War Stories

Posted on August 24, 2016 by Derek Gregory

Thursday 15 September 7 – 9.30 p.m. on the Goldcorp Stage at the BMO Theatre Centre – 162 West 1st Avenue, Vancouver:

War stories from Afghanistan, Iraq and other conflict zones told by foreign correspondents, combat veterans and scholars.

Award-winning Iraqi-Canadian photojournalist Farah Nosh and writer/photographer Ann Jones will share images and stories of the impact of war on civilians. Wall Distinguished Professor and geographer Derek Gregory will discuss changes in the evacuation of war casualties from battlefields over the past century. Contact! Unload, a play directed by Wall Scholar George Belliveau, will feature Canadian veterans depicting what it means to transition home after overseas service. The play highlights Marv Westwood’s Veteran’s Transition Program and artist Foster Eastman’s Lest We Forget Canada! mural. Moderated by Emmy Award winning journalist Peter Klein.

Following the presentations the performers will engage with the audience in a discussion about the different perspectives and approaches to sharing war stories, and the value of storytelling’s ability to chronicle, enlighten and heal.

Register here (free). I’m really excited about this – I admire the work of Farah Nosh and Ann Jones enormously, I’m looking forward to the extracts from Contact! Unload – I’m still thinking about Rosie Kay‘s Bodies on the line and Owen Sheers‘ wonderful work in a similar vein – and Peter Klein will be a wonderful interlocutor. Do come if you can.

UPDATE: We’re sold out, but there is a wait list. And you can find more on WAR STORIES from the wonderful Charlie Smith at the Georgia Straight here.

‘Dearer to the Vultures’

Posted on June 5, 2016 by Derek Gregory

Over at the Paris Review Scott Beauchamp has a beautiful short essay that complements my own reading of Harry Parker‘s Anatomy of a Soldier: ‘Dearer to the Vultures‘.

Here’s how it begins:

My memories of war are fractured: faces disappear like smoke while literal plumes of smoke, their specific shapes and forms, linger on vividly for years. I remember the mesh netting, concrete, and dust smell of tower guard, but the events of entire months are completely gone. I remember the sound of a kid’s voice, but not anything he actually said. I guess that’s what Tim O’Brien meant when he wrote about Vietnam, “What sticks to memory, often, are those odd little fragments that have no beginning or end.”

Memories of people, too complex to carry through the years, fall apart. It’s easier to find purchase on memories of objects. The weapon I was assigned on my first deployment to Iraq was an M249 SAW, or what we would colloquially and inaccurately refer to as the “Squad Assault Weapon.” I remember the way it felt to disassemble—the slight give of the heat-shield assembly, its tiny metal pincers clinging to the barrel. I remember the sound of the feed tray snapping shut on a belt of ammunition. And I remember the tiny rust deposits on the legs of my weapon’s bipod, which would never go away, no matter how hard I scrubbed with CLP (Cleaner, Lubricant, and Protectant oil). I remember my SAW’s voice and the things it said.

During my second deployment, I served as the gunner in a Bradley Fighting Vehicle. We ran over two Soviet-era landmines that had been stacked on top of each other. Besides a few bruises and perforated eardrums, everyone in the crew was fine. When I would try to tell people the story back home, civilians would get caught up on the descriptions of objects they had never heard of, objects that were integral to understanding my experience of the event. “Were you hurt?” Not really, I’d say, but my head slammed against the ISU, and since we had the BFT mounted in a weird place, that sort of got in the way. “What’s an ISU and a BFT?”

I came to realize that the barrier in explaining my injuries to civilians wasn’t quite phenomenological so much as it was ontological. Everyone has experienced pain, fear, and frustration, but not everyone knows what an Integrated Sight Unit is or has had their face slammed into one. Even in just trying to narrate the events to family members, it seemed like any understanding of my trauma would have to come through a knowledge of the materials around me that made the trauma possible: the ISU, the Bradley Fighting Vehicle, the way the tracks moved, the type of soil underneath the tracks, how the mine mechanism worked, the radios we used to call in the explosion to base.

Harry Parker, a former British Army Captain, recently published Anatomy of a Soldier, a novel that puts forward an object-oriented ontology of war: an assertion that the material objects sharing the battleground with humans play an equal role in the composition of reality itself.

And the rest is equally worth reading, including some interesting reflections on ‘the rush from the intimate to the inanimate’ –and its limitations.

I first wrote about Anatomy of a Soldier here, followed it up with a notice of an interview with Harry Parker at the Imperial War Museum here (where I’m currently working, deep in the Research Room), and finally summarised my conference presentation on the book and its implications in San Francisco here (‘Object Lessons’: the presentation slides are available under the DOWNLOADS tab).

In the footsteps of war

Posted on May 10, 2016 by Derek Gregory

An update to my discussion of ‘The prosthetics of military violence‘: Gizmodo has published an arresting series of images from the ICRC’s rehabilitation centre in Kabul. As Jamie Condliffe notes, and as I tried to show in that extended post:

Last week, bioengineering’s most advanced prosthetics were shown off at the world’s largest orthopedics event in Germany. But in Afghanistan, things are a little different.

These photographs, from AP, show the work being carried out at the International Committee of the Red Cross’s physical rehabilitation center in Kabul, Afghanistan. There, those who have suffered the loss of a limb — whether children with birth defects or adults who’ve been injured in war — are fitted with the best prosthetics the ICRC can provide.

As you can see, they’re not quite as advanced as those shown off in Germany last week. Think less of carbon fiber and 3D printing, and more of plaster and orbital sanders.

An Afghan employee of the International Committee of the Red Cross (ICRC) works on a prosthetic leg at the ICRC physical rehabilitation center in Kabul, Afghanistan, Tuesday, May 10, 2016. Afghanistan is one of the world’s most heavily mined countries. (AP Photo/Rahmat Gul)

You can find many more remarkable photographs from the ICRC centre at Getty Images here.

War crimes

Posted on May 2, 2016 by Derek Gregory

In my preliminary commentary on the US military investigation into the air strike on MSF’s trauma centre in Kunduz in October 2015 – and I’ll have much more to say about that shortly – I circled around the Pentagon’s conclusion that even though those involved in the incident had clearly violated international humanitarian law (‘the laws of war’) and the Rules of Engagement no war crimes had been committed.

That conclusion has sparked a fire-storm of protest and commentary, and to track the narrative I’ve transferred some of my closing comments from that post to this and continued to follow the debate. (It’s worth noting that when the Pentagon published its updated Law of War Manual last year it produced an equally heated reaction – much of it from commentators who complained that its provisions hamstrung commanders and troops in the field: see here and scroll down).

At Just Security Sarah Knuckey and two of her students complained that the report provided no justification for such a claim. After listing the gross violations of IHL (failure to take precautions in an attack, failure to distinguish between civilians and combatants, failure to respect the requirement of proportionality), they concluded:

While it is legally correct to state that the war crime of murder requires an “intent” to kill a protected person (e.g., a civilian), nowhere in the 120-page report is there an analysis of the legal meaning of “intention.” The report actually makes no specific or direct findings about war crimes. (“War crime” appears only once, in reference to a report by the United Nations Assistance Mission in Afghanistan) [Here I should note that UNAMA’s view of what constitutes a war crime has on occasion changed with the perpetrator. As this commentary shows, the Taliban have sometimes been held to a higher standard than the US military: in one case UNAMA suggested that the very use of high explosives in an urban area ‘in circumstances almost certain to cause immense suffering to civilians’ rendered the Taliban guilty of war crimes, whereas after the Kunduz air strike UNAMA declared that ‘should an attack against a hospital be found to have been deliberate, it may amount to a war crime’ (emphasis added)] .

Under international law, “premeditation” is not necessary for the war crime of murder, but the precise scope of intention is less clear. Numerous cases have stated that genuine mistakes and negligence are insufficient for murder. But a number of international cases and UN-mandated inquiries have found that “recklessness” or “indirect intent” could satisfy the intent requirement. Article 85 of Additional Protocol I also provides that intent encompasses recklessness. (See The 1949 Geneva Conventions: A Commentary, from page 449, for a full discussion.)

The investigation released today makes clear that US forces committed numerous violations of fundamental rules of the laws of war, violations which should and could have been avoided. Yet the report provides zero direct analysis of whether these violations amounted to war crimes. Given the seriousness of the violations committed, the US should specifically explain why the facts do not amount to recklessness, and explain the legal tests applied for the commission of war crimes.

Over at Lawfare, Ryan Vogel argues that the report will ‘will surely attract the attention of the International Criminal Court’s (ICC) Office of the Prosecutor (OTP)’. In fact, while the OTP has acknowledged

that the strike was being investigated by the United States [it has also] declared that “the [a]lleged crimes committed in Kunduz [would] be further examined by the Office” as part of the ongoing preliminary examination [see extract below]. By characterizing the incident as a violation of international law (and choosing not to prosecute), the United States may unwittingly be strengthening the OTP’s case. It is true that CENTCOM’s release statement makes clear that the investigation found that the actions of U.S. personnel did not constitute war crimes, noting the absence of intentionality. But the OTP might disagree with CENTCOM’s legal rationale, as it seems to have done previously with regard to detention operations, and decide to investigate these acts anyway as potential war crimes.

As both commentaries make clear, much hangs on the interpretation of ‘intentionality’. At Opinio Juris the ever-sharp Jens David Ohlin weighs in on the question. Drawing from his essay on ‘Targeting and the concept of intent‘, he notes:

The word “intentionally” does not have a stable meaning across all legal cultures. … [It] is generally understood in common law countries as equivalent to purpose or knowledge, depending on the circumstances. But some criminal lawyers trained in civil law jurisdictions are more likely than their common law counterparts to give the phrase “intentionally” a much wider definition, one that includes not just purpose and knowledge but also recklessness or what civilian lawyers sometimes call dolus eventualis.

He concludes that the consequences of the latter, wider interpretation would be far reaching:

If intent = recklessness, then all cases of legitimate collateral damage would count as violations of the principle of distinction, because in collateral damage cases the attacker kills the civilians with knowledge that the civilians will die. And the rule against disproportionate attacks sanctions this behavior as long as the collateral damage is not disproportionate and the attack is aimed at a legitimate military target. But if intent = recklessness, then I see no reason why the attacking force in that situation couldn’t be prosecuted for the war crime of intentionally directing attacks against civilians, without the court ever addressing or analyzing the question of collateral damage. Because clearly a soldier in that hypothetical situation would “know” that the attack will kill civilians, and knowledge is certainly a higher mental state than recklessness. That result would effectively transform all cases of disproportionate collateral damage into violations of the principle of distinction and relieve the prosecutor of the burden of establishing that the damage was indeed disproportionate, which seems absurd to me.

His solution is to call for the codification of ‘a new war crime of recklessly attacking civilians, and the codification of such a crime should use the word “recklessly” rather than use the word “intentionally.”’ This would then ‘create a duty on the part of attacking forces and then penalize them for failing to live up to it.’ And this, he concludes, would allow a prima facie case to be made that those involved in the attack on the Kunduz trauma centre were guilty – but in his view, clearly, they also escape under existing law.

Note those five, deceptively simple words: ‘those involved in the attack’. I’ve had occasion to comment on this dilemma before – the dispersal of responsibility that is a characteristic of later modern war (see also here: scroll down) – and Eugene Fiddell, writing in the New York Times, clearly dismayed at the way in which the military inquiry was conducted, sharpens the same point:

Among the challenges a case like Kunduz presents is how to achieve accountability in an era in which an attack on a protected site is not the act of an isolated unit or individual. In today’s high-tech warfare, an attack really involves a weapons system, with only some of the actors in the aircraft, and others — with real power to affect operations — on the ground, in other aircraft, or perhaps even at sea.

And what if some of those ‘actors’ are algorithms and/or machines?

UPDATE: Kevin Jon Heller offers this counter-reading to Jens’s:

As I read it, the war crime of “intentionally directing attacks against a civilian population” consists of two material elements: a conduct element and a circumstance element. (There is no consequence element, because the civilians do not need to be harmed.) The conduct element is directing an attack against a specific group of people. The circumstance element is the particular group of people qualifying as a civilian population. So that means, if we apply the default mental element provisions in Art. 30, that the war crime is complete when (1) a defendant “means to engage” in an attack against a specific group of people; (2) that specific group of people objectively qualifies as a civilian population; and (3) the defendant “is aware” that the specific group of people qualifies as a civilian population. Thus understood, the war crime requires not one but two mental elements: (1) intent for the prohibited conduct (understood as purpose, direct intent, or dolus directus); (2) knowledge for the necessary circumstance (understood as oblique intent or dolus indirectus).

Does this mean that an attacker who knows his attack on a military objective will incidentally but proportionately harm a group of civilians commits the war crime of “intentionally directing attacks against a civilian population” if he launches the attack? I don’t think so. The problematic element, it seems to me, is not the circumstance element but the conduct element: although the attacker who launches a proportionate attack on a legitimate military objective knows that his attack will harm a civilian population, he is not intentionally attacking that civilian population. The attacker means to attack only the military objective; he does not mean to attack the group of civilians. They are simply incidentally — accidentally — harmed. So although the attacker has the mental element necessary for the circumstance element of the war crime (knowledge that a specific group of people qualifies as a civilian population) he does not have the mental element necessary for its conduct element (intent to attack that specific group of people). He is thus not criminally responsible for either launching a disproportionate attack or intentionally directing attacks against a civilian population.

It’s a sharp reminder that international humanitarian law offers some protections to civilians but still renders their killing acceptable. The exchange between Kevin and Jens continues below the line to this conclusion:

But if you read Charles Dunlap at Lawfire (sic), you will find him insisting that the mistakes made by the US military in firing on the MSF hospital ‘do not necessarily equate to criminal conduct’ – even though the investigation report concedes that they amounted to violations of international law – and that the charge of recklessness needs to be laid at the smashed-in door of MSF. Really. Here is what he says:

Had, for example, the hospital been marked with large Red Crosses/Red Crescents or one of the other internationally-recognized symbols (as the U.S. does) or something that would make its protected use clear from the air, isn’t it entirely plausible that the aircrew (or someone) might have recognized the error and stopped the attack before it began?

There were in fact two large MSF flags on the roof of the Trauma Centre, which was also one of the few buildings in the city on that fateful night to have been fully illuminated (from its own generator).

But in case you are still wondering about the responsibility borne by MSF – as ‘one of the few international humanitarian organisations that carries professional liability insurance’ (in contrast to amateur insurance, I presume), Dunlap says that is an admission that ‘even honest, altruistic, and well-intended professionals do make mistakes, even tragic ones, especially when trying to operate in the turmoil of a war zones’, here is a paragraph from that investigation report:

How reckless was that? The crew of the gunship that carried out the attack – in case you are still wondering – ‘specifically did not have any charts showing no strike targets or the location of the MSF Trauma Center.’

And if you picked up on Dunlap’s suggestion that if not the aircrew then ‘someone’ might have recognised the error, try this for size from the same source (and note especially the last sentence):

More to come.

‘Acceptable CIVCAS is 0’

Posted on April 29, 2016 by Derek Gregory

Finally US Central Command has released a redacted version of its investigation into the US airstrike on MSF’s Trauma Center in Kunduz (see my posts here, here and especially here). You can download it from CENTCOM’s Freedom of Information Act library here. (All the extracts pasted below capture communications exchanges before the attack, but the report includes redacted interviews with the participants involved in clearing, executing and continuing the air strike; the image above – and the title for this post – is taken from a briefing slide included in the report).

I’ll be spending the weekend reading it, but meanwhile the Intercept has published its own long-form account of the attack by May Jeong – ‘Death from the sky: searching for ground truth in the Kunduz hospital bombing‘. It was written before CENTCOM’s investigation was released but includes details from a series of interviews and is truly compelling reading.

I obviously won’t be alone in working my way through the report. Yesterday MSF was briefed by the head of CENTCOM, General Joseph Votel, and today released this preliminary statement:

MSF will take the time necessary to examine the U.S. report, and to determine whether or not the U.S. account answers the many questions that remain outstanding seven months after the attack.

MSF acknowledges the U.S. military’s efforts to conduct an investigation into the incident. Today, MSF and other medical care providers on the front lines of armed conflicts continually experience attacks on health facilities that go un-investigated by parties to the conflict. However, MSF has said consistently that it cannot be satisfied solely with a military investigation into the Kunduz attack. MSF’s request for an independent and impartial investigation by the International Humanitarian Fact Finding Commission has so far gone unanswered….

The hospital was fully functioning at the time of the airstrikes. The U.S. investigation acknowledges that there were no armed combatants within – and no fire from – the hospital compound.

The nature of the deadly bombing of the MSF Kunduz Trauma Centre, and the recurring attacks on medical facilities in Afghanistan, demand from all parties to the conflict a clear reaffirmation of the protected status of medical care in the country. MSF must obtain these necessary assurances in Afghanistan before making any decision on if it is safe to re-start medical activities in Kunduz.

The Pentagon has insisted that no war crimes were committed but confirmed that 16 people had been punished. Mark Thompson explains:

None of those involved will face court martial, but the administrative punishments levied against them—ranging from removal from command, letters of reprimand, to counseling—likely mark the end of their careers in uniform. None was identified by name. Those involved—the highest-ranking was a two-star general—included those aboard the AC-130 gunship that repeatedly fired on the Doctors Without Borders hospital in Kunduz, as well as members of the Army Special Force team on the ground that called in the strikes.

MSF has, understandably, condemned this response, arguing that the punishments

are out of proportion to the destruction of a protected medical facility, the deaths of 42 people, the wounding of dozens of others, and the total loss of vital medical services to hundreds of thousands of people. The lack of meaningful accountability sends a worrying signal to warring parties, and is unlikely to act as a deterrent against future violations of the rules of war.

That last sentence is particularly important, because there has been a steady increase in the targeting of medical personnel and medical facilities in Afghanistan, occupied Palestine, Syria and elsewhere: all gross violations of medical neutrality.

So this commentary from Joanne Liu (International President of MSF) and Peter Maurer (President of the International Committee of the Red Cross) – also published today – is much more than a response to the bombing of yet another MSF facility, this time in Aleppo:

What we are witnessing is a sustained assault on, and massive disregard for, the provision of healthcare during times of conflict. Under international humanitarian law and principles, health workers must be able to provide medical care to all sick and wounded regardless of political or other affiliation, whether they are a combatant or not. And under no circumstances should they be punished for providing medical care which is in line with medical ethics. The doctor of your enemy is not your enemy.

But we are confronted with violations of these fundamental rules, with serious humanitarian consequences, for entire communities and healthcare systems that are already stretched to the limit. And this is not just the opinion of MSF and the Red Cross Red Crescent Movement.

That is why we, as the presidents of MSF and the ICRC, welcome the proposal for a landmark UN resolution to protect healthcare. But we urge the UN security council to make the resolution effective. First, it should send a powerful political message that healthcare needs to be protected. All parties to an armed conflict must fully comply with their obligations under international law, including humanitarian law. And they must clearly state their respect for the delivery of impartial medical care during times of conflict.

Second, it must urge states and all parties to armed conflict to develop effective measures to prevent violence against medical personnel, facilities and means of transport. States need to bolster, where appropriate, their legislation including by lifting restrictions and sanctions impeding impartial wartime medical care.

Armed forces and all parties to a conflict should integrate practical measures for the protection of the wounded and sick and for those engaged in medical work. These should be incorporated into orders, rules of engagement, standard operating procedures and training.

Third, it must acknowledge that when attacks on medical facilities and personnel do take place, there needs to be full, prompt, impartial and independent investigations to establish the facts. It cannot only be the victims or perpetrators who attempt to establish the facts. And there should be regular and formal reporting of such attacks at the highest level and an annual debate in the security council.

Underpinning everything has to be the acceptance that the medical needs of people – no matter who they are, where they are from or what side they support or fight for – must take precedence. Medical staff are present in areas of conflict in order to care for the sick and wounded, on the basis of need. And only need. This is the fundamental principle of impartiality and is the basis of medical ethics. It is the very fact that doctors treat on the basis of need – and are not involved in hostilities – that they can claim protection under international humanitarian law.

But there is more. John Sifton from Human Rights Watch insists that General Viotel was simply wrong to claim that war crimes must be deliberate or intentional, so that those involved in the attacks on the MSF hospital could be absolved of criminal responsibility because the acts they committed were genuine mistakes. According to the New York Times, Sifton argued:

There are legal precedents for war crimes prosecutions based on acts that were committed with recklessness, and that recklessness or negligence do not necessarily absolve someone of criminal responsibility under the United States military code.

Wounded

Posted on April 27, 2016 by Derek Gregory

This summer London’s Science Museum is staging an exhibition that is of direct relevance to my current research on casualty evacuation from war zones over the last hundred years: Wounded: Conflict, Casualties and Care. It opens on 29 June and is designed to commemorate the centenary of the Battle of the Somme:

57,000 casualties were sustained by British Forces on 1 July 1916, the first day of the Battle of the Somme, creating huge and unprecedented medical challenges. Wounded: Conflict, Casualties and Care, a new exhibition opening at the Science Museum on 29 June, will commemorate the 100th anniversary of this battle and the remarkable innovations in medical practices and technologies that developed as a result of this new kind of industrialised warfare.

During the First World War ten million combatants were killed, but double that number were wounded and millions were left disabled, disfigured or traumatised by their experiences. The challenges were immense. For medical personnel near the front line treating blood loss and infection was the immediate priority in order to save lives. However medics also encountered new forms of physical and mental wounding on a scale that had never been seen before, creating huge numbers of veterans returning home with serious long term care needs.

At the centre of the exhibition will be a remarkable collection of historic objects from the Science Museum’s First World War medical collections, illustrating the stories of the wounded and those who cared for them. From stretchers adapted for use in narrow trenches to made-to-measure artificial arms fitted back in British hospitals, medical technologies, techniques and strategies were pioneered or adapted throughout the war to help the wounded along each stage of rescue and treatment. Visitors will also see unique lucky charms and improvised personal protective items carried by soldiers on the frontline alongside examples of official frontline medical equipment.

I’m looking forward to seeing this over the summer. The organisers note that:

Warfare has changed dramatically over the last one hundred years, but similarities remain with the military medical challenges faced today, both through the experiences of the wounded and in their treatment and care. The Wounded exhibition team has worked closely with two UK charities that were formed during the First World War, Combat Stress and Blind Veterans UK, to draw out these parallels and share the personal experiences of soldiers wounded in more recent conflicts.

You can find some of my preliminary thoughts on casualty evacuation from the Western Front here and here, and on twenty-first century casualty evacuation in Afghanistan here and here. Some of the differences between the two systems are summarised in this slide from a presentation on the project I gave in 2014.

Much more to come!

The Geographies of Sixty Minutes

Posted on April 14, 2016 by Derek Gregory

One of the cardinal principles informing modern casualty evacuation is the Golden Hour. In 1975 R. Adams Cowley, founder of Baltimore’s Shock Trauma Institute, argued that ‘the first hour after injury will largely determine a critically injured person’s chances for survival.’ It’s not a straightforward metric, and combat medical care and evacuation has been transformed since it was first proposed, but the rule of thumb is that the chances of survival are maximised if the time between traumatic injury and definitive care is kept to 60 minutes or less.

Following a fire-storm of criticism on 15 June 2009 US Secretary of Defense Robert Gates required the standard time between a call for evacuation and treatment of the critically injured to be 60 minutes or less. For US military personnel in the Second World War the average time was 10 hours; in Korea that had been cut to 5 hours (the result of using helicopters for speedy evacuation); and in Vietnam it was already down to one hour. The reason for Gates’s intervention was that in Afghanistan the aim was two hours…

U.S. Air Force Sgt. Daniel Fye serving on a tour in the Kandahar province of Afghanistan in April 2011. (Courtesy of Daniel Fye)

The importance of those time-critical sixty minutes was no secret to the troops in the line of fire. Here is a scene from Brian Castner‘s truly brilliant All the ways we die and kill which imagines the thoughts running through one soldier’s head – Air Force Technical Sergeant Dan Fye on his third tour of duty with Explosive Ordnance Disposal (above) – after he stepped on an IED during a clearance operation in Mushan (Panjwayi) on 27 May 2011:

They worked on Fye a long time, and the longer they worked, the more anxious Fye got about the precious minutes slipping away. “I don’t hear the bird,” he said, over and over. They wrote the time of the tourniquet application on the white headband Fye wore under his helmet. Hopkins pushed morphine into his veins.

Eventually, an eon since Hopkins arrived but only twenty-five minutes after the blast, the hyperactive thump of helo blades cutting air slowly emerged in the distance.

Fye thought it was the most wonderful sound he had ever heard. They were at the extreme limit of the NATO footprint, and so it was a sixty-kilometer flight to the main hospital at Kandahar [see map below]. If they moved quickly, Fye would just make it in the magic golden hour.

Castner writes that as Fye was bleeding out in the back of the helicopter, he was

‘clinging to one thought and one thought only, running in a continuous Times Square news ticker across the front of his oxygen-starved brain: One hour. If I can get back to Kandahar in one hour, I’ll live. One hour, and I’ll live. That’s what they say. You’ll make it if you can get back to the hospital in one hour.’

He made it. The new, modernised and expanded Role 3 NATO hospital at Kandahar had opened a year earlier, and its executive officer claimed that ‘They hit our doors, they live.’

But Fye was lucky. Later he learned why it had taken so long for the helicopter to arrive, and why he very nearly never made it to Kandahar at all:

Over multiple radio calls between Hopkins’s platoon and the rescue operations center, his report of “bilateral amputation” had been converted, telephone-game style, into “bilateral lacerations.” The medical operations center had actually turned the rescue mission off; helos don’t fly for scraped knees. The bird that eventually picked up Fye wasn’t even a real medevac bird. That’s why the robotic flight crew ignored him, didn’t treat his wounds as they went. They weren’t medics. The helo pilots had just been in the air and happened to overhear the radio traffic, including the original call for help. They understood the mistake and had disobeyed orders to go get Fye. If the human pilot of that bird had been less stubborn, the golden hour would have been long past by the time Fye made it to KAF, and he could well have been one of the 1 percent.

(More from Brian on medical evacuation here and here).

Even without miscommunication the logistical challenges were formidable. In 2007, two years before Gates’ intervention, ISAF produced this map showing the medevac coverage – what Fye called the ‘NATO footprint’ – that supported that two-hour standard (I have taken this map and the following one from a report prepared by Col Dr Ingo Hartenstein for NATO/ISAF in December 2008 which is available here; scroll down):

Like Vietnam, Afghanistan was a ‘war without fronts’ with a battlefield geometry that imposed a radically different evacuation model from the classical line of evacuation that had been established during the First World War. Here is how Brian Turner puts it in My life as another country:

We won’t hear the battle in progress and work our way toward it as baggage trains of wounded, exhausted soldiers and civilians carrying their lives on their backs travel in the opposite direction. Our battle space – and perhaps it’s a cliché now – will occur in a 360-degree, three-dimensional environment.

More technically, here is Brigadier Martin Bricknell, who served (among many other roles) as Medical Adviser to ISAF’s Regional Command South in Kandahar in 2010:

The tactical geometry for the current operating environment is based upon security forces holding areas of ground and securing this space from opposition activity. This converts the battlefield from the conventional force-on-force linear geometry with an identifiable confrontation line to an area battlefield with multiple nodes of contested space. Thus the MEDEVAC mission is converted from a linear flow to area support, hence MEDEVAC planning is based upon a ‘range ring’ coverage with a radius of 40–60 nautical miles.

Given the available resources, a second map showed how those ‘range rings’ would contract if the Golden Hour were to be imposed over the evacuation grid:

In practice, the situation was more variable than these maps imply – not least because there was a significant difference between the ways in which American and British contingents organised medical evacuation.

The US military, drawing on their experience in Vietnam, used Blackhawk or Pavehawk helicopters to get paramedics or combat medical technicians to the casualty as fast as possible:

The British used larger Chinook helicopters to dispatch a Medical Emergency Response Team (MERT) with a trauma surgeon onboard to the casualty close to the point of injury (POI):

The response time was usually longer but the MERT enabled advanced trauma care to begin as soon as the patient was onboard.

There has been considerable debate and disagreement about the robustness of the ‘Golden Hour’ in military trauma care and its relation to evacuation pathways: see, for example, Jonathan Clarke and Peter Davis, ‘Medical evacuation and triage of combat casualties in Helmand Province, Afghanistan: October 2010-April 2011’, Military Medicine 171 (11) (2012) 1261-6. But a research team has now calibrated the effects of reduced evacuation time on US casualty fatality rates (CFR) in Afghanistan between 2001 and 2014 [Russ Kotwal et al, ‘The effect of a Golden Hour policy on the morbidity and mortality of combat casualties’, JAMA Surgery 151 (1) (2016) 15-24; see also here]:

For 4,500 cases of US military casualties with detailed data the study showed a substantial change in the CFR following the Secretary of Defense’s mandate to evacuate casualties within 60 minutes: as the median evacuation time fell from 90 minutes to 43 minutes the CFR fell from 13.7 to 7.6; before the mandate 25 per cent of casualty evacuation missions fell within the Golden Hour, after the mandate the proportion soared to 75 per cent.

The interpretive field is a complicated one – while a significant number of casualties who would previously have died from their wounds now survived, a proportion of those who would previously have been recorded as ‘killed in action’ (KIA) none the less now ‘died of wounds’ (DOW) – and the reasons for the improvement in survival rates are also multivariate:

‘Secondary effects resulting from the mandate that contributed to achieving the mandated time included stream-lined authority and helicopter launch procedures, increased number and dispersion of Army helicopters, and the addition of Air Force helicopters to assist with the Army prehospital transport mission. As decreased time from critical injury to treatment capability was the underlying goal, personnel with increased expertise (blood transfusion protocol-trained basic medics, critical care paramedics, and critical care nurses) were trained and assigned to prehospital flights more routinely, resulting in earlier availability of blood products and other advanced care.

In addition, an increase in the number and dispersion of small but mobile forward surgical teams across the battle-field brought major surgical capability even closer to the point of injury and provided an alternative to transporting patients longer distances to large, but less mobile, civilian trauma center–equivalent [Combat Support Hospitals].’

These findings – together with the experience of the British MERTs – intersect with a recalibration of the Golden Hour. The US Combat Casualty Care Research Program (CCCRP) has proposed an ‘evolved concept’ (see the figure above) that moves from a location-based protocol to a physiological one:

The program must be willing to turn the doctrine of fixed or traditional echelons of care on its side and innovate for scenarios in which Level II and III care is performed aboard transport vehicles (land-, air- or sea-based) or within local structures of opportunity. In such circumstances, field care may be prolonged, lasting for days or even weeks. Combat casualty care research with these complex scenarios in mind promises to enhance resuscitative capability for injured service personnel regardless of environment, leveraging communications networks (i.e., telementoring) and targeted resupplies of materials. In the future, CCCRP must focus on transforming the concept of the golden hour into one bound not by the time to reach traditional echelons of care or fixed facilities, but the time until enhanced resuscitative capability can be delivered to the injured troop, regardless of location or need for transport.

There are two riders to add. First, embedded within the Golden Hour are ‘the platinum ten minutes’: the imperative to stop bleeding (which has led to the re-emergence and re-engineering of the tourniquet) and to control the casualty’s airway within 10 minutes of wounding.

The second is that the speed of treatment and trauma care available to American and British soldiers is radically different from that available to Afghan soldiers and police officers. Previously, they could rely on aeromedical evacuation by their allies. But now most of their medical evacuations take place by land, over difficult and dangerous roads. Last September Josh Smith reported:

Under the dim light of a single bulb, a local Afghan policeman lay severely injured, slipping in and out of consciousness. A military doctor reported to an Afghan army brigade commander that the man was unlikely to live through the night.

Despite the doctor’s pleas, the commander stood firm. The army could not spare any soldiers or ambulances [below] to make the five-hour drive to a better hospital at that late hour through territory teeming with Taliban ambushes and roadside bombs.

The lack of speedy evacuation is a tragically common problem for the rising number of Afghan police and soldiers being injured on the battlefields of Afghanistan. U.S. advisers have worked to help close the capability gap, but mostly behind the scenes, far from the battlefields where many Afghan troops say they increasingly feel alone.

Although the American forces still stationed in the country have conducted more than 200 airstrikes since their combat mission was declared over at the end of 2014, as of July, U.S. military aircraft had not flown a single conventional medical evacuation mission, according to data released by the U.S. Air Force Central Command.

U.S. military officials say they haven’t flown evacuation missions because they haven’t been asked. Also, there are far fewer American resources available for such missions now.

The difference shows up in the ratios of those killed and those who survived their wounds.

About 2,363 Americans have died in Afghanistan, with a little more than 20,000 wounded, a ratio of roughly 1-to-10. In the first half of 2015 alone, 4,302 Afghan soldiers and police were killed in action and 8,009 more were wounded, a ratio of about 1-to-2.

Even where aircraft and trained medical technicians are available, Jeff Schogol found that the Afghan capability falls well outside the Golden Hour:

The time it takes to fly patients to hospitals varies depending on the point of injury, but it can take between 90 minutes and two and a half hours to fly an aeromedical evacuation mission in a C-208, plus one hour to transfer patients from Kandahar to Kabul in a C-130.

And the situation for Afghan civilians – as I explored in detail in ‘The prosthetics of military violence‘ – is still worse.

This is not a problem confined to Afghanistan: think of how the possibility of the Golden Hour recedes in urban combat zones subjected to artillery fire and bombing – the difficulties faced by first responders in Gaza or in the ravaged, rubble-strewn towns and cities of Syria (see also Annie Sparrow‘s report here).

A Syrian youth walks past a destroyed ambulance in the Saif al-Dawla district of the war-torn northern city of Aleppo on January 12, 2013. An accident and emergency centre in Aleppo uses an abandoned supermarket to conceal a fleet of 16 ambulances, just 10 of which are in working order and are driven by 22 staff members. AFP PHOTO/JM LOPEZ/ (Getty Images)

And there is no guarantee of safety even once casualties reach hospital since the principle of medical neutrality is now being routinely and systematically violated.

Trauma Central

Posted on April 13, 2016 by Derek Gregory

To more than supplement my notes on the US air attack on the MSF hospital in Kunduz last October, two first-hand accounts have just been published. The first is by Dr Evangeline Cua, a Philippina surgeon who was on duty in the Trauma Centre when the attack started. She describes, in extraordinary detail, her work before the attack and then the nightmare (that keeps returning to haunt her, long after she has left Afghanistan):

We were like two headless chickens running in total darkness — me and the surgeon who assisted me in an operation. The nurses who were with us a moment ago had run outside the building, braving the volley of gunshots coming from above. I was coughing, half-choked by dust swirling around the area. Behind my surgical mask, my mouth was gritty, as if somebody forced me to eat sand. I could hear my breath rasping in and out. Layers of smoke coming from a nearby room made it hard to see where we were. Blinking around, I caught sight of a glow, from a man’s hand holding a phone. He seemed mortally wounded but was still trying to send a message…perhaps to a loved one?

I stood transfixed, not knowing where to turn or what to do. All around us, bombing continued in regular intervals, shaking the ground, sending debris sweeping and flying. One. Two. Three. I tried to count but there seems to be no abatement to the explosions. I stopped counting at eight and silently prayed that we could get out of there alive.
Fire licked at the roof at one end of the building, dancing and sparkling in the dark, reaching towards the branches of the trees nearby. The ICU was burning.

The second is by Dr Kathleen Thomas, an Australian doctor who was in charge of both the ICU and the ER (more from her here):

Dr Osmani [below] was the senior doctor in the unit the night the fighting started and decided to stay with us, camping out in the hospital throughout the week. He had nothing with him except the clothes on his back, not even a toothbrush. His family were extremely worried for his welfare. He had a constant flow of phone calls checking on him, probably asking him to leave. We all knew that at times, our hospital was in the middle of the rapidly changing front line – we could feel it. When the fighting was close – the shooting and explosions vibrated the walls. I was scared – we were all scared. When a loud “BOOM” would sound a bit closer to the hospital, we would all drop to the floor away from the large windows that lined the ICU walls. We also tried to move the patients and large (flammable) oxygen bottles away all from the windows, but the layout of the ICU prohibited doing this effectively. I worried constantly about the exposure from those windows – yet never thought to worry about the exposure from the roof.

By the end of the week we were physically, mentally and emotionally exhausted. There were moments when a sense of hopelessness overwhelmed us. Dr Osmani expressed these sentiments on the final day, following a tragic incident where a family trying to escape Kunduz was caught in crossfire, killing several children at the scene, then two more dying in our ER and OT. The remaining children were being treated with severe injuries, he stated: “the people are being reduced to blood and dust. They are in pieces.”

She continues:

When the US military’s aircraft attacked our hospital, its first strike was on the ICU. With the exception of one three-year-old, all the patients in the unit died. The caretakers with the patients died. Dr Osmani died. The ICU nurses Zia and Strongman Naseer died. The ICU cleaner Nasir died. I hope with all my heart that the three sedated patients in ICU, including our ER nurse Lal Mohammad, were deep enough to be unaware of their deaths – but this is unlikely. They were trapped in their beds, engulfed in flames.

The plane hit with alarming precision. Our ER nurse Mohibulla died. Our ER cleaner Najibulla died. Dr Amin suffered major injuries but managed to escape the main building, only to then die an hour later in the arms of his colleaguesas we desperately tried to save his life in the makeshift operating theatre set up in the kitchen. The OT nurse Abdul Salam [below] died. The strikes tore through the outpatients department, which had become a sleeping area for staff. Dr Satar died. The medical records officer Abdul Maqsood died. Our pharmacist Tahseel was lethally injured. He also made it to safety in the morning meeting room, only to die soon after. He bled to death. Two of the watchmen, Zabib and Shafiq, also died.

Our colleagues didn’t die peacefully like in the movies. They died painfully, slowly, some of them screaming out for help that never came, alone and terrified, knowing the extent of their own injuries and aware of their impending death. Countless other staff and patients were injured; limbs blown off, shrapnel rocketed through them, burns, pressure-wave injuries of the lungs, eyes and ears. Many of these injures have left permanent disability. It was a scene of nightmarish horror that will be forever etched in my mind.

More details on the MSF employees killed in the strike can be found here. There is still no sign of the US’s internal investigation into the attack being released.

Earlier this month, six months after the attack, MSF confirmed that it had still not decided whether to reopen the Trauma Centre:

We first need to obtain clear reassurances from all parties to the conflict that our staff, patients and medical facilities will be safe from attack. We need to know that the work of our doctors, nurses and other staff will be fully respected in Kunduz and in all places where we work in Afghanistan. We require assurances that we can work according to our core principles and to international humanitarian law: namely, that we can safely treat all people in need, no matter who they are, or for which side they may fight. Our ability to operate hospitals on the frontline in Afghanistan and in conflict zones everywhere depends on the reaffirmation of these fundamental principles.

Death sentences

Posted on April 12, 2016 by Derek Gregory

Living under drones is both a chilling report and a nightmare reality. In November 2014, in a New Yorker essay called ‘The unblinking stare‘, Steve Coll reported a conversation with Malik Jalal from North Waziristan:

‘Drones may kill relatively few, but they terrify many more… They turned the people into psychiatric patients. The F-16s might be less accurate, but they come and go.’

Now Reprieve has put a compelling face to the name – to a man who believes, evidently with good reason, that he has been included in the CIA’s disposition matrix that lists those authorised for targeted killing.

‘Malik’ is an honorific reserved for community leaders, and Jalal is one of the leaders of the North Waziristan Peace Committee (NWPC). Its main role is to try to keep the peace between the Taliban and local authorities, and it was in that capacity that he attended a Jirga in March 2011. He says this was on 27 March, but I think it must have been the strike that killed 40 civilians at Datta Khel on 17 March (see the summary from the Bureau of Investigative Journalism here and my post here).

Here are the relevant passages from my ‘Dirty dancing’ essay, following from a discussion of Pashtunwali and customary law in the Federally Administered Tribal Areas (I’ve omitted the footnotes and references):

***

‘In short, if many of the Pashtun people in the borderlands are deeply suspicious of and even resentful towards Islamabad (often with good reason) they are ‘neither lawless nor defenceless.’

‘Yet the trope of ‘lawlessness’ persists, and it does important work. ‘By alleging a scarcity of legal regulation within the tribal regions,’ Sabrina Gilani argues, ‘the Pakistani state has been able to mask its use of more stringent sets of controls over and surveillance within the area.’ The trope does equally important work for the United States, for whom it is not the absence of sovereign power from the borderlands that provides the moral warrant for unleashing what Manan Ahmad calls its ‘righteous violence’. While Washington has repeatedly urged Islamabad to do much more, and to be less selective in dealing with the different factions of the Taliban, it knows very well that Pakistan has spasmodically exercised spectacular military violence there. But if the FATA are seen as ‘lawless’ in a strictly modern sense – ‘administered’ but not admitted, unincorporated into the body politic – then US drone strikes become a prosthetic, pre-emptive process not only of law enforcement but also of law imposition. They bring from the outside an ‘order’ that is supposedly lacking on the inside, and are reconstituted as instruments of an aggressively modern reason that cloaks violence in the velvet glove of the law.

And yet the CIA’s own willingness to submit to the principles and procedures of modern law is selective and conditional; we know this from the revelations about torture and global rendition, but in the borderlands the agency’s disregard for the very system it purports to defend also exposes any group of men sitting in a circle with guns to death: even if they are gathered as a Jirga. On 27 January 2011 CIA contractor Raymond Davis was arrested for shooting two young men in Lahore. The targeted killing program was suspended while the United States negotiated his release from custody, agreeing to pay compensation to the victims’ families under Sharia law so that he could be released from the jurisdiction of the court. On 16 March, the day after Davis’s release, a Jirga was convened in Dhatta Khel in North Waziristan. A tribal elder had bought the rights to log an area of oak trees only to discover that the land also contained chromite reserves; the landowner was from a different tribe and held that their agreement covered the rights to the timber but not the minerals, and the Jirga was called to resolve what had become an inter-tribal dispute between the Kharhtangi and the Datakhel. Maliks, government officials, local police and others involved in the affair gathered at the Nomada bus depot – a tract of open ground in the middle of the small town – where they debated in two large circles. Agreement was not reached and the Jirga reconvened the next morning. Although four men from a local Taliban group were present, the meeting had been authorised by the local military commander ten days earlier and was attended by a counsellor appointed by the government to act as liaison between the state, the military and the maliks. It was also targeted by at least one and perhaps two Predators. At 11 a.m. multiple Hellfire missiles roared into the circles. More than forty people were killed, their bodies ripped apart by the blast and by shattered rocks, and another 14 were seriously injured.

There is no doubt that four Taliban were present: they were routinely involved in disputes between tribes with competing claims and levied taxes on chromite exports and the mine operators. But the civilian toll from the strike was wholly disproportionate to any conceivable military advantage, to say nothing of the diplomatic storm it set off, and several American sources told reporters that the attack was in retaliation for the arrest of Davis: ‘The CIA was angry.’ If true, this was no example of the dispassionate exercise of reason but instead a matter of disrespecting the resolution offered by Sharia law and disordering a customary judicial tribunal. Even more revealing, after the strike an anonymous American official who was supposedly ‘familiar with the details of the attack’ told the media that the meeting was a legitimate military target and insisted that there were no civilian casualties. Serially: ‘This action was directed against a number of brutal terrorists, not a county fair’; ‘These people weren’t gathering for a bake sale’; ‘These guys were … not the local men’s glee club’; ‘This was a group of terrorists, not a charity car wash in the Pakistani hinterlands.’ The official – I assume it was the same one, given the difference-in-repetition of the statements – provided increasingly bizarre and offensively absurd descriptions of what the assembly in Datta Khel was not: he was clearly incapable of recognising what it was. Admitting the assembly had been a properly constituted Jirga would have given the lie to the ‘lawlessness’ of the region and stripped the strike of any conceivable legitimacy. The area was no stranger to drone attacks, which had been concentrated in a target box that extended along the Tochi valley from Datta Khel through Miran Shah to Mir Ali, but those responsible for this attack were clearly strangers to the area.

***

‘Like others that day,’ Jalal concedes, ‘I said some things I regret. I was angry, and I said we would get our revenge. But, in truth, how would we ever do such a thing? Our true frustration was that we – the elders of our villages – are now powerless to protect our people.’

This was the fourth in a series of strikes that Jalal believes targeted him:

‘I have been warned that Americans and their allies had me and others from the Peace Committee on their Kill List. I cannot name my sources [in the security services], as they would find themselves targeted for trying to save my life. But it leaves me in no doubt that I am one of the hunted.’

He says he is an opponent of the drone wars – but if that were sufficient grounds to be included on the kill list it would stretch into the far distance.

He also says that the Americans ‘think the Peace Committee is a front’ working to create ‘a safe space for the Pakistan Taliban.’

‘To this I say: you are wrong. You have never been to Waziristan, so how would you know?’

And he describes the dreadful impact of being hunted on him and his family:

‘I soon began to park any vehicle far from my destination, to avoid making it a target. My friends began to decline my invitations, afraid that dinner might be interrupted by a missile.

‘I took to the habit of sleeping under the trees, well above my home, to avoid acting as a magnet of death for my whole family. But one night my youngest son, Hilal (then aged six), followed me out to the mountainside. He said that he, too, feared the droning engines at night. I tried to comfort him. I said that drones wouldn’t target children, but Hilal refused to believe me. He said that missiles had often killed children. It was then that I knew that I could not let them go on living like this.’

And so he has travelled to Britain to plead his case:

‘I came to Britain because I feel like Britain is like a younger brother to America. I am telling Britain that America doesn’t listen to us, so you tell them not to kill Waziristanis.’

You can hear an interview with him on BBC’s Today programme here.

In you think Britain is distanced from all this, read Reprieve‘s latest report on ‘Britain’s Kill List‘ here (which focuses on the Joint Prioritised Effects List in Afghanistan and its spillover into Pakistan) and Vice‘s investigation into the UK’s role in finding and fixing targets in Yemen here.

Object Lessons

Posted on April 12, 2016 by Derek Gregory

I was supposed to give a shortened version of ‘Little boys and blue skies‘ at the AAG Annual Meeting in San Francisco (about drones and atomic war: available under the DOWNLOADS tab) and fully intended to do so. But in the event – and as I implied in a previous post – I decided to talk instead about Harry Parker‘s Anatomy of a soldier. It was a spur of the moment decision, though it had been pricking away in my mind ever since I read the novel, and I only decided to do it at 10.30 the night before: madness. But it was much closer to the theme of the sessions organised by Kate Kindervater and Ian Shaw on ‘Objects of Security and War: Material Approaches to Violence and Conflict‘ than my original presentation would have been.

I’ve added the presentation to those available under the DOWNLOADS tab (scroll right down).

I hope that most of it will be self-explanatory, but some notes might help. I started out by invoking Tim O’Brien‘s twin accounts of the Vietnam War, The things they carried and If I should die in a combat zone, which provide vivid reminders of the weight – physical and emotional – borne by ground troops and the toll they impose on the soldier’s body.

I talked about this in ‘The natures of war‘ (also under the DOWNLOADS tab) and – following in the footsteps of that essay – I sketched a brief history of the objects soldiers carried in to the killing fields: from the Somme in 1916 through Arnhem in 1944 to Helmand in Afghanistan in 2014 [shown below]. My source for these images was photographer Thom Atkinson‘s portfolio of Soldiers’ Inventories.

But I was more interested now in the objects that carried the soldiers, so to speak, which is why I turned to Anatomy of a soldier.

In order to throw the novel into even sharper relief, I outlined some of the other ways in which IED blasts in Afghanistan have been narrated. These ranged from the US Army’s own schematics [the image below is taken from a presentation by Captain Frederick Gaghan here] to Brian Castner’s truly brilliant non-fiction All the ways we kill and die, in which he describes his investigation into the death of his friend Matt Schwartz from an IED blast in Helmand in January 2012. (This book has taught me more about the war in Afghanistan than anything – I mean anything – I’ve ever read).

All of this prepared the ground for Parker’s novel which tells the story of a young British officer in Helmand, Tom Barnes, who loses his legs to an IED blast – told in 45 short chapters by the different objects involved. Not all of the chapters are wholly successful, but many of them are utterly compelling and immensely affecting. The overall effect is to emphasize at once the corporeality of war – ‘virtually every object-fragment that is proximate to Barnes is impregnated with his body: its feel – its very fleshiness – its sweat, its smell, its touch’ – and the object-ness of military violence.

I juxtaposed the novel to Parker’s own story – he too lost his legs to an IED in Afghanistan in July 2009. Yet he constantly emphasises that he never wanted the novel to be about him.

Still, the body is central to all this – Parker’s body and Barnes’s body – and so finally I drew on Roberto Esposito‘s Persons and Things to draw the wider lesson and, in particular, to nail the treacherous lie of ‘bodiless war’: