems[END_REF], and mounting questions about the impact of professionalization and institutionalization on social care (Banks, 2004).

THE QUESTION OF RELIGIOUS WELFARE AND THE MORAL NATURE OF SOCIAL POLICY I would argue, then, that there appears to be a crisis in the ethic of welfare in western social policy, which is characterized by a search for the underlying moral values that can support social solidarity. Debates about the crisis of democracy in the face of neoliberalism, the rise of the voluntary sector and the concern to find a new moral glue for postmodern society suggest that the capacities of the local social movements in the Middle East that are offering social services need to be supported. Indeed, at the heart of social policy is a concern with the moral content of social life.

This concern is highlighted by the debate on the ethics of care in the western theoretical literature (Banks, 2004). The welfare ethics of religious organizations in the Middle East are fundamentally based on caring, which are built on relationships of personal trust. Banks (2004) argues that these qualities are being undermined in the modern context of social care in the UK.

Religious identity, whether Muslim, Christian or Jewish, is an intrinsic part of the history and identity of the Middle East's populations. The civilizational and developmental legacy of religion on these societies is long and well established. It is also attested to by some of our review authors (such as El-Ghonemy, 1998;Heyneman, 2004). Both these authors, as well as Clark (Islam, Charity and Activism) and [START_REF] Thompson | Colonial Citizens: Republican Rights, Paternal Privilege, and Gender in French Syria and Lebanon[END_REF] cite, for example, the role of the Islamic welfare institution of waqf (religious endowments) in promoting the social, political and economic development of the region especially during the Ottoman empire.

Thus, there is a rational basis and indeed an urgent need to pose seriously the question of religious welfare in social policy in the Middle East. It is in recognition of this that the classification of social policy as residual or 'Rentier' in the Middle East loses ground. But religious welfare is not only relevant to the Middle East. Much of the anxiety in western social policy also rests in the problematic resurgence of faith-based welfare in the USA and the UK. One of the more controversial developments in this regard is the establishment in 2000 of the Office of Faith-Based Services in the USA [START_REF] Milligan | Contemporary Landscapes of Welfare: The "Voluntary Turn"?[END_REF].

Conclusion

This essay has sought to challenge the mainstream thinking about social policy in the Middle East. The analysis presented in the books reviewed centres social policy on the role of the state and its capacity to redistribute wealth and develop the economic capacities of both men and women. But this is a partial analysis of social policy in the region, and it is one that narrows the room for manoeuvre for future social action. I have argued that by changing how we think about the policy process and the nature of social policy, it may still be possible to find new ways of understanding existing problems in the Middle East and therefore, of finding new solutions.

Culture and political economy complement each other to offer a more holistic understanding of human well-being. The new developments in the Western social policy literature about the role of the voluntary sector, the limits to participative democracy, and the need to develop more personalized and ethical understandings of social welfare all highlight the possibilities of positive social action within the voluntary sector in the Middle East. After all, religious and secular understandings of social justice share a common heritage in this region.

Based on the simple precept that religious welfare organizations in the Middle East are acting out of social solidarity to solve social problems, allowing them formal recognition into the social policy apparatus may form a step in the right direction.

A

  'STATIST' POLITICAL-ECONOMIC APPROACH TO SOCIAL POLICY Social policy is primarily a job for the state. Moghadam and Karshenas et al. (Social Policy in the Middle East), El-Ghonemy (1998), Henry and Springborg

  Banks, S. (2004) Ethics, Accountability and the Social Professions. Basingstoke: Palgrave Macmillan.

Jawad: Social Action in the Middle East


Globalization, Conflict and Mental Health

Keywords: globalization, mental health, political violence, psychological trauma, war

Violent conflict for political ends, including war and civil war, is a major cause of mental ill health and although there are different approaches and ways to understand this relationship some consensus is emerging on the psychological, social and cross sector responses to post conflict situations. Globalization has changed the relationships of nation states, corporations and international organizations creating different patterns of political violence and different ways to organize the responses. Victims, weapons and humanitarian aid are considered within a public mental health framework, describing the consequences of war and other forms of political violence. Secondary and primary levels of intervention in public mental health consider the monitoring, preparation for and prevention of political violence, taking the new sciences of human relationships as a basis to look at international relationships. The need to re-establish a reformed United Nations at the centre of global decision making and to increase the global expenditure on peace making are two conclusions from this analysis.

Introduction

This article comes from a mental health perspective, in that it is aimed at the prevention and amelioration of mental ill health and the promotion of mental well-being. As a starting point violent conflict is seen as a major cause of mental ill health [START_REF] Murthy | Mental Health Consequences of War: A Brief Review of Research Findings[END_REF]; the Cairo declaration of the World Psychiatric Association in 2002 [START_REF] Okasha | The WPA Cairo Declaration[END_REF] asserts that mass violence is a major public health problem with important mental health implications, urging research and training on both its consequences and its prevention. Taking a public health approach to conflict (Levy and Sidel, 1997) allows examination of broad determinants and consequences, of impacts on populations, while addressing practical and policy issues in a variety of scenarios.

The three elements of globalization, conflict and mental health, are huge in their ramifications and the article will start by outlining some key aspects of each, also considering how they might interact with each other. This is followed by a more detailed analysis of mental health and conflict within a public health framework.

G L O B A L I Z AT I O N

Globalisation itself is neither good nor bad. It has the power to do enormous good. But in much of the world it has not brought comparable benefits. For many, it seems an unmitigated disaster … (Stiglitz, 2002: 20) The propensity for humans to trade and travel, to impose their views, to capture the resources at a global level is not new; it has been part of their activity as far back as we can tell, with different epochs having different areas in dominance (Toynbee, 1976: 27-37). There is debate as to whether the current global relationships are simply part of a continuum [START_REF] Hirst | The Future of Globalisation: Cooperation and Conflict[END_REF] or whether there has been a step change, a technological revolution equivalent to the agrarian or industrial revolution, which takes us into a new and exciting domain [START_REF] Friedman | The Lexus and the Olive Tree: Understanding Globalisation[END_REF], or if ' … a much less governable world is the inevitable result of the forces … ' (Gray, 1998: 67).

Major changes in sovereignty and the place of the nation state are part of globalization; activities within a state no longer being the sole province of government. The changes in information technology and media have allowed information that was previously hidden to become more open, the transnational corporations have removed financial control from many nations and the international organizations such as the United Nations (UN), International Monetary Fund (IMF), World Bank and the World Trade Organization (WTO) have established an international superstructure that some see as an emerging global governance while others see as simply adding complexity to the Hobbesian jungle of human social relationships [START_REF] Weiss | Governance, Good Governance and Global Governance: Conceptual and Actual Challenges[END_REF].

Globalization acts on health through institutions, economics, cultural and societal changes, migration and environmental change, from global policy to the individual [START_REF] Huynen | The Health Impacts of Globalisation: A Conceptual Framework[END_REF], and with a profound negative impact for many on unequal access to the determinants of good health [START_REF] Koivusalo | The Impact of Economic Globalisation on Health[END_REF]. Privatization of health care adds to this burden; a similar picture is emerging for mental health [START_REF] Kelly | Globalisation and Psychiatry[END_REF][START_REF] Okasha | Globalisation and Mental Health: A WPA Perspective[END_REF].

C O N F L I C T Violent conflict has played a central role in the emergence of globalization, the 'Long War' described by Phillip Bobbit (2002: 24) defining the final acts of the nation states from 1914 to 1990 before giving way to what he describes as the 'Market State'. The new technologies and social processes of globalization influenced the winning of this war while the conflict itself helped forge these; in this view conflict and globalization are inextricably entwined.

Following the collapse of the Soviet Union there was a period of optimism that a new world order less rooted in violence would emerge and the idea of a liberal peace gained some credence (Duffield, 2001: 11). There is evidence that the number of wars, battlefield deaths and genocides actually decreased during the 1990s (Human Security [START_REF] Centre | The Neurological Burden of the War in Iraq and Afghanistan[END_REF]; however, a series of civil conflicts typified by Chechnya, Rwanda and Yugoslavia, suggested a new set of conditions for war had emerged following the loss of the old, containing, political structures. In addition, a more fundamental shift in world order, submitting the poorer nations to networks of corporate and transnational interests, appeared to be behind some conflicts, particularly those in sub-Saharan Africa involving diamonds, coltran and other natural resources [START_REF] Kaldor | New and Old Wars: Organized Violence in a Global Era[END_REF]. Asymmetrical conflicts have emerged, some with little use of new technologies, but which are population based, diffuse and hard to monitor, using terror, especially suicide bombings as an instrument of violence. A particular asymmetrical conflict emerging over the Middle Eastern oilfields uses highly organized networks and new globalizing technologies with the ability to reach into population centres such as the case with 9/11 (Abbot et al., 2006).

The state, religion and corporate interest appear to be key institutions of war. Some point to a clash of civilizations, describing an ancient human process of group formation and identity driving us to conflict [START_REF] Huntington | The Clash of Civilisations and the Remaking of World Order[END_REF], while others see the roots of violence in the desire for wealth and power, with religion and nationalism being used to engage popular support, and an increased merging of crime, war and private profit [START_REF] Kaldor | Nationalism and Globalisation[END_REF]. Definitely new are the size, speed and complexity of the networks that are determining the liberal peace, the new wars, and the moral choices before us [START_REF] Duffield | Global Governance and the New Wars[END_REF].

From a health perspective the term political violence draws attention to the complexity of the causes and the consequences of violence and the systemic impact on health [START_REF] Zwi | Towards an Epidemiology of Political Violence in the Third World[END_REF]. Violence used for political purposes such as war, civil war, genocide, violent repression of populations and torture, merges with structural violence, the suffering brought about through social structures maintained by political power (Farmer, 2003: 8), such as poverty and the lack of health care. Identifying the political processes allows preventative strategies and advocacy to emerge [START_REF] Patel | Beyond Evidence: The Moral Case of International Mental Health[END_REF] while in terms of risk, political violence carries with it the greatest threat to human well-being, ultimately the destruction of our civilization and perhaps humanity itself through war and weapons of mass destruction.

M E N TA L H E A LT H

There are different models of mental health and illness; unlike the body, the mind is not the province of medicine, and while there have been great gains by applying biomedical models and classifications such as ICD10 to abnormal thoughts and behaviours (WHO, 1992), the mind still remains firmly attached to society (Geertz, 2000: 203-17). This period of globalization has seen western ideas, especially the biomedical approach and its focus on individual pathology, dominate the global discourse (Bracken and Thomas, 2005: 28-30), largely ignoring views from other cultures and the still strong link between spiritual matters and the mind. Some argue that because mental wellbeing is so embedded in culture there must be a greater exchange on these matters (Skultans and Cox, 2000). The biopsychosocial model emerged within psychiatry [START_REF] Engel | The Need for a New Medical Model: A Challenge for Biomedicine[END_REF], in an attempt to broaden the theoretical base of psychiatry, but the psychological and social theories have largely been picked up and developed by other disciplines [START_REF] Pilgrim | The Biopsychosocial Model in Anglo-American Psychiatry: Past, Present and Future[END_REF] and any consideration of mental health requires a multi-disciplinary approach.

Globally, the burden of mental health disorders is associated with poverty, human rights abuses and stigma, and the needs of those with severe mental illness are often neglected (WHO, 2003). Severe mental illness is often considered to be more biologically determined and there appears to be a psychosocial space, wherein happiness and well-being exist with depression, anxiety and sadness, frequently referred to as common mental disorders; there is considerable evidence of social causation for these [START_REF] Brown | Social Origins of Depression[END_REF][START_REF] Patel | Poverty and Common Mental Disorders in Developing Countries[END_REF]. This has particular relevance for conflict, where the external social impact is so dominant, though even with conflict related disorders individual attributes influence outcome.

There have been significant disagreements between mental health professionals in understanding the impact of traumatic events and how to respond to them; the term Post-Traumatic Stress Disorder (PTSD) has been criticized and the motives of a growing 'trauma business' have been questioned [START_REF] Summerfield | Effects of War: Moral Knowledge, Revenge, Reconciliation, and Medicalised Concepts of "Recovery[END_REF]. However, a greater consensus may be emerging (Van Ommeren et al., 2005: 73), the authors concluding that 'there is considerable agreement on what constitutes good public mental health practice'. Psychosocial interventions after conflict aim to promote community cohesion, disrupted by war, and support those most affected and in the longer term consider peace building and justice through locally appropriate means (Inter-Agency Standing Committee [IASC], 2007) as traditional models of healing may promote a society's sense of worth and ability to recover from traumatic experiences [START_REF] Gidley | Setting the Truth in Stone: Guatemala's Monuments to the Dead[END_REF].

There are concerns that the impact of war may increase the likelihood of future violence through hatreds and the desires for revenge and through the disruption of normal attachment processes in child development leading in turn to cycles of violence [START_REF] De Zulueta | From Pain to Violence: The Traumatic Roots of Destructiveness[END_REF]. War itself has been considered a form of social mental pathology (Poteliakhoff, 2006: 3). This, however, extends the meaning of mental disorder beyond the usually accepted notions and there is also a view that war has been a normal part of nation building and law making (Howard, 2002: xvi).

Public Mental Health and Political Violence

Public mental health is more than evaluating interventions, population surveys or public education; it must examine the broad determinants of mental health such as poverty, social isolation, social upheaval and violence, work on prevention of mental disorder at local, national and global levels and consider how to maximize mental health.

The application of public health models to political violence also focuses analysis and intervention at so called 'primary, secondary and tertiary levels' (Levy and Sidel, 1997: 389), where the causative process, in this case political violence, is absent at a primary level, emerging at a secondary and giving rise to morbidity and mortality at a tertiary level. In this public mental health model the tertiary focus is on the impact of violence on mental health, the treatment of disorders, the management of the psychological and social issues, and rehabilitation. At a secondary level there is a need to consider how actual violence emerges from a background of sub-violent political conflict. At a primary level the focus is on understanding the root causes of violence and political violence.

T E RT I A RY L E V E L

Globalization influences the mental health consequences of conflict through the models and language used by western psychiatry and whatever the debates, new information has come from these scientific and epidemiological approaches. Globalization has also influenced who the victims of violence are and the impact on those victims, especially soldiers and displaced civilian populations. New weapons have emerged through new technologies while new forms of communication and social organization have led to new responses. These matters are part of the tertiary level consideration.

E P I D E M I O L O G Y

There have been several epidemiological studies using standard criteria for mental disorders such as PTSD, anxiety and depression, summarized by [START_REF] Murthy | Mental Health Consequences of War: A Brief Review of Research Findings[END_REF], which give a measure of the morbidity caused by political violence. Risk factors include gender (women being more at risk), exposure to traumatic events, lack of social support, migration and subsequent life events. The morbidity is great with prevalence rates for PTSD and common mental disorders reported as high as 70% or 80% in a sample of refugees and those caught acutely in war. The WHO (2001) estimates that 10% of people who experience severe traumatic events will develop serious mental health problems and another 10% will develop behaviours that will hinder their ability to function effectively.

There have been descriptive studies looking at longer term social reconstruction and functioning [START_REF] Gutlove | Psychosocial Healing and Post-Conflict Social Reconstruction in the Former Yugoslavia[END_REF], there is data on long term sequelae of psychological suffering [START_REF] Bramsen | Fifty Years Later: The Long Term Psychological Adjustment of Ageing WWII Survivors[END_REF], on the relationship to family breakdown and violence [START_REF] Orcutt | Male-Perpetrated Violence Among Vietnam Veteran Couples: Relationships with Veteran's Early Life Characteristics: Trauma History, and PTSD Symptomatology[END_REF], on trans generational impacts [START_REF] Yehuda | Vulnerability to Postraumatic Stress Disorder in Adult Offspring of Holocaust Survivors[END_REF] and on the desire for revenge [START_REF] Cardozo | Mental Health, Social Functioning, and Feelings of Hatred and Revenge of Kosovar Albanians. One Year After the War in Kosovo[END_REF]. Alongside this is a concern about an overmedicalization of PTSD and a need to focus on issues of resilience and the variance in response to treatments [START_REF] Stein | Post Traumatic Stress Disorder: Medicine and Politics[END_REF].

Victims of War

Increasing globalization has come hand in hand with increasing global violence. Deaths through war in the 20th century are estimated at around 190m; estimates of military deaths per million rising from 10m in the 19th century to 180m in the 20th century and civilian deaths rising from around 10% of all deaths at the beginning of the century to 60% or more at the end [START_REF] Garfield | The Human Consequence of War[END_REF][START_REF] Meddings | Civilians and War: A Review and Historical Overview of the Involvement of Non-Combatant Populations in Conflict Situations[END_REF]. The injuries of war are estimated as ranging from 0 to 13 per death, for different weapons and scenarios [START_REF] Coupland | Mortality Associated with Use of Weapons in Armed Conflicts, Wartime Atrocities, and Civilian Mass Shootings: Literature Review[END_REF]; there is no such ratio established for mental health disorders yet for each death there must be an associated mental impact on observers, relatives and perpetrators; and for each injury a victim and risks of disability.

S O L D I E R S

The recognition by the military of the mental effects of war has added to our understanding of cause, consequence and treatment of violence related mental health disorders [START_REF] Jones | Shell Shock to PTSD: Military Psychiatry from 1900 to the Gulf War[END_REF]. The difference between the mental health impact of the Iraq War compared to the Gulf War [START_REF] Horn | Is There an Iraq War Syndrome?: Comparison of the Health of UK Service Personnel after the Gulf and Iraq wars[END_REF] supports the suggestion that medical countermeasures in 1991 were associated with ill health and that different arrangements for war preparation, health care and surveillance in the Iraq War may have led to a reduced incidence of mental disorders.

Differences are emerging in psychological sequelae between US and UK troops serving in the Iraq War, with UK troops showing no greater evidence of PTSD or depression than those deployed elsewhere [START_REF] Hotopf | Neuropsychological Changes Following Military Service in Iraq[END_REF], while up to 20% of the US troops show symptoms of PTSD and 25% receive mental health diagnoses on return [START_REF] Seal | Bringing the War Back Home Mental Health Disorders among 103 788 US Veterans Returning from Iraq and Afghanistan Seen at Department of Veterans Affairs Facilities[END_REF]. Selection, training, experience and deployment have been suggested as reasons for this difference but it is clearly sensitive and remains unexplained. It is, however, remarkable that a group of young people can be deployed in war, suffer serious physical casualties, take part in all the horrors of war and yet apparently suffer no psychological consequences. This may support the view that mental health problems following violent conflict are largely determined by social relationships and this clearly needs long-term follow up.

Rapid emergency treatment on the battlefield, improved body armour and rapid extraction to high-tech medical facilities outside the battle area appear to be associated with an increasing number of chronically disabled servicemen in the USA through increased survival. Traumatic Brain Injury from explosions is the major cause of neurological damage with severe long-term psychosocial consequences [START_REF] Centre | The Neurological Burden of the War in Iraq and Afghanistan[END_REF]. Young men in military or in militia service remain the major direct victims of war in terms of mortality and morbidity (Human Security [START_REF] Centre | The Neurological Burden of the War in Iraq and Afghanistan[END_REF]; how those who do not have access to modern medicine are faring in Iraq or Afghanistan is largely unknown.

D I S P L A C E D P E O P L E

The movement of people fleeing from war is not a new process; the vast majority still journey to the nearest place of safety, either internally displaced or in neighbouring countries (UNHCR, 2006a). In addition to the more acute problems of movement, there are 38 long-lasting and intractable situations accounting for some 6.2m people, most in Africa but the best known probably being the Palestinians in the Middle East. Long-term refugee camps present with many mental health problems, skewed populations, chronic lack of opportunities for children, general ill health and may help maintain the conflicts from which they arose, as sources of combatants and grievance [START_REF] Kett | Internally Displaced Peoples in Bosnia-Herzegovina: Impacts of Long-Term Displacement on Health and Well-Being[END_REF].

For the richer world the globalizing aspect of this problem is asylum seeking. The number of people seeking asylum in Europe has varied depending on conflicts, changes in trafficking and European asylum processes, from around 100,000 in 1983, peaking in 1992 at around 700,000 and in 2002 at around 500,000 but falling to just over 200,000 in 2006200,000 in (UNHCR, 2006b)). A recent report from the UK Parliamentary Joint Committee on Human Rights (2007) noted that, while there is anxiety about immigration causing rapid changes in our communities and increasingly punitive approaches to asylum seekers, the majority of people in our society are financially better off and benefiting from the processes of globalization, reflecting the [START_REF] Stiglitz | Globalisation and its Discontents[END_REF] view that some wish to reap the benefits while letting others pay the price.

The mental health problems of asylum seekers in the UK are considerable and management is complex [START_REF] Tribe | Mental Health of Refugees and Asylum-Seekers[END_REF]. This globalizing problem of forced migration has resulted in the UK in a very mixed group of people, with different cultures, expectations, personal experiences, innate capacities, unknown early experiences, dislocated from their social roots, presenting to services with misery attached to past experience, dreadful transit and present uncertainty. Although relatively small in number the services are still struggling to cope with this group appropriately [START_REF] Ward | Mapping the Provision of Mental Health Services for Asylum Seekers and Refugees in London[END_REF]. The Joint Committee (2007) warned that the process in the UK in many cases lead to a failure to protect asylum seekers from inhuman and degrading treatment.

Weapons

The new technologies have brought about new weapons while new markets have brought about increased distribution of older weapons. Most mental health research concentrates on the relationship between victim, the events experienced and the social circumstances but not on the weapon used. Is the unseen enemy in the sky more likely to cause psychological disturbance than the enemy at the gates? The notion of shock and awe in Iraq may have had similarities to the practice of the Blitzkrieg, but the latter was defined in military not psychological terms.

The use of psychological jargon has come into military language. Psychological Operations, or 'PsyOps' have been reported in recent conflicts (CNN, 1999) using all available media -leaflets from the air, radio, TV and Internet -to foment unrest against leaders and create fear. Such propaganda is intended to undermine psychological strength, but how it relates to the ultimate psychological sequelae of a war is unknown. The International Committee of the Red Cross in a project to outlaw weapons causing 'Superfluous Injury or Unnecessary Suffering' included a category of abnormal psychological states [START_REF] Coupland | Superfluous Injury or Unnecessary Suffering[END_REF]. Psycho active substances are probably part of chemical weapons development [START_REF] Wheelis | Biotechnology and Biochemical Weapons[END_REF] but their potential impact is as yet unknown.

There is some evidence that chemical weapons have a special psychological effect; survivors of chemical attacks in the Iran-Iraq war show particularly high levels of PTSD some years after the events [START_REF] Hashemian | Anxiety, Depression, and Posttraumatic Stress in Iranian Survivors of Chemical Warfare[END_REF], perhaps related to the unseen nature of the attack, the fear and rumours that are associated with such a weapon and the fear of dying of asphyxiation. A similar effect might hold true of biological weapons; after the anthrax attacks in the USA there were reports of high stress levels and avoidance of public systems [START_REF] Gray | Dealing with the Dangers of Fear: The Role of Risk Communication: Fear itself is a Risk and must be Part of Risk-Management Policy Making[END_REF]. The mental health sequelae of the atomic bombs at the end of the Second World War were profound, unexpected and documented in Robert [START_REF] Lifton | Life After Death[END_REF] account, Life after Death; the impact is still measurable today. Some might argue that the suicide bombing is a new weapons system. The relationship of suicide bombing to mental health is complex, but it is more likely to arise as an instrumental aspect of war from asymmetrical conflict than from psychopathology [START_REF] Grimland | The Phenomenon of Suicide Bombing: A Review of Psychological and Non-Psychological Factors[END_REF]. Experience in Israel suggests the mental health consequences are considerable, both to direct victims and the wider community with suggestions that susceptibility and resilience are factors that change over time, reflecting both internal, personal and external social factors [START_REF] Bleich | Mental Health and Resiliency Following 44 Months of Terrorism: A Survey of an Israeli National Representative Sample[END_REF]. An increasing fear is that highly destructive weapons can be created and distributed into population systems by the new global terrorist networks using suicide agents, this fear becoming one of the drivers for the wars in Iraq and Afghanistan (Rogers, 2006: 2).

Hand guns, small arms and light weapons are more available due to the freer global markets and looser national boundaries with a global trade worth about US$10bn. Most illegal small arms start in the legal market but the regulation required to monitor and control the flow is lacking [START_REF] Arya | Confronting the Small Arms Pandemic[END_REF]. One third of the world's 700m firearms are to be found in the USA, and move from there to all parts of the world. The burden in death in the year 2000 was over 400,000 people (Cukier and Sidel, 2006: 14), with great regional variations, the majority that year being due to suicide. The psychosocial impact of small arms has been estimated in a variety of settings [START_REF] Mahmudi-Azer | Arms Trade and its Impact on Global Health[END_REF]) but detailed epidemiological work on mental health and gun use is not available. Traditional codes of conduct containing violent conflict become overwhelmed when guns replace knives and spears, leading to a spiralling violence and death, hastening the break up of traditional cultures with grave psychosocial consequences [START_REF] Gebrewold | The Relationship Between Human Security, Demand for Arms and Disarmament in the Horn of Africa[END_REF]. As [START_REF] Meddings | Civilians and War: A Review and Historical Overview of the Involvement of Non-Combatant Populations in Conflict Situations[END_REF] observes 'concentrated 20th Century killing power resting in the hands of individuals with fifteenth century organisation and discipline', the parallels with gangs and urban crime are evident.

Humanitarian Response

As the International Committee of the Red Cross commenced its humanitarian mission in the 1860s, the First Geneva conventions were established to allow for the treatment of soldiers in war; these conventions were later extended to the protection of prisoners of war and to civilians caught up in war and civil war. Such sentiments to help and protect people from war were not new to humanity [START_REF] Meddings | Civilians and War: A Review and Historical Overview of the Involvement of Non-Combatant Populations in Conflict Situations[END_REF]) but these two events prepared for the oncoming globalization of war.

Key players in this area are the big non-governmental organizations (NGOs), such as Médicins Sans Frontières, Médicins du Monde, the Red Cross and Crescent, the International Medical Core, Action Aid, Oxfam, along with international governmental organizations (IGOs), such as the WHO, UNICEF, UNHCR, Office for the Coordination of Humanitarian Affairs (OCHA); however, it is essential not to ignore the small NGOs, many faith based, that may be local or global in their reach and more difficult to bring into a coordinated action. Three themes are briefly explored here: the relationship of the military to the humanitarian effort, post-conflict health and mental health.

In the last few decades the networks and relationships between humanitarian and military actors has become more complex and intense. Increasingly Peace Support Operations [START_REF] Court | The Role of the Military in Post-Conflict Situations[END_REF][START_REF] Pugh | Military Intervention and Humanitarian Action: Trends and Issues[END_REF] are leading to active military involvement in the post-conflict humanitarian work with civilian populations. The UN role of peace making and peace keeping, the need for security to allow humanitarian activity to take place and the political notion of winning the hearts and minds appear to be part of this development. With the diminution of the UN role in the last decade, these activities have become incorporated into national armies, especially the US and UK military.

Where there is conflict it is clear that there must be a relationship between those who provide security and those who provide aid; however, this military role in providing humanitarian assistance has been criticized, seen as risking confusion between humanitarian workers and military, thus placing humanitarian workers at risk [START_REF] Bristol | Military Incursions into Aid Work Anger Humanitarian Groups[END_REF]. There are more deep-seated concerns with suggestions that the fundamental principles of impartiality, neutrality and independence require a clear distinction between the two activities (Struder, 2001).

Three recent wars have seen very different processes of post conflict health reconstruction. In Kosovo, there was no local ministry of health and the WHO took on a primary planning and implementing role with services coming from a mixed set of providers [START_REF] Shuey | Planning for Health Sector Reform in Post-Conflict Situations: Kosovo 1999-2000[END_REF]. In Afghanistan there was an early and significant role for NGOs, the World Bank and other donors supporting the Ministry of Public Health in coordinating activities [START_REF] Cook | Post Conflict Reconstruction of Afghanistan[END_REF][START_REF] Palmer | Contracting Out Health Services in Fragile States[END_REF]. A third model developed in Iraq, with extensive use of the private sector, both in terms of planning and in delivery (Medact, 2006). Each of these situations is very different in terms of security, the nature of the conflict and the structure of health care.

The criticisms of the first two models have been that the WHO dominance leads to too much central planning and insufficient enablement of local actors, while the NGO model is too fragmented and allows certain interest groups too much local power. These are natural tensions; the key problem is how to bring in the local skills and enable local actions while maintaining coordination and distribution of resources based on population needs assessments.

As in the development field there have been concerns expressed over the increasing role of the private sector in post conflict health provision, which has been the dominant model in Iraq. A significant criticism of this model is that those agencies with experience in post conflict were not engaged in the reconstruction and there was a serious lack of coordination with a failure to develop an early health response (Medact, 2006).

The issue of rights and equity would seem to demand a service based on population need. This seems of particular importance in the mental health arena. A comprehensive package for considering and delivering mental health and psychosocial support in emergencies, including war, is well described in the IASC guidelines (IASC, 2007) with six guiding principles: responses should be built on human rights and equity; on participation of the affected population; that any intervention should not cause harm to any group; that interventions should build on available resources and capacities; there should be integration of activities across providers and all sectors; and intervention needs to be multi-layered, with different types of activity and response to different groups and severity of problems. Although at pains to emphasize empowerment and local involvement, there will be a risk that it becomes translated into a blueprint for action, with programmes being delivered through rigid vertical processes. Evaluation will be complex and funding for mental health remains a low priority.

The management of pre-existing severe mental illness remains a key factor post-conflict as these people are among the most vulnerable. There is little data on how they manage during war. There is a risk that the focus on 'postconflict mental health', on 'trauma' and on the 'psychosocial' might detract from services for those with long-standing and enduring mental illness.

Secondary Levels

At the secondary level the causative process, political violence, has started but has yet to break out into open hostilities or overtly damage mental well-being. Most human societies exist in this state with political violence around them in time and space and preparation for political violence within; we live in a state of 'para-war', being constantly beside and reminded of war. Our streets hold memorials to war, our history is punctuated with war, and our media bring daily news of war; yet we know the mental, social and physical effects of war are horrific.

The tasks at this level of intervention include assessing the impact of the threat of violence, preparation for conflict, monitoring the likelihood of violent conflict breaking out and considering interventions that might reduce the likelihood of violence. Though these move well beyond the spheres of mental health and health in general, health policy and professions have roles in these activities, which are global in their scope.

The mental health impact of the threat of violence is hard to estimate; however some observations from areas of conflict such as Northern Ireland suggest that perception of the risk of violence is an important factor in mental well-being and that denial of risk is an important protective device [START_REF] Cairns | The Impact of Political Violence on Mild Psychiatric Morbidity in Northern Ireland[END_REF]. There is evidence that the fear of nuclear annihilation is associated with anxiety, though not necessarily causative [START_REF] Poikolainen | Fear of Nuclear War Increases the Risk of Common Mental Disorders Among Young Adults: A Five-Year Follow-Up Study[END_REF]. Whether to develop programmes on these issues must depend on the prevalence of these ideas and the likelihood of the feared concern.

Protection from mental health sequelae of violence has been carefully considered within the military and the NGO humanitarian agencies. The low incidence of PTSD in soldiers serving in Iraq has been in part attributed to pre-conflict training [START_REF] Hotopf | Neuropsychological Changes Following Military Service in Iraq[END_REF]. Many NGOs working in humanitarian crises consider training, supervision and self care as important devices to protect the mental welfare of their staff (IASC, 2007). For helping general populations cope with the threat and presence of violence, evidence comes from areas of chronic war, such as the Middle East and South East Asia, such as observations that training of school children in war situations can reduce the risks of mental health consequences [START_REF] Minowski | Protection of the Young Child's Brain: Personal Observations and Thoughts in the Postwar Stress Syndrome and in Natural Catastrophes[END_REF]. Resilience, the individual capacity to manage traumatic events, requires greater understanding and emphasis.

The preparation for war influences the likelihood of war in a complex manner, as some aspects may deter an enemy but others may endorse the idea of war. In monitoring the likelihood of war, indicators include preparations for war and observations of language used in the media, such as the radio in the Rwandan genocide. Health professionals may monitor the incidence of violent deaths and injuries in particular areas of strife such as in the Horn of Africa [START_REF] Gebrewold | The Relationship Between Human Security, Demand for Arms and Disarmament in the Horn of Africa[END_REF]; mental health professionals have played a role in monitoring the use of torture in various countries through assessments of asylum seekers (Medical Foundation, 2002). This health data, collected from many sources and used with political and social data may help draw the attention of the international community to particular emergent problems, with the new globalizing communication networks sharing information and strengthening advocacy.

Interventions that reduce the likelihood of violence intensifying have become a global priority, encompassing action in many spheres, governmental, intergovernmental, UN and NGO (Department for International Development, 2006), with increasing realization that conflict is hindering the achievement of the Millennium Development Goals in many areas, while the failure of development increases the likelihood of violence. The boundaries between development aid and pre and post conflict humanitarian support are blurred and overlapping, as are the distinctions between peace building and psychosocial programmes, where the essence is to promote social cohesion, dialogue and social capital. There are roles for health policy in this including such programmes as 'Peace through Health' and 'Health Bridges for Peace' [START_REF] Arya | Peace Through Health I: Development and use of a Working Model[END_REF], and some specifically mental health related tasks, examining the psychological and social processes in particular conflicts or situations [START_REF] Alderdice | The Individual, the Group and the Psychology of Terrorism[END_REF].

Primary Levels

At a primary level the search is for a deeper understanding of human conflict about which mental health writers have much to say. The correspondence in 1932 in which Einstein asked Freud if there is a solution to war provoked two observations; first that humankind has an instinctual drive for destruction and second that this individual drive is contained by a communal authority that emerges from a power struggle within the community. Freud goes on to say: ' … attempts are made by certain rulers to set themselves above the prohibitions which apply to everyone … to go back from a dominion of law to a dominion of violence … the oppressed members of the group make constant efforts to obtain more power … they press forward from unequal justice to equal justice for all' (Freud, 1950: 277).

There are other explanations of the human capacity for violence highlighting positive drives of attachment, of respect and of relationships [START_REF] De Zulueta | From Pain to Violence: The Traumatic Roots of Destructiveness[END_REF][START_REF] Fromm | The Anatomy of Human Destructiveness[END_REF][START_REF] Gilligan | Violence: Reflections on our Deadliest Epidemic[END_REF]. Attachment theory proposes that the failure to provide the right emotional environment for infants and children risks increasing their capacity for hatred and dehumanizing; these being the attributes necessary to be taken up in the crusade, the jihad or the jingoism. Bringing evidence to bear from many sources these authors suggest that the proper regard for all humans has become a matter for the science of survival, as well as morality. Strategies to reduce the likelihood of violence are essentially to ensure good economic and social fabric for people, especially those in conflict, those fleeing from conflict and those from the most deprived spheres of our communities.

The struggle identified by Freud between those in power and those underprivileged is quite apparent today as a driver for major conflict. The social determinants of health are very similar to the social determinants of violence, at the centre is the inequality of wealth, which influences the individual through childhood and into adulthood [START_REF] Wilkinson | The Impact of Inequality: How to Make Sick Societies Healthier[END_REF]. Feelings of shame are most associated with violent thought and actions [START_REF] Gilligan | Violence: Reflections on our Deadliest Epidemic[END_REF]. The drivers of war in the developing countries include extreme poverty, political, economic and social inequalities [START_REF] Stewart | Root Causes of Violent Conflict in Developing Countries[END_REF], though wealth itself may bring conflict as in the notion of the 'resource curse' for such countries as the Democratic Republic of the Congo [START_REF] Kett | Drivers of Violent Conflict[END_REF]. The analysis of [START_REF] Kaldor | New and Old Wars: Organized Violence in a Global Era[END_REF] and [START_REF] Duffield | Global Governance and the New Wars[END_REF] cited earlier is that the economics of greed and fear are the prime movers of political violence in the wealthy world.

At this primary level of intervention the search is for the right way for human society to conduct itself to diminish the likelihood of political violence and maximize mental health and such policy for future action should take account of these emerging sciences of human relationships [START_REF] Piachaud | Terrorism, a Facet of the Global Struggle for Power and Survival[END_REF]. When considering the global application of our understandings of human relationships, bearing in mind the future risks of climate change, the energy crisis and nuclear proliferation, the path that emerges for reduced likelihood of conflict is the need for greater equity and greater strength to global governance and to communal authority; the question at this primary level being whether these global challenges can be met without descending back into the global conflicts of the 20th century.

It is hard to see how this goal can be achieved without the institution of the United Nations being reformed and brought back to the centre of global decision making. In his book, Collapse: Tracking the Failures of Human Societies to Deal with their Vital Environmental Risks, Jared Diamond (2005) identifies factional governance, using power, roles and rituals to fight over dwindling resources as the least successful model, and yet this is how the current global governance might be construed. While some degree of argument and factionalism are inevitable, global agreements and treaties between nations on the use of the global resources must emerge and be compelling. For the globalizing corporations and financial institutions some greater democratic accountability must be developed and ways of ensuring they have social responsibility for the societies in which they operate, not simply wealth creation, built into their governance [START_REF] Bennett | Multinational Corporations, Social Responsibility and Conflict[END_REF]. In terms of global law, the Report by the International Commission on Intervention and State Sovereignty (ICISS, 2001) The Responsibility to Protect needs to come into much greater prominence when considering the use of deadly force to resolve political conflicts and the International Criminal Court needs to be ratified by all nations.

In considering the global militarism that emerged during the last century, treaties on disarmament need to be more rigorously followed and new treaties on small arms registration and monitoring need to be agreed. The global burden of military expenditure has passed the one trillion US dollar mark. In 2005, the UN budget for all its functions was at US$12bn, 1.4% of the global military expenditure (Global Health Watch, 2006: 262), less than the US earned in arms sales in 2003 [START_REF] Mahmudi-Azer | Arms Trade and its Impact on Global Health[END_REF]. There must be greater global emphasis on peace making, understanding the issues that drive us to war and a far greater expenditure on research, evaluation and application of practice [START_REF] Elworthy | Cutting the Costs of War: Non-Military Prevention and Resolution of Conflict[END_REF].

Conclusions

The relationship between conflict and mental health is increasingly well described. This article has reviewed some aspects that relate to globalization and has proposed a model of public mental health, which considers analysis and actions at various stages of conflict, and lends itself to the development of policy, both in health service delivery and at more political levels.

At a tertiary level the consequences of war are overt and in one respect it is 'plus ca change plus ca le même chose' as suffering from bereavement, personal threat and disruption of family and society has been part of humanity since its beginnings and there are some commonalities across time and space that unite us. There are, however, differences that are bound to language, culture, the new nature of war and new global institutions. Our models of mental health will continue to evolve along with our culture and the language we use to describe them; new forms of warfare and new weapons will create the context within which these mental health problems emerge; social attitudes to forced migrations will evolve and influence the well-being of those caught up. There will be an ongoing need to research and assess these relationships, but we already know enough about promoting welfare to be critical of the global responses to refugees and victims of war and to advocate for greater resources and coordination of responses. The last 10 years has shown that market driven responses to post-conflict fail more comprehensively than globally coordinated responses focused on equity and population well-being.

At a secondary level there is recognition that war is ubiquitous and that societies exist in a state of 'para-war'. Important roles that promote mental well-being include understanding better how the threats of war impact on populations, preparation when the risks of facing open violence are high, monitoring the emergence of open violence and seeking interventions that reduce the likelihood of violent conflict. The synergies between peace-building and psychosocial interventions need further exploration as does the emergence of global networks working on these issues.

At a primary level two key issues arise; one is the human propensity for violence with some clearer explanations emerging from the multidisciplinary fields of human relationships and the need for far greater expenditure, research and application on issues of peace making. The second is the need for stronger global governance and a strengthened role for a reformed UN, acknowledging that regional squabbles over resources by competing powers and trans-national organizations is the least likely path for sustainable peace.

Piachaud: Globalization, Conflict and Mental Health

Global Social Policy 8(3)

r é s u m é

La Mondialisation, la Conflit, et la Santé Mentale

Le conflits violents pour atteindre des fins politiques, y compris la guerre et la guerre civile, la cause considérable de maladie mentale, et bien qu'il y a des façons différentes d'aborder et de comprendre cette relation, un certain consensus émerge sur les réponses psychologiques, sociales, et intersectorielles à la suite des hostilités. La mondialisation a changé les rapport parmi des États-nations, sociétés, et organismes internationaux, créant des modèles différent de violence politique et des façons différentes d'organiser des réponses. Cette article considéré les victimes, les armes, et l'aide humanitaire dans un cadre public de santé mentale en décrivant les conséquences de la guerre et d'autres formes de violence politique. Les niveaux secondaires et primaires de l'intervention dans la santé mentale publique devraient tenir compte notamment de la surveillance, la préparation et la prévention de la violence politique. Ils devraient utiliser les nouvelles sciences des rapports humains justification pour considérer des rapports internationaux. La nécessité de rétablir les Nations Unies reformées au centre de la prise de décision internationales et d'augmenter la dépense globale pour le rétablissement de la paix sont deux conclusions de cette étude.

resumen

La Globalización, el Conflicto y la Salud Mental

El conflicto violento para lograr fines políticos, incluso la guerra y la guerra civil, es la causa más grande de la mala salud mental. Aunque existen enfoques y maneras diferentes para entender esta relación, hay algun consenso sobre las reacciones psicológicas, sociales, y las reacciones entre diferentes sectores, frente a las situaciones de posguerra. La globalización ha cambiado las relaciones de los estados-nación, las corporaciones y las organizaciones internacionales, creando pautas diferentes de violencia política y maneras diferentes de organizar las reacciones. Las víctimas, las armas y la ayuda humanitaria están consideradas dentro de un marco de salud mental pública, describiendo las consecuencias de la guerra y otras formas de violencia política. Los niveles primarios y secundarios de intervención en la salud mental pública toman en consideración la preparación para la violencia política, su observación y su prevención. Toman las nuevas ciencias de las relaciones humanas como base para examinar las relaciones internacionales. La necesidad de restablecer las Naciones Unidas al centro de la toma de decisiones global y de aumentar el gasto global para medidas pacificadoras son dos conclusiones de este análisis.