A doctor tends to a soldier injured in fighting in Qaraqosh in Mosul, Iraq. (photo: Chris McGrath/Getty)
When
Military Wars End in the Middle East, Medical Ones Begin
By Robert Fisk, The
Independent
18 May 17
In one example, tissue samples from the three-week 2008-2009
Israeli-Hamas Gaza war show remnants of heavy metals in the wounds of
Palestinians which can lead to cancers
The
details were horrific. Outside the besieged city of Mosul, 13,000 wounded
civilians are today waiting for reconstructive surgery – from just this one
seven-month battle. Another 5,000 Iraqi police militiamen are waiting for the
same surgery from recent military offensives, in their case to be cared for by
the Iraqi ministry of interior. But the health infrastructure that exists in
the whole of Iraq cannot look after these wounded. As a result, some are
turning up in Damascus – amid the frightfulness of the Syrian war – for the
surgery they cannot obtain at home. A new graft in Damascus costs $200.
In the
balmy early summer of Beirut this week came these detailed new horrors of
Middle East war. For beside the state-of-the-art American University of Beirut
Medical Center (AUBMC) in the city, doctors from across the region, from Iraq,
Syria, Yemen and Palestine – along with the International Red Cross and
Medecins Sans Frontieres – came to discuss their fears for the wounded and the
sick and their conviction that drug-resistant bacteria are growing in hospitals
in the Middle East. Just how to deal with this may be within the knowledge of
the military medical authorities – but not within the hands of civilian
doctors.
Did
this start in Bosnia, as one doctor suspects, where civilian and military
casualties merged into each other – it was, after all, a war where a civilian
turned into a soldier and then re-emerged as a civilian the moment he entered a
hospital? Or do the clues lie much further back, in the vicious sanctions which
the UN imposed on Saddam’s Iraq, at America’s urging, in the aftermath of the
dictator’s invasion of Kuwait in 1990? The first Global Conflict Medicine
Congress, arranged by Glasgow-trained Professor Ghassan Abu-Sittah, head of
plastic and reconstructive surgery at AUBMC, raised these questions in stark
and painful ways.
Drug
resistance, he said, did not exist in the 1980-88 Iran-Iraq war – when 150
Iraqi soldiers were wounded each day during the Fao peninsula battles alone –
so what happened during the post-1990 sanctions period? “Iraqis were allowed to
use only three antibiotics for 12 years,” he says. “These were the only ones
allowed in by the UN. Heavy metals had been used in the 1991 [liberation of
Kuwait] war. You found celinium [present in the smashed concrete of destroyed
houses], tungsten and mercury in the casing of penetrating bombs. What are the
long-term effects of these metals on the human body?”
A
Medecins Sans Frontieres analysis – presented at the conference by Abu-Sitta
and Dr Omar Dewachi who co-direct a newly created Conflict Medicine Programme
at the AUB supported by Jonathan Whittall of Medecins sans Frontieres – said
that multidrug resistant [MDR] bacteria now accounts for most war wound
infections across the Middle East, yet most medical facilities in the region do
not even have the laboratory capacity to diagnose MDR, leading to significant
delays and clinical mismanagement of festering wounds.
Beyond the physical
damage caused by weaponry, Whittall added, “destroyed or degraded sanitation
facilitates the microbiological seeding of wounds. The body, weakened by the
wound, is reinjured when it interacts with the harsh, physically degraded
environment.”
Iraqi-trained
and Harvard-educated Dewachi, the American University of Beirut’s assistant
professor of medical anthropology, spoke at length of Iraq’s cavalry of war
victims and quotes an Iraqi patient waiting for treatment in Beirut. “Most of
the good doctors have left the country,” the man told Dewachi, “and those who
remain have lost their humanity”. Dewachi’s forthcoming book, Ungovernable
Life: Mandatory Medicine and Statecraft in Iraq, which traces Iraq’s
medical history from the First World War to 2003, will reveal that successive
post-2003 Iraqi governments have been sending civilians, military and security
forces personnel, parliamentarians – and even militia and political party
members – to hospitals in Beirut.
So
dangerous is life for physicians in Iraq itself – where the families of wounded
patients often want revenge for perceived poor treatment by doctors – that the
Baghdad government recently allowed doctors to carry guns to their hospitals
and surgeries. About half the medical force in Iraq has fled over the past 20
Saddam and post-Saddam years and the British National Health Service, where
many Iraqis were trained, “hosts one of the largest populations of Iraqi
medical doctors outside Iraq”, according to Dewachi. The post-World War One
British mandate created UK medical training and standards in Iraq and this
cooperation continued long after independence.
The
MSF analysis not only raised questions about the long-term effects of the 1990
UN sanctions regime, but also the reversal of medical advances in the treatment
of cancer and diabetes. “This is often due to the inability of healthcare
systems and technology to provide the same level of care in harsh and complex
war environments. Kidney failure patients can no longer access dialysis units
and the delivery of chemotherapy to cancer patients is severely compromised…”
Dewachi
is fearful of the way in which the nature of illness has changed in Middle East
wars, where “the change in the base line of cancers has become very
aggressive”. As he puts it, “when a young woman of 30, with no family history
of cancer, has two different primary cancers – in the breast and in the
oesophagus – you have to ask what is happening. You have to know what is
happening.” Dewachi is overwhelmed by the sheer number of wounded patients in
the Middle East. “There was a nine-year old girl with shrapnel wounds to the
face. She was wounded in Baghdad in a 2007 car bombing. Her mother who was
caring for her had a glass eye from a wound. Her father had a prosthetic arm
after amputation surgery in the 1980-88 Iran-Iraq war. We found an Iraqi
policeman injured in a car bombing who was being looked after by his brother
who had lost three fingers in the Iran-Iraq war.”
In
Iraq, patients wounded in Saddam’s wars were initially treated as heroes – they
had fought for their country against non-Arab Iran. But after the US invasion
of 2003, they became an embarrassment. “The value of their wounds’ ‘capital’
changes from hero to zero,” Abu-Sitta says. “And this means that their ability
to access medical care also changes. We are now reading the history of the
region through the wounds. War’s wounds carry with them the narrative of the
wounding which becomes political capital.” Abu Sitta believes that the building
– and deconstruction – of medical care goes hand-in-hand with state-building
and state-destruction. “Today, it’s about dismembering nations rather than
building them.”
For
Abu-Sittah, “there is no such thing as wars that end – we call all this in
medicine as ‘a chronic condition with acute flare-ups!’” In other words, war
wounds continue to cause pain – and kill – long after wars have ended and
restarted. “A wounded body ages differently,” he says. In Gaza, for example, a
bullet wound affects a patient for decades after the wound is inflicted. “We
have found that Israeli snipers fire at the back of the knee of the person they
are shooting at – the back of the knee and the lower third of the thigh. This
does not necessarily kill – but it almost always requires amputation. This is
the junction of the sciatic nerve, the popliteal artery and the knee joint –
with one bullet you manage to do all three. That’s why the IRA used to do
knee-capping in Northern Ireland.”
An
Italian professor of genetics says that tissue samples from the three-week
2008-2009 Israeli-Hamas Gaza war shows remnants of heavy metals in the wounds
of Palestinians, both carcinogenic and teratogenic – which, she said, can lead
to cancers and deformed children. Other physicians noted that Hezbollah’s
medical corps had transformed the treatment of its wounded in the Syrian war.
Speakers in Beirut included even those foreign doctors who witnessed the 1982
Sabra and Chatila Palestinian camps massacre at the hands of Israel’s Lebanese
Christian militia allies.
All of
the horrific developments in the medical history of the Middle East’s wars has
prompted both the American University of Beirut Medical Centre and MSF to
create a research and training partnership in conflict medicine – Abu-Sitta,
Dewachi and Whittall are on its steering committee – which means that no-one
expects the five major wars in the region to end soon. All in all, I guess, a
sobering reflection on all the wars on "terror" which the West and
Russia and its friendly dictators claim to be fighting in the Middle East –
where the cancer of national and international power is just as fatal as the
cancers which afflict the bodies of the victims.
C 2015 Reader Supported News
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to the Baltimore Nonviolence Center, 325 E. 25th St., Baltimore, MD
21218. Ph: 410-323-1607; Email: mobuszewski [at] verizon.net. Go to http://baltimorenonviolencecenter.blogspot.com/
"The master class
has always declared the wars; the subject class has always fought the battles.
The master class has had all to gain and nothing to lose, while the subject
class has had nothing to gain and everything to lose--especially their
lives." Eugene Victor Debs
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