About Derek Gregory

I'm Peter Wall Distinguished Professor and Professor of Geography at the University of British Columbia in Vancouver.

Cities under siege (II)

In this second post on Cities under siege I provide a back-story to the re-intensification of military and paramilitary violence against civilians in Syria I described here.  But it’s also a back-story to the stunning image above, ‘Deluge’ by Imranovi: people were evacuated to what eventually became nominally ‘de-escalation zones’ from besieged cities like Aleppo, but many more continued to flee Syria altogether – like Imranovi himself (more on Imranovi here and here).  It’s worth pausing over his artwork: every time we see video of those perilous boats crammed with desperate refugees we ought to reflect on the oceans of bloody rubble strewn across their land and the millions of other displaced people in their wake.

There is a close connection between internal displacement and cities under siege.  Here is the UN’s estimate of the displaced population in December 2016:

They are concentrated in towns and cities.  Many people have managed to escape areas under siege, risking their lives to do so, but many others have sought refuge in towns and cities that have themselves come under siege.  Here, for example, is Siege Watch‘s description of Eastern Ghouta in mid-2016:

The capture of besieged towns on the south and eastern sides of Eastern Ghouta had a negative impact on conditions throughout the entire besieged region. IDPs from the frontline areas fled into host communities that have also been subjected to the same long-term siege and lack the infrastructure and resources to support the newly displaced families. There is now a higher concentration of people living in temporary shelters or sleeping on the streets.

The UN defines a besieged area as ‘an area surrounded by armed actors with the sustained effect that humanitarian assistance cannot regularly enter, and civilians, the sick and wounded cannot regularly exit the area.’  

But the definition  and its application turn out to be as problematic as perhaps you would expect.  Here is Annie Sparrow:

Estimates of the number of Syrians currently living under siege vary widely, according to who is doing the reporting. For example, last December [2015], the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) in Damascus communicated back to the UN secretary-general’s office that 393,700 civilians were besieged. For the same period, Siege Watch estimated that the real figure was more than one million…

From its base at the five-star Four Seasons Hotel in Damascus, OCHA decided that an area is merely “hard to reach” rather than besieged if it has received an aid convoy in the last three months, regardless of whether the supplies are sufficient for one month, let alone three.

One doesn’t need to travel far from Damascus to see how little a distinction there often is between a “hard to reach” and a “besieged” area.

I’ll return to that last, vital point, but here are two of those OCHA maps.  The first shows the situation in January 2016 and the second in April 2017:

Even those attenuated maps are alarming enough, but the Syrian American Medical Society (SAMS) also believes that the OCHA reports systematically under-report the magnitude of the crisis, and in Slow Death: Life and Dearth in Syrian communities under siege (March 2015) they provided a more sensitive three-tier classification.

These are, of course, heterogeneous communities – none of the reports I have cited (nor those I will draw on later) conceals the presence of armed groups of various stripes within them, often jostling for control – but siege warfare renders them as homogeneous.  The presence of civilians, for the most part desperately struggling to survive in the midst of chaos and conflict, is erased; this begins as a discursive strategy but rapidly becomes a visceral reality.  In short, siege warfare becomes a version of enemy-centric counterinsurgency and counterterrorism, the Syrian government less invested in ‘performing the state’ through the provision of services than in denying services to the entire population in these areas.  By these means the Assad regime has pursued a strategy that mimics the Islamic State’s determination to ‘extinguish the grey zone‘:

Like Annie, I have been impressed by the work of Siege Watch and so I’ll start with their regular reports that have provided a series of powerful insights into the effects of sieges on everyday life.  In their first report they identified characteristics shared by all communities besieged by the Syrian government.  When that report was compiled almost 50 communities were besieged; only two of them were under siege by forces other than the Syrian government and a third was besieged on one side by the Syrian government and on the other by Islamic State.

There are three characteristics that I want to emphasise:

Deprivation:

  • ‘Civilians in the besieged areas struggle to survive. Electricity and running water are usually cut off, and there is limited (if any) access to food, fuel, and medical care. In many of these areas, civilians have died from malnutrition due to the severity with which the blockades are enforced. In all of these areas, civilians with diseases, chronic conditions, and injuries have died as a result of the lack of access to medical care. Other recorded causes of siege-related deaths include hypothermia due to the lack of heating oil in the winter, and poisoning after eating something toxic while scavenging for food. Poor sanitation conditions in the besieged areas have resulted in frequent outbreaks of infectious diseases.’

Extortion and economic development:

  • ‘The pre-war economies in all of the government-besieged areas have collapsed. They have been replaced with siege economies that depend on smuggling, bribery, and local production; and because they are nearly-closed economic systems they experience extreme price volatility. Unemployment levels in besieged areas are high, reaching 100% in some of the worst Tier 1 communities such as Jobar. The Syrian government profits off of the sieges by allowing a few pro-government traders to sell goods – sometimes expired – through the checkpoints at tremendously inflated prices and taking a cut of the profits. Sometimes civilians can pay extremely high bribes to government forces or smugglers to escape the besieged areas, although both methods entail tremendous personal risk. These extortive practices have drained the areas under long-term siege of their financial resources.’

An improvised fuel stand in besieged Eastern Ghouta, February 2017

Violence:

  • ‘Most of these besieged areas are targeted with violent attacks by the Syrian armed forces and its allies. In addition to sniping and the use of explosive weapons with wide area effects in populated areas, there have also been confirmed uses of internationally banned weapons such as landmines, cluster munitions, and chemical weapons….  Most of the communities also contain AOGs [Armed Opposition Groups] which defend the the areas against incursion by pro-government forces, launch offensive attacks against the Syrian military and its allies, and coordinate with the Local Councils to varying degrees. Many Siege Watch survey respondents noted that AOGs were present only around the periphery of their communities, and a few respondents from towns in the interior of the Eastern Ghouta said that AOGs were not active in their areas at all.… [In addition] both Syrian government forces and extremists compete to recruit recruit men and boys from besieged communities using threats, blackmail, fear, propaganda, and indoctrination.’  

Siege Watch notes how, in consequence, ordinary people have ‘adjusted’ to these new, bleak realities: ‘Creative survival tactics such as rooftop gardening [below: eastern Aleppo], burning plastic to extract oil derivatives, and the local production of some basic medical supplies have become more common over time, and people have begun to acclimatise to a more primitive lifestyle’ [see also here].

That sentence gestures towards a sharper point made by José Ciro Martinez and Brent Eng (‘Struggling to perform the state: the politics of bread in the Syrian civil war’, International political sociology 11 (2) (2017) 130-47):

‘Most accounts [of the war in Syria] choose to privilege bellicose affairs over the humdrum concerns of daily life, which are deemed humanitarian issues separate from the violent battles and geopolitical struggles said to comprise the “actual” politics of war. This portrayal of conflict is illusory: it disregards the majority of interactions that shape both life and politics in contemporary war zones, where “most people most of the time are interacting in non-violent ways” (Tilly 2003, 12). One result of prevalent depictions of civil war is that civilians are frequently rendered powerless. If they do appear, it is as pawns in a conflict fought by armed groups autonomous from the societies they struggle to control.’

That’s an important qualification, but it plainly doesn’t erase the struggles of civilians either – which makes ‘acclimatisation’ a remarkably weak term to describe the multiple, extraordinary ways in which civilians have been forced to adjust to a new, terrifyingly abnormal ‘normal’ in order to survive.  Here, for example, is a doctor in Homs describing ‘Siege Medicine’ [more here]:The Center for Civilians in Conflict has also provided a report on civilian survival strategies that lists a series of other extraordinary, collective measures (and the title, Waiting for No One, says it all).  These strategies include the provision of makeshift early warning systems against incoming air attacks (spotter networks, radios and sirens); the provision and protection of medical infrastructure (in part through improvised field hospitals and the construction of underground hospitals); and the development of local aid and rescue teams (including the Syrian Civil Defence or White Helmets); protection from unexploded ordnance (‘the armed groups typically harvest them for their own makeshift weapons’ but the White Helmets and other groups have sought to render them harmless).

But Siege Watch – and José and Brent – have in mind something more: something in addition to strategies that are necessarily but none the less intimately related to direct, explosive and often catastrophic violence.  They also want to emphasise the ways in which otherwise ordinary, everyday activities have been compromised and ultimately transformed by siege warfare.

Here I focus on food (in)security.  Here is Annia Ciezadlo reporting from Yarmouk in Damascus:

In a dark kitchen, by the flickering light of a single safety candle, two men bundled in hats and jackets against the cold put on an impromptu video satire: live from Yarmouk, at the southernmost edge of Damascus, a cooking show for people under siege.

“This is the new dish in the camp of Yarmouk. It hasn’t even hit the market yet,” said the man on the right, 40-year-old Firas Naji, the blunt and humorous host.

He picked up a foot-long paddle of sobara, Arabic for prickly pear cactus. Holding it carefully by one end to avoid thorns, he displayed first one side and then the other for the camera.

“In the U.S., they get Kentucky [Fried Chicken], hot dogs. In Italy, spaghetti and pizza,” he said, his raspy voice caressing the names of unattainable foods. “Here in Yarmouk, we get sobara.

“It’s not enough we have checkpoints in the streets and shelling,” he added, laying the cactus back on the counter with a sad laugh. “Even our cooking has thorns.”

 

Yarmouk was established in 1957 as a refugee camp for Palestinians but gradually it had absorbed more and more Syrians displaced by drought, famine and eventually fighting.  As the war intensified, so the siege tightened:

The government checkpoints in and out of Yarmouk would close for four days, then five, then six. Soldiers would confiscate any amount of food over a kilo…. On July 21, 2013, the regime closed the main checkpoint into Yarmouk for good. The siege was total: Nobody could leave, and nothing could enter except what the soldiers permitted.

Over the next six months, the price of everything went up. A single radish reached $1.50 at one point; a kilo of rice was $100.

And so the inhabitants turned to gardening:

Between buildings, in abandoned lots and on rooftops, the siege gardeners of Yarmouk have been cultivating everything from eggplants to mulukhiyeh, a jute plant whose glossy leaves make a rich green stew. Come harvest time, they bag the produce into 1-kilo portions, hang the bags on the handlebars of beat-up bicycles and pedal around the camp distributing the food to their neighbors. They focus on those most in danger of starving: children, poor people and the elderly.

But the situation was much bleaker than the picture conjured up by that paragraph; the siege waxed and waned, and UNRWA was occasionally granted permission to deliver emergency relief, but the image below – of residents queuing for food supplies – shows how desperate the situation became.

Here is a woman in September 2014 describing the horrors of the siege to Jonathan Steele:

There was no anger or hysteria in her voice, just a calm recollection of facts. “You couldn’t buy bread. At the worst point a kilo of rice cost 12,000 Syrian pounds (£41), now it is 800 pounds (£2.75) compared to 100 Syrian pounds (34p) in central Damascus. It was 900 pounds (£3.10) for a kilo of tomatoes, compared to 100 here,” Reem recalled. “We had some stocks but when they gave out we used to eat wild plants. We picked and cooked them. In every family there was hepatitis because of a lack of sugar. The water was dirty. People had fevers. Your joints and bones felt stiff. My middle daughter had brucellosis and there was no medication,” she said. In October 2013, in a sign of how bad things had become, the imam of Yarmouk’s largest mosque issued a fatwa that permitted people to eat cats, dogs and donkeys.

Control of Yarmouk see-sawed between the Syrian Arab Army, Al-Nusrah and Islamic State, with thousands of civilians trapped behind the siege lines so that time and time again the community was thrown back on its own, desperately strained resources to survive.

Here is how Mamoon Yalabasi described a second satirical video from Yarmouk, made shortly after IS over-ran the camp, in April 2015:

“We are in the Yarmouk camp, the camp of plentifulness…  Take a look at the floor,” said the man as the camera shows water in the street. “This is not water. This is an excess of cooking [flooding the streets].”

The youth then moved on to mockingly give his viewers advice on how to lose weight.

“Would you like to lose weight? Green tea won’t work, nor will ginger … just come to Yarmouk camp for five months, in each month you’ll lose 9kg,” he said, adding the Arabic proverb: “Ask someone with experience instead of asking a doctor.”  …  “We ask the troublesome channels that claim Yarmouk camp is under siege to stop reporting that. It is ‘absolutely’ [said in English] not true,” one said.  “It’s true that my grandmother died of hunger but not because the camp was under siege but because my grandfather was so stingy – he never allowed her near the fridge,” he added.

Perhaps you think all this extreme, even exceptional, comforted by those images of rooftop gardens, and believe that those who bravely tended them could somehow perform their own green revolution.  So here are Zeinat Akhras and her brother describing how they survived during the siege of Homs:

The examples can be multiplied many times over, but in a way this last testimony is exceptional – amongst those on which I’m drawing, at any rate – because it only became available once the siege had been lifted.  Those videos from Yarmouk point towards something different: the possibility of breaching siege lines through digital media.

So let me turn to Madaya, a town in the Qalamoun Mountains 45 km north-west of Damascus and once famous for its fruits and vegetables.  It came under siege from the Syrian Arab Army and Hezbollah militias in July 2015: the town was encircled by 65 sniper-controlled checkpoints (below) and its surrounding countryside sown with thousands of landmines.

In January 2016 the UN still classified Madaya as a ‘hard-to-reach area’, so listen to one local resident describing conditions to Amnesty International that same month:

Every day I wake up and start searching for food. I lost a lot of weight, I look like a skeleton covered only in skin. Every day, I feel that I will faint and not wake up again… I have a wife and three children. We eat once every two days to make sure that whatever we buy doesn’t run out. On other days, we have water and salt and sometimes the leaves from trees. Sometimes organizations distribute food they have bought from suppliers, but they cannot cover the needs of all the people.

In Madaya, you see walking skeletons. The children are always crying. We have many people with chronic diseases. Some told me that they go every day to the checkpoints, asking to leave, but the government won’t allow them out. We have only one field hospital, just one room, but they don’t have any medical equipment or supplies.

I’ve described that field hospital before, but Mohammad‘s testimony reminds us that war produces not only catastrophic injuries; it also produces and intensifies chronic illnesses that a protracted siege eventually renders untreatable.  (The Syrian American Medical Society issued a report, Madaya: Starvation under Siege, which you can read here).

Two days later there were reports of a different digital satire: one that denied the existence of a siege in Madaya and mocked its victims.

A hashtag has swept Facebook and Twitter,  #متضامن_مع_حصار_مضايا , which translates to “in solidarity with the siege on Madaya”, where individuals have posted pictures of food or skeletons, mocking those in Madaya. While many believe that the siege is a myth, some appear to be genuinely mocking the suffering of innocent people…’

The posts were subsequently removed, but here is one I captured:

Fortunately a different digital economy was already at work.  Rym Momtaz, a producer with ABC News, had started a text exchange with a young mother of five children in Madaya:

We communicate through secure messaging apps over the phones, over the internet really. So the way we went about finding her was to go through a wide network of sources that we’ve cultivated over the years of covering the war in Syria. We had to work for a few weeks, I have to say, to identify the right person and then to get in touch with her and to gain her trust in order for her to feel comfortable enough to engage in this conversation with us because she felt and her family felt that it might put her in danger.

‘‘She would text me from the moment she woke up, which was very, very, early, like 5 a.m.,’ Rym explained, ‘and then she would text me truly throughout the day.’  And that same month – January 2016 – ABC started publishing those precious despatches from Madaya.  ‘They can’t get out of Madaya – and we can’t get in,’ ABC News’ Foreign Editor emphasised, but ‘they can tell their story to the world.’

Working with Marvel Comics, ABC transformed her story into a free digital comic: Madaya Mom.

For Dalibor Talajic, the Marvel Comics illustrator who worked on the project,

The most striking parts is for me the most intimate ones as she – for instance, she decides to even though they are – they’re all starving, she decides to stop eating herself because this little amounts of supplies and food that she has, she distributes it to her children and of course husband. And she herself just stopped eating. And it’s not like a dramatic decision. It’s, like, a logical thing to do. These are the moments that stick with me most.

And it is through the assault on the intimacies of everyday life – on something as vital as feeding one’s family – that siege warfare is at its most vicious.

In case you are wondering how the family managed to charge their phones, not at all incidentally, here is the answer:

After protracted negotiations aid convoys were allowed in from time to time, but the situation remained grave.  An aid worker who accompanied a UNICEF convoy into Madaya in September 2016 described the stories told by patients who flocked to a makeshift medical clinic:

Parents whose children had stopped eating because their bodies could no longer tolerate only rice and beans. Children who could no longer walk straight because of the lack of Vitamin D and micronutrients that had riddled their bones with rickets, or who had stopped growing entirely, stunted from lack of essential vitamins. One mother showed us her baby’s bottle filled with rice water – the teat so worn it had to be sewn back to together. “Look at what I am feeding my child” she said.

Almost everyone we spoke to asked for protein – meat, eggs, milk, vegetables – something more to sustain themselves than the dry goods that were available. One mother explained that every time her child now smells boiled burgal, she starts to cry.

The doctor reported an increase in miscarriages, 10 cases in the last 6 months, because of the nutritional status of mothers. Over the last year alone, he has had to perform over 60 caesarian sections. This number was unheard of before the crisis, she told us  But women no longer have the strength for childbirth, and many pregnancies go over term, again because of the poor health of pregnant women.

Six months later life in Madaya remained precarious in the extreme:

Throughout the siege there were accusations of profiteering, but these ran in both directions (it is partly through them that Hezbollah elected to acknowledge the suffering of the city – only to point the fingers of blame at the rebels inside).  According to Avi Asher-Schapiro for VICE News, who spoke to the local leader of Ahrar al-Sham, Abdulrahman, via Skype in January 2016:

Hezbollah media outlets are accusing Abudlrahman and his men of confiscating food in Madaya, holding the population hostage, and profiteering during the crisis. In early January, a video surfaced of a woman from Madaya condemning rebels for hoarding food among themselves. The rebels are “only traders in people’s blood,” she told a scrum of reporters who gathered at the barricades outside Madaya. “They only care about securing food supplies for their families.”

That video [above] was aired around the world by Reuters and Al Jazeera. The accusations enraged Abdulrahman. “When Madaya goes hungry, we go hungry,” he says. “These are vicious lies.” VICE News spoke with another woman who claimed to be at the barricades that day. Although it was impossible to verify her claims, she said that Hezbollah fighters — who can be seen in the video frame — told women to condemn the rebels and praise Assad in exchange for food and safe passage from the town.

In a press release from early January, Hezbollah also accused Abdulrahman of profiteering. “Armed groups in Madaya control food supplies within the town and sell to whoever can afford it,” the statement read, “Thus, starvation is widespread among poor civilians.” VICE News spoke to a Hezbollah commander stationed outside Madaya who repeated these claims, and said that Hezbollah has been sending food inside the town. The rebels, he said, are keeping it for themselves. He also strongly denied that Hezbollah was trading food for propaganda.

VICE News also spoke with aid workers at the Doctors Without Borders-affiliated field hospital in Madaya, who reported no interference from Abdulrahman’s men in the dispensation of aid.

For further, still more shocking twists on the story, see here and a response here.  It’s difficult to adjudicate these competing claims in the face of skilfully organised propaganda campaigns (in which the alt.left is often as grotesque as the alt.right), but wherever the truth lies, it is clear that food has been consistently transformed into a weapon of war (‘surrender or starve‘) – a crime expressly forbidden by international humanitarian law (see also here) – and that 40,000 civilians inside Madaya were trapped in the midst of the battle.

In my previous post on this subject, I described all this as the back-story to the carnage now taking place in Idlib, in eastern Ghouta and elsewhere, but it is of course only one back-story: there are many more.  Still, on 14 April 2017 under the ‘Four Towns Agreement’ a fleet of sixty buses transported several thousand people, rebels and civilians, from Madaya – to Idlib.

Only 2,200 out of 40,000 people signed up to go, and ‘Madaya Mom’ expressed the catch-22 facing the besieged population perfectly:

If we leave, we’re labeled terrorists and we go to Idlib where the chemical attack happened last week; and if we stay we don’t know how the government will treat us.

At first, those who left were relieved and even heartened.  Deutsche Welle spoke with one young evacuee from Madaya soon after he arrived in Idlib:

I was surprised. I saw markets [below, June 2017], people walking in the streets; there is electricity, internet, ice cream and food – things we did not have in Madaya. Madaya and Zabadani are destroyed. In Idlib, the destruction is not too bad. There are a lot of cars and I was really surprised to see cars. I felt like the little children that came from Madaya to Idlib: they were surprised when they saw a banana, a cherry, biscuits or chocolate. They have never seen that before. It sounds stupid, but I felt a little bit the same when I saw cars again.

I can eat everything. The first thing I ate was fried chicken and it was great. And I have had a lot of chocolate, too.

But as the interview progressed, his elation was punctured by a growing realisation of the  bleak future ahead:

But in general, Idlib is a poor city… I started to search for jobs, but there are almost no jobs here. Idlib is like a big prison. It’s like Gaza. It’s like Madaya, but a big Madaya. So we are imprisoned here.

We know what horrors lay in wait, and we know something of what is happening in Idlib now.  But what of Madaya?  Here are extracts from a report (‘community profile’) for September 2017 (you can find more from SIRF/REACH here):

  • Movement was unrestricted within Madaya. For movement in and out of the area, two access points have been used since the implementation of the Four Towns Agreement. In September, 26-50% of the population were reportedly able to use formal access points providing they showed identi cation. However, men reportedly did not feel safe using the access points, fearing conscription and detention when crossing, while both men and women reported verbal harassment.
  • Since May 2017, commercial vehicle access has been permitted to the area. However, access restrictions on vehicle entry continued to be reported in September and included documentation requirements, confiscation of loads, required fees and limited entry depending on the day or time.
  • Humanitarian vehicle entry has reportedly not been permitted for the past six months.
  • The cost of a standard food basket in Madaya has remained stable since May 2017, with the average cost around 12% more expensive than nearby communities not classi ed as besieged or hard-to-reach.
  • Water continued to be insufficient and some residents reportedly reallocated money intended for other things to purchase water. Meanwhile, access to generators remained stable at 4-8 hours a day in all areas of the community.

I’m conscious of how much I haven’t been able to address in this post.  In particular, I’ve chosen to focus on the ‘silent violence’ of hunger and malnutrition rather than the explosive violence of mortars, missiles and bombs.  The two coincide in all sorts of ways – think, for example, of the air strikes on bakeries, what Anna Ciezadlo called ‘the war on bread‘, and on hospitals and clinics – but the contrast is really my point.  As one resident of Aleppo told Amnesty,

You need months before you die of starvation. The air strike attacks were a different story. You could die from a piece of shrapnel in a fraction of a second. Nobody was protected from the air strikes and shelling. Civilians, rebels, buildings, cars, bridges, trees, gardens etc. were all a target.

And so one final digital satire.  In April 2016 the Syrian government held elections and claimed that even opposition-held areas were enthusiastically participating.  Responding to what they called ‘the theatrics of the Assad regime’, teenagers in Madaya posted a video of their own mock hustings:The rival candidates were “Deadly Starvation”, “Deadly Illness”, and “Airstrikes”.

Journey of a wounded soldier

I’ve written before about Harry Parker‘s Anatomy of a soldier – an extraordinary novel(for multiple reasons) that reconstructs the journey of a British soldier who steps on an IED in Afghanistan through the evacuation chain to Camp Bastion and on to Selly Oak in Birmingham (see also ‘Object Lessons’, DOWNLOADS tab).  I’ve also sketched out an ‘anatomy of another soldier‘, describing in similar terms the precarious journey of a soldier wounded on the Western Front in the First World War back to Blighty.  It’s part of my project on medical care and casualty evacuation from war zones – the Western Front, the Western Desert, Vietnam, and now Afghanistan, Syria and Iraq.

Much of my archival work (on the First and Second World Wars) has been done at the Imperial War Museum and the Wellcome Library in London, and now the IWM has provided a series of short but sharp insights into the journey of a wounded soldier from Afghanistan back to Britain.

It’s not the experiment that Harry conducts – which isn’t to disparage either of them, and in fact Harry did a reading from ‘Anatomy’ at the IWM – but works through the IWM’s signature mix of objects, documentary and interview.  It includes an interview with Corporal Harry Reid, recalling his experience of being wounded;

‘… a vague recollection of spinning round in the air, not sure if I did or not…  I lay on my back, looked down, I couldn’t see my legs at that stage, a big dust cloud all around, so I couldn’t really see anything, and I couldn’t hear anything…  I weren’t in any pain at that particular time, I just felt like shock and numbness, as if I’d walked into a door…

I looked across to this left hand, thinking right, I need to get a first aid kit out here, because your training kicks in straight away, in your right-hand pouch you’ve got your tourniquets, your first field-dressing, and your morphine…  I knew something violently had just happened… I looked across and this finger was hanging off … so I kept hold of that and I thought I’m not losing that as well…  I looked across at my right arm and it were twisted up around my back so then I shouted for a medic … but obviously I shouted but I couldn’t hear myself shouting, which was quite strange…

He crawled back towards me, risking his own life … and he gave me some morphine and started putting tourniquets on.  He put  a tourniquet on my arm, pulled it obviously really tight to stop the blood flow but I felt it pinch my skin … that felt painful, I couldn’t really feel anything else, so I told him not very politely to calm down a bit because it was pinching my skin…

Then I remember being in and out of consciousness..’

That last sentence is crucial; it turns out that one of the most traumatic after-effects of blast injuries is the inability to remember what happened between the initial shock and recovering consciousness in hospital.  Many of those wounded in the First and Second World Wars recalled only too well what they suffered during their evacuation, but later modern war is accompanied by powerful narcotics that combine analgesics with amnesia.    Here is Emily Mayhew in A Heavy Burden:

As ITUs [Intensive Therapy Unit] became more advanced, so did a condition known as ITU-PTSD –the stress induced, post-traumatically, by not knowing what has happened to the patient during the hours and days that are missing from their memory.

How much worse … would this be for the soldier who fell in the desert, was swooped away by MERT {Medical Emergency Response Team], saved and nursed at Bastion, flown half a continent away and then woken, not with their unit around them dusty and shouting, but their family, strained and weeping.

Recovering those lost hours, days and even weeks is a central part of my own work (see also ‘The Geographies of Sixty Minutes’ here).

So it’s good that the web page for Journey of a Wounded Soldier also features a triptych of images from the brilliant work of David Cotterell showing evacuation from Bastion to Britain (above), and interview clips addressing treatment and rehabilitation at Birmingham.

Geographical imaginations

I’ve re-designed the blog but all the familiar features are still here; I hope it works better, and it should certainly be easier on the eye(s), but let me know if something isn’t working for you.  I had wanted to change the title too, and use just the three words that have always appeared below it – I am a man without discipline (!) – but that proved to be a bridge too far.  For now, anyway.

The images behind the title are on automatic rotation – ah, algorithms! – so don’t be put off if the blog looks different the next time you visit.

I’d like to draw your attention to the tabs at the head of the blog: DOWNLOADS provides easy access to much of my recent work, but if something is missing that you need please let me know; the GUIDE is a series of signposts to the blog and is probably a better place to start than the ‘search’ box; and TEACHING includes not only course outlines and reading lists but also the slides for some recent lectures relevant to the focus of the blog.

If you want to download one of the longer posts, hint the ‘Print’ button at the end and save as a pdf.

Thanks for visiting.

Cities under siege (I)

This is the first of a two-part post, in which I return (at last!) to a promissory note I issued last year about siege warfare in Syria.  My return is prompted by a series of reports about the catastrophic situation in Eastern Ghouta (a suburb of Damascus) and Idlib.

First, Eastern Ghouta, which has been under siege by the Syrian Arab Army and its allies since April 2013.  Most of Eastern Ghoutta was designated as one of four ‘de-escalation zones’ (see map above) under an agreement reached in May 2017, in which aerial violence and all other hostilities would be suspended for six months and humanitarian aid would be allowed across the siege lines.

But the agreement turned out to be primarily a way of killing time.  Aron Lund writes:

In September, just as the Eastern Ghouta’s de-escalation zone was finalized, the situation abruptly worsened. After ordering a halt to the already heavily restricted commercial traffic through the Wafideen crossing [see map below: more here and here], the Syrian government refused to permit any more UN aid missions.

It was a transparent attempt to stoke the humanitarian emergency in Eastern Ghouta, but this time the effect was more severe than during previous rounds of food cuts. With the rebel trading tunnels out of commission for half a year, smuggling could no longer compensate for the shortfall or bring in medicine or basic necessities like fuel, which has not entered the Ghouta since February.

Food stockpiles dwindled quickly and triggered a scramble for whatever remained available on the market, the panicky mood inflamed by suspicions that rebel-connected businessmen were hoarding goods for speculation purposes. From August to October, the already high prices inside Eastern Ghouta increased fivefold, far beyond any other region of Syria.

Air strikes (above) and artillery bombardment resumed in November and have continued, and urgent medical evacuations were denied.  Here is UN Senior Adviser Jan Egelan in December 2017:

Six months ago a very detailed evacuation plan was delivered to the government for needy cases of evacuation, on medical grounds from eastern Ghouta.  Since then, names have been added regularly and it is now, we now have a revised list of 494 names. There are among them 282 cases that need] specialized surgery, specialized treatment, specialized investigations that [they] cannot get inside. There are 73 severe cancer cases, 25 kidney failure cases and 97 heart disease cases [that are] very concerning, five acutely malnourished children that need to be evacuated, six acute mental health cases etc.

The list had to be revised because 12 patients had died while waiting for ‘a half an hour drive to hospitals in Damascus and elsewhere that stand ready to help and save lives.’  Egelan explained that ‘231 of the cases are female, 137 are children, 61 are over 65 years old.  So these are civilians, in the midst of this horrific war.’

He added:  ‘Civilians, children, no one can be a bargaining chip in some kind of tug of war, where many things are negotiated at the same time. These have a right to be evacuated and we have an obligation to evacuate them.’

Siege warfare involves not only closure of movement across the lines for those inside; it also involves opening the zone to violence from the outside.  The assault on Eastern Ghouta has provided ample evidence, but the second case is even more instructive.

And so, second, what was supposed to be the ‘de-escalation’ zone of Idlib has been converted into a ‘kill box’ (for a discussion of the term in relation to remote warfare, see here and here).  Here is Martin Chulov and Kareem Shaheen writing in the Guardian:

Russian and Syrian jets bombed towns and villages across north-west Syria on Monday, devastating civilian areas and forcing fresh waves of refugees to flee to open ground in the biggest aerial blitz on opposition-held areas since the fall of Aleppo more than a year ago.  Monitoring groups said as many as 150 airstrikes were recorded in Idlib province by Monday, with dozens more pounding up to 18 towns across the region by nightfall.  Residential areas bore the brunt of the strikes, which severely damaged at least two major hospitals, and levelled dozens of buildings in which panicked locals had taken shelter.

Refugees and locals say they fear that Idlib has been transformed into a kill box, with the international community paying scant regard to their fate, as regional powers, Russia, Turkey and Iran all vie for influence in a vital corner of the country.

These strikes were in retaliation for the downing of a Russian aircraft – in this spectacularly asymmetric war, only air-to-ground attacks are acceptable – but aerial violence against civilian infrastructure in Idlib precedes that incident.  Owdai (al Hisan) hospital in Saraqab City was hit by air strikes on 21 and 29 January, for example, and has now closed indefinitely  MSF reports that the loss of the hospital is all the more devastating because ‘medical needs in the area are expected to increase due to the massive displacement of Syrians fleeing fresh violence in Idlib’s eastern countryside and northeast Hama.’

Since then, the strikes intensified:

“The Russians are on a frenzy. They’re going mad. The shelling is ongoing throughout the day and night. The warplanes are hitting residential areas,” Hadi Abdullah, a local journalist, told Al Jazeera by phone from the town of Kafr Nabl in the northwestern Syrian province bordering Turkey…

The main hospital in Maaret al-Numan [above: this was the largest hospital in Idlib], east of Kafr Nabl, has stopped working after it was hit by air strikes, according to the civil defence – also known as the White Helmets.  “About 10 air raids hit the hospital. It was a disaster,” said Hadi, who had rushed to the scene.”The most difficult and heartbreaking scene was when the volunteers were quickly pulling the babies out of the hospital. I can’t get the image out of my head,” he recalled with a trembling voice.

‘De-escalation’ has become a prelude to its inverse.  “There is a misperception that the de-escalation areas have resulted in peace and stability,’ UN assistant secretary-general Panos Moumtsiz said today. “If anything, these have been serious escalation areas.”

With all these horrors in mind, in my second post I’ll turn to the back-story.  You can find other dimensions to the critique of siege warfare in Susan Power, ‘Siege warfare in Syria: prosecuting the starvation of civilians’, Amsterdam Law Forum 8: 2 (2016) 1-22 here or Will Todman, ‘Isolating dissent, punishing the masses: siege warfare as counterinsurgency’, Syria Studies 9 (1) (2017) 1-32.

There’s also a series of important quarterly reports from Siege Watch; these started in February 2016, and the most recent covers August-September 2017 and includes a detailed analysis of both Eastern Ghouta and Idlib.

I plan to approach the issue through one of my favourite books, Steve Graham‘s Cities under siege.  Steve’s object was what he called ‘the new military urbanism’ but the situation in Syria – and elsewhere: think Mosul in Iraq (see, for example, here: scroll down) or Israel’s endless sieges of Gaza (see, for example, here) – demonstrate the extraordinary capacity of later modern war to combine cutting-edge technology (never has that adjective been more dismally appropriate) with medieval cruelty.  There is another difference; for all Steve’s analytical passion – and empathy – the voices of those inside the cities under siege are largely silent, yet in Syria (again: and elsewhere) digital media allow us to listen to them and to witness their suffering.  More soon.

Re-launch and Rescue

The much-missed Radical Philosophy has just re-launched as an open access journal with downloadable pdfs here.  The site also includes access to the journal’s wonderful archive.

Among the riches on offer, I’ve been particularly engaged by Martina Tazzioli‘s Crimes of solidarity. which picks up on one of the central themes in the last of the ‘old’ RP series.  It addresses what she calls ‘migration and containment through rescue’, the creeping criminalisation of the rescue of migrants in the Mediterranean.  In a perceptive section on ‘Geographies of Ungrievability’ Martina writes:

The criminalisation of alliances and initiatives in support of migrants’ transit should not lead us to imagine a stark opposition between ‘good humanitarians’, on the one side, and bad military actors or national authorities, on the other. On the contrary, it is important to keep in mind the many entanglements between military and humanitarian measures, as well as the role played by military actors, such as the Navy, in performing tasks like rescuing migrants at sea that could fall under the category of what Cuttitta terms ‘military-humanitarianism’. Moreover, the Code of Conduct enforced by the Italian government actually strengthens the divide between ‘good’ NGOs and ‘treacherous’ humanitarian actors. Thus, far from building a cohesive front, the obligation to sign the Code of Conduct produced a split among those NGOs involved in search and rescue operations.

In the meantime, the figure of the refugee at sea has arguably faded away: sea rescue operations are in fact currently deployed with the twofold task of not letting migrants drown and of fighting smugglers, which de facto entails undermining the only effective channels of sea passage for migrants across the Mediterranean. From a military-humanitarian approach that, under Mare Nostrum, considered refugees at sea as shipwrecked lives, the unconditionality of rescue is now subjected to the aim of dismantling the migrants’ logistics of crossing. At the same time, the migrant drowning at sea is ultimately not seen any longer as a refugee, i.e. as a subject of rights who is seeking protection, but as a life to be rescued in the technical sense of being fished out of the sea. In other words, the migrant at sea is the subject who eventually needs to be rescued, but not thereby placed into safety by granting them protection and refuge in Europe. What happens ‘after landing’ is something not considered within the framework of a biopolitics of rescuing and of letting drown. Indeed, the latter is not only about saving (or not saving) migrants at sea, but also, in a more proactive way, about aiming at human targets. In manhunting, Gregoire Chamayou explains, ‘the combat zone tends to be reduced to the body of the enemy’. Yet who is the human target of migrant hunts in the Mediterranean? It is not only the migrant in distress at sea, who in fact is rescued and captured at the same time; rather, migrants and smugglers are both considered the ‘prey’ of contemporary military-humanitarianism.

As I’ve explained in a different context, I’m no longer persuaded by Grégoire’s argument about the reduction of the conflict zone (‘battlefield’) to the body, but the reduction of the migrant to a body adds a different dimension to that discussion.

In the case of the eastern Mediterranean, Martina describes an extraordinary (though also all too ordinary) ‘spatial rerouting of military-humanitarianism, in which migrants [fleeing Libya] are paradoxically rescued to Libya’:

Rather than vanishing from the Mediterranean scene, the politics of rescue, conceived in terms of not letting people die, has been reshaped as a technique of capture. At the same time, the geographic orientation of humanitarianism has been inverted: migrants are ‘saved’ and dropped in Libya. Despite the fact that various journalistic investigations and UN reports have shown that after being intercepted, rescued and taken back to Libya, migrants are kept in detention in abysmal conditions and are blackmailed by smugglers, the public discussion remains substantially polarised around the questions of deaths at sea. Should migrants be saved unconditionally? Or, should rescue be secondary to measures against smugglers and balanced against the risk of ‘migrant invasion’? A hierarchy of the spaces of death and confinement is in part determined by the criterion of geographical proximity, which contributes to the sidelining of mechanisms of exploitation and of a politics of letting die that takes place beyond the geopolitical borders of Europe. The biopolitical hold over migrants becomes apparent at sea: practices of solidarity are transformed into a relationship between rescuers and drowned.

There’s much more in this clear, compelling and incisive read.  A good companion is Forensic Architecture‘s stunning analysis of ‘Death by Rescue’ in The Left-to-Die Boat here and here (from which I’ve taken the image that heads this post).

Losing sight

May Jeong – whose excellent investigation of the US air strike on the MSF Trauma Centre at Kunduz I’ve commended before – has a new, equally enthralling extended report over at the Intercept on the sole survivor of a US drone strike in Kunar province in eastern Afghanistan on 7 September 2013: ‘Losing Sight‘.

It’s a long, rich read, but there are two issues I want to highlight.

First, May captures the stark, bio-physical horror of an air strike with an economy and force I’ve rarely seen equalled.  As I’ve noted before (see here and here), many critical analyses emphasise the bio-convergences that animate what happens behind the digital screens of the kill-chain and say remarkably little about those that lie on the other side.  It’s all too easy to lose sight of the embodied nature of remote warfare, though in another powerful essay Joseph Pugliese argues that it’s often not possible to speak of the corporeal at all in the face of such catastrophic violence: ‘The moment of lethal violence transmutes flesh into unidentifiable biological substance that is violently compelled geobiomorphologically to assume the topographical contours of the debris field’ ( ‘Death by Metadata: The bioinformationalisation of life and the transliteration of algorithms to flesh’, in Holly Randell-Moon and Ryan Tippet (eds) Security, race, biopower: essays on technology and corporeality (London: Palgrave, 2016) 3-20).

So here is May describing the strike on a pick-up truck in the early evening as it ground its way along a rough road through the Pech Valley; inside the cabin were the driver, three women and four young children, while seven men were crammed into the back along with sacks of flour they had bought to take back to their village.  There were a couple of miles from home, Gambir, when five missiles hit the truck in a 20-minute period.  Minutes later a second truck – which had been racing to catch up with the first – arrived close to the scene.  The driver (Mohibullah) scrambled up a small hill with a local villager:

[T]hey saw the husk of the pickup, strafed and lit up in flames. They hurried toward the fire.

When Mohibullah arrived at the blast site, he saw that of the 17 bags of flour he had helped load onto the truck, just two were intact. The rest had splayed open. There was a sick beauty to the scene — white powder over blood-red carnage.  These were men and women Mohibullah had grown up with, but he couldn’t recognize any of them. Their mangled body parts made it difficult to ascertain where one person ended and another began: spilled brains over severed limbs over ground flesh…

At first, it was just Mohibullah, another driver named Hamish Gul, and three villagers from Quroo who came to help. Most people in the area knew to stay away. The ghanghai [drones] often attacked again. Even so, the five of them worked at untangling the dead bodies — among them Aisha’s mother, father, grandmother, and little brother — and stacking them in neat rows atop the bed of Mohibullah’s truck.

Astonishingly, there was one survivor, but she too had been brutalised beyond recognition:

Mohibullah did not recognize the girl — her face had been “scrambled, she didn’t have her nose.” She still had both of her legs, but he wasn’t sure if her torso was connecting them to the rest of her body. It wasn’t until she asked in a frail voice — “Where is my father? Where is my mother?” — that he understood her to be his 4-year-old niece Aisha

A neighbor named Nasir held Aisha together for the drive back to Gambir. During the 2-mile journey, Aisha did not make a sound. Life seemed to be slipping away from her. Nasir assumed she would be buried. But when they arrived in Gambir, Aisha turned her head and asked for water. Her voice was so full of intent that they decided to rush her to a hospital in Asadabad.

Read those paragraphs again to see what Pugliese means.

Now the second issue starts to come into focus.  They reached Asadabad Provincial Hospital at 10 p.m., but the duty nurse could do little for Aisha:

Her stomach was missing, as were parts of her face and her left arm. He registered her into the hospital database, writing “acute abdominal injuries” next to her name, treated her with basic first aid, and sent her to the nearest hospital in Jalalabad, 57 miles away.

Aisha reached Jalalabad Public Health Hospital shortly after midnight, where her burns were dressed.  But here too there was little the surgeon could do; she had multiple head injuries, had lost one of her hands, and had major internal injuries.  A helicopter was called to take her to Kabul but it couldn’t land; a second helicopter arrived at midnight – 24 hours after she had reached Jalalabad – and ferried her to the French military hospital at Kabul Airport.

That hospital was a NATO Role 3 hospital, which had been run by the French since July 2009; by the summer of 2013 43 per cent of the procedures carried out by its staff had involved orthopaedic surgery.  Half of these were emergency surgeries; just 17 per cent of the patients were French military personnel and another 17 per cent were Afghan National Army or other ISAF soldiers,  while 47 per cent were Afghan (adult) civilians and 17 per cent were children.

Like other Role 3 hospitals, the facility was tasked with ‘damage-control’, for which it could call on three surgical teams rotation with a general surgeon, (abdominal, chest or vascular surgery) and an orthopedic surgeon as well as an ophthalmologist,  a neurosurgeon and an ENT or maxillofacial surgeon (I’ve taken these details from O. Barbier and others, ‘French surgical experience in the Role 3 Medical Treatment Facility of KaIA (Kabul International Airport…’, Orthopaedics and Traumataology: Surgery & Research 100 (6) (2014) 681-5; see also Christine Joubert and others, ‘Military neurosurgery in operation’, Acta Neurochir 158 (8) (2016) 1453-63).

While Aisha was being treated the hospital was visited by Afghan President Hamid Karzai.  Here is May again:

There, Karzai was confronted with a girl who had lost her sight, her nose, her lower lip, the skin on her forehead, the skin on her torso, her left hand, and nine members of her family, including her grandmother, her uncles, her aunts, her cousin, her mother, her father, and her baby brother.

“I cannot describe what I saw there,” Rangin Spanta, who served as national security adviser under Karzai and accompanied him to the hospital that day, told me from his home in Kabul. We were sitting on a rattan set on his front porch. In telling this story, Spanta covered his face and wept. “Still I have my trauma.” Spanta had lost five family members in the war, but the sight of Aisha, a girl who had been reduced to a “piece of biological construct,” gave him “the feeling that this was a kind of a nightmare.” Spanta, who had seen the guts of suicide bombers splattered across his car window and has visited double, triple, and quadruple amputees, said Aisha was the “most shocking thing I’ve seen in this war.” Karzai asked the attending doctor why her face was covered. “Because there is nothing there” was the answer.

That a high proportion of patients the military hospital were Afghan civilians was by no means unusual for a Role 3 facility, but as I’ve noted before ISAF had strict Rules of Medical Eligibility.  Afghan civilians who were injured during military operations and/or needed ‘life, limb or eyesight saving care’ – both of which applied to Aisha – could be admitted to the international medical system.  But as soon as possible, Afghans were to be treated by Afghans and so, after surgical intervention, they had to be transferred to the local healthcare system.



That system was – is – often rudimentary, which is why Aisha was passed from Asadabad to Jalalabad before reaching Kabul.  And returning someone in her post-operative condition to that system was obviously fraught with danger.  Here is Emily Mayhew in A Heavy Reckoning describing the dilemma for doctors at the Role 3 hospital at Camp Bastion in Helmand province:

Some of the most difficult decisions taken by the Deployed Medical Director related to local patients, Afghans civilians, their families and others. Locals made up the majority (probably as much as 80 per cent) of the patients cared for during the lifetime of the hospital. During the war there were no Afghan hospitals with the technology or capability to ventilate patients with severe chest wounds, therefore leaving Bastion meant death. So anyone intubated who could not be returned to Britain had to stay at Bastion until they could breathe unaided, which sometimes took days or weeks. They were discharged only when it was certain they could survive away from Bastion: probably in a local hospital that was under severe stress, and which could only provide medical care for two or three hours a day, where the rest of the time they would be looked after by their families.

I’ll return to this in a later post, because in some cases those local hospitals have been supplemented and even supplanted by more advanced medical facilities operated or supported by international NGOs like Emergency or MSF.

But what is extraordinary in Aisha’s case is that her pathway did not follow any of these routes.  Karzai had asked both the French and the Germans to help, but they deferred to the Americans who insisted that she be taken to the United States for further treatment.  ‘Twelve days after the strike,’ May reports, ‘Aisha was gone’: but nobody ever told her relatives what had happened to her.  Every attempt they made to find out was rebuffed.

Months later her uncle was informed that she was at Walter Reed hospital in Maryland; she had been sponsored by an American organisation, Solace for the Children.  According to its website:

Each Summer Solace for the Children Summer Medical Program brings children from areas affected by war to the United States so they may receive medical care unavailable to them in their country. We currently focus our efforts on children in Afghanistan. Each fall, applications are accepted for treatment. Our office in Afghanistan typically receives more than 50 applications they must review and qualify. Youth are qualified for services based on need and health condition. They are then placed with a host family for approximately 6 weeks while receiving the medical care they require. After care, youth return to Afghanistan with a better quality of life, brighter future and hope for peace.

While ‘there was no official relationship between the U.S. military and Solace,’ May was told by the charity’s director Patsy Wilson, ‘individual members of the military often reached out to Solace, which had been the case for Aisha.’

“We just get calls. We get calls from the military all over Afghanistan,” she said. She repeatedly deferred to the military, stating, “I am sure they don’t say we kidnap children.” Wilson also expressed doubts that Aisha had been injured in a drone strike, despite the claims of scores of villagers interviewed by The Intercept. “We do not necessarily believe Aisha was in a drone strike, but I know that is one of the stories,” she said. When pressed for details, she said, “I have been told not to discuss that,” adding, “We have no facts. There are no facts.”

Those last sentences are becoming all too familiar, but in this case ISAF not only acknowledged the ‘IM [international military] aerial attack’ but carried out its own investigation into the civilian casualties.  It has never been declassified.

New depths

I’m still working on the (very) long-form version of ‘The Death of the Clinic’; in a previous post I described the attacks on hospitals in Syria and, in particular, the the construction – and destruction – of the underground Cave Hospital in Hama, Syria (see also my update on ‘Bombs, bunkers and borders’ here).  You can find videos and photographs from Jake Godin here.  The hospital has provided trauma surgery and paediatric care, treatment for major illnesses, and emergency treatment for victims of gas attacks (below):

Th hospital opened in late 2015; it suffered series of devastating air strikes in October 2016 (see here).

I have just received this bleak news:

A few hours ago, at 12:15 pm Damascus time [on 1 February], the Al Maghara (Dr. Hassan Al Araj) Cave Hospital in Kafr Zita, Hama was hit by five missiles from an airstrike. The hospital, built under 60 feet of rock, suffered extensive damage.

The pharmacy was destroyed and there was extensive damage to the emergency department, which UOSSM supports, and ambulances. There were minor injuries and no casualties reported. The facility was put out of service. The hospital serves a population of 50,000 people, has 7,000 beneficiaries a month and performs roughly 150 major surgeries a month.

The hospital was previously hit by three airstrikes in 2018; on January 30, January 5, January 2. The hospital was built under 60 ft. of rock to protect it from airstrikes and is considered one of the most structurally fortified hospitals in all of Syria. Damaging the structure to this extent is only possible through advanced weapons/ bunker buster missiles.