Death and the Contemporary

The latest (double) issue of New Formations (89/90: 2017) is devoted to ‘Death and the Contemporary’, and it includes two essays likely to be of particular interest to readers of this blog.

First, François Debrix, ‘Horror beyond Death: Geopolitics and the pulverisation of the human‘:

From territorial conquests or wars of attrition to the concentration camps or policies of control of displaced populations, the biopolitical capture of human life in configurations of geopolitical power has often involved the putting to death of populations. While, following Foucault’s work, we can argue that late modern political power has been concerned with the management of people’s lives or with the ‘health’ of a population, this capacity to ‘make live and let die’ (as Foucault put it) is never separate from a modality of force premised upon a right to put to death. Thus, the distinction between biopolitics and what has been called thanatopolitics or necropolitics can no longer be guaranteed. The goal of this essay is to push further the biopolitical/ necropolitical argument by showing that, in key contemporary instances of geopolitical violence and destruction, the life and/or death of populations and individual bodies is not a primary concern. What is of concern, rather, is what I have called the pulverization of the human. I consider this targeting of the human, or of humanity itself, to be a matter of horror. Horror’s aim, when it enters the domain of geopolitical destruction, appears to be to put bodies to death. But, more crucially, its aim is to render human bodies, beyond the fact of life and death, unrecognizable, unidentifiable, and sometimes undistinguishable from non-human matter. Horror does not care to recompose human life or humanity. This essay briefly details the argument about horror and horror’s ‘objectives’ beyond death. It also takes issue with recent theories that have argued that traces of human life can be recovered from contemporary instances of geopolitical violence and destruction. Finally, this essay offers two contemporary illustrations of horror’s targeting of the human by examining the role and place of horror in suicide bombings and in drone attacks.

Second, Andrea Brady, ‘Drone poetics‘:

‘Drone Poetics’ considers the challenge to the theory and practice of the lyric of the development of drone warfare. It argues that modernist writing has historically been influenced by aerial technology; drones also affect notions of perception, distance and intimacy, and the self-policing subject, with consequences for contemporary lyric. Indeed, drone artworks and poems proliferate; and while these take critical perspectives on drone operations, they have not reckoned with the phenomenological implications of execution from the air. I draw out six of these: the objectification of the target, the domination of visuality, psychic and operational splitting, the ‘everywhere war’, the intimacy of keyhole observations, and the mythic or psychoanalytic representation of desire and fear. These six tropes indicate the necessity for a radical revision of our thinking about the practice of writing committed poetry in the drone age.

‘Empire of the Globe’

Klementinum Library, Prague

A quick heads-up: the latest issue of Millennium [44 (3) (2016) 305-20] includes Bruno Latour‘s, ‘Onus Orbis Terrarum: About a Possible Shift in the Definition of Sovereignty’, a keynote address that – amongst many other targets – goes after the globe and geopolitics….  To give you a taste:

To put it more dramatically, the concept of the Globe allows geopolitics to unfold in just the same absolute space that was used by physicists before Einstein. Geopolitics remains stubbornly Newtonian. All loci might be different, but they are all visualised and pointed to on the same grid. They all differ from one another, but in the same predictable way: by their longitude and latitude.

What is amazing if you look at geopolitical textbooks, is that, apparently, the Globe remains a universal, unproblematic, and uncoded category that is supposed to mean the same thing for everybody. But for me, this is just the position that marks, without any doubt, the imperial dominion of the European tradition that is now shared, or so it seems, by everyone else.

I want to argue that the problem raised by the link between Europe and the Globe is that of understanding, as Peter Sloterdijk suggests, why it is that the onus orbis terrarum has been spread so efficiently that it has become the only space for geopolitics to unfold. Why is it that the res extensa, to use a Latin term that pertains to the history of art as well as of science and of philosophy, has been extended so much?

Instead of asking what vision of the Globe Europe should develop, it seems to me that the question should be: is Europe allowed to think grandly and radically enough to get rid of ‘the Globe’ as the unquestioned space for geopolitics? If it is the result of European invention and European dominion, this does not mean that it should remain undisputed. If there is one thing to provincialise, in addition to Europe, it is the idea of a natural Globe itself. We should find a way to provincialise the Globe, that is, to localise the localising system of coordinates that is used to pinpoint and situate, relative to one another, all the entities allowed to partake in geopolitical power grabs. This is the only way, it seems to me, to detach the figure of the emerging Earth from that of the Globe.

Geopolitics limited to absolute space?  The Globe as the ‘unquestioned space’ for geopolitics (and a geopolitics that is indifferent to, even silent about ‘the Earth’)?  Really?

MINCA and ROWAN Schmitt and SpaceIn an interview with Mark Salter and William Walters, which appears as a coda to the issue, there is also a lot about Carl Schmitt and the Nomos of the Earth (and a pointed rejection of the interpretation offered by Claudio Minca and Rory Rowan), and this passage on drones that loops back to the discussion of sovereignty:

The point, I think, is that ‘sovereign’ has one very precise meaning, which is: a referee. So, is there a referee or not? In my understanding of Schmitt, in the two great ideas of his – the ones on politics and the ones in Nomos – there is no referee, precisely. And so, you have to do politics, which means you have to have enemies and friends. Not because of any sort of war-like attitude (even though there is some talk of that in Schmitt as well). But because, precisely, if you have no referee, then you have to doubt; you have to risk that the others might be right, and that you might be wrong. You don’t know your value; you are not in a police operation. OK, so that defines the state now, because the state goes, all the way down, to a police operation. If there is a police operation and not war, then there is a State, in some ordinary sense. That is how we can understand the first hegemon of the United States, entering the First World War as a police operation, no question. The drone, now, flowing over [and] … moving on top of the space of the land, is a police operation because the one who sent it has no doubt that he or she acts as referee. So, the first thing is to draw the extent of that hegemon. How we would do that, I don’t know. Certainly, there would have been a book by Schmitt a few days after the first drone, about this new definition of the State, extending above air its police operation everywhere.

Good knock-about stuff, but I’m not convinced about any of this either (and exasperated by the current preoccupation with the hypostatisation of ‘policing’)…

More tortured geographies

Route Map 2

There have been several attempts to reconstruct the geography of the CIA’s program of extraordinary rendition. I’ve long admired the work of my good friend Trevor Paglen, described in his book with A.C. ThompsonTorture Taxi: on the trail of the CIA’s rendition flights, available in interactive map form through Trevor’s collaboration with the Institute for Applied Autonomy as Terminal Air. (I’ve commented on the project before, here and especially here).

terminal-air

And you can only applaud Trevor’s chutzpah is displaying the results of his work on a public billboard:

paglenemerson-cia-flights-2001-6

The project, which involved the painstaking analysis of countless flight records and endless exchanges with the geeks who track aircraft as a hobby, triggered an installation in which the CIA was reconfigured as a ‘travel agency‘:

Terminal Air travel agency

At the time (2007), Rhizome – which co-sponsored the project – explained:

Terminal Air is an installation that examines the mechanics of extraordinary rendition, a current practice of the United States Central Intelligence Agency (CIA) in which suspected terrorists detained in Western countries are transported to so-called “black sites” for interrogation and torture. Based on extensive research, the installation imagines the CIA office through which the program is administered as a sort of travel agency coordinating complex networks of private contractors, leased equipment, and shell companies. Wall-mounted displays track the movements of aircraft involved in extraordinary rendition, while promotional posters identify the private contractors that supply equipment and personnel. Booking agents’ desks feature computers offering interactive animations that enable visitors to monitor air traffic and airport data from around the world, while office telephones provide real-time updates as new flight plans are registered with international aviation authorities. Seemingly-discarded receipts, notes attached to computer monitors, and other ephemera provide additional detail including names of detainees and suspected CIA agents, dates of known renditions, and images of rendition aircraft. Terminal Air was inspired through conversations with researcher and author Trevor Paglen (Torture Taxi: On the Trail of the CIA’s Rendition Flights – Melville House Publishing). Data on the movements of the planes was compiled by Paglen, author Stephen Grey (Ghost Plane: The True Story of the CIA Torture Program – St. Martin’s Press) and an anonymous army of plane-spotting enthusiasts.

There’s a short video documenting the project on Vimeo here and embedded below (though strangely Trevor isn’t mentioned and doesn’t appear in it):

Although Trevor subsequently explained why he tried to ‘stay away from cartography and “mapping” as much as possible’ in his work, preferring instead the ‘view from the ground’, the cartography of all of this matters in so many ways – from the covert complicity of many governments around the world in a global geopolitics of torture through to the toll exerted on the bodies and minds of prisoners as they were endlessly shuffled in hoods and chains over long distances from one black site to another.

And now, thanks to the equally admirable work of the Bureau of Investigative Journalism, it’s possible to take the analysis even further.  Here is Crofton Black and Sam Raphael introducing their project, ‘The boom and bust of the CIA’s secret torture sites‘:

In spring 2003 an unnamed official at CIA headquarters in Langley sat down to compose a memo. It was 18 months after George W Bush had declared war on terror. “We cannot have enough blacksite hosts,” the official wrote. The reference was to one of the most closely guarded secrets of that war – the countries that had agreed to host the CIA’s covert prison sites.

Between 2002 and 2008, at least 119 people disappeared into a worldwide detention network run by the CIA and facilitated by its foreign partners.

Lawyers, journalists and human rights organisations spent the next decade trying to figure out whom the CIA had snatched and where it had put them. A mammoth investigation by the US Senate’s intelligence committee finally named 119 of the prisoners in December 2014. It also offered new insights into how the black site network functioned – and gruesome, graphic accounts of abuses perpetrated within it.

Many of those 119 had never been named before.

The report’s 500-page summary, which contained the CIA official’s 2003 remarks, was only published after months of argument between the Senate committee, the CIA and the White House. It was heavily censored, while the full 6,000-page study it was based on remains secret. All names of countries collaborating with the CIA in its detention and interrogation operations were removed, along with key dates, numbers, names and much other material.

In nine months of research, the Bureau of Investigative Journalism and The Rendition Project have unpicked these redactions to piece together the hidden history of the CIA’s secret sites. This account unveils many of the censored passages in the report summary, drawing on public data sources such as flight records, aviation contracts, court cases, prisoner testimonies, declassified government documents and media and NGO reporting.

Although many published accounts of individual journeys through the black site network exist, this is the first comprehensive portrayal of the system’s inner dynamics from beginning to end.

CIA black sites (BOIJ:REndition Project)

At present the mapping is rudimentary (see the screenshot above), but the database matching prisoners to black sites means that it ought to be possible to construct a more fine-grained representation of the cascade of individual movements.  The Rendition Project has already identified more than 40 rendition circuits involving more than 60 renditions of CIA prisoners: see here and the interactive maps here.

War at a distance

Porter-The-Global-Village-Myth-webNews from Patrick Porter of a new book due out in March, The global village myth: distance, war and the limits of power (from Hurst in the UK/Georgetown University Press in the US):

According to security elites, revolutions in information, transport, and weapons technologies have shrunk the world, leaving the United States and its allies more vulnerable than ever to violent threats like terrorism or cyberwar. As a result, they practice responses driven by fear: theories of falling dominoes, hysteria in place of sober debate, and an embrace of preemptive war to tame a chaotic world.

Patrick Porter challenges these ideas. In The Global Village Myth, he disputes globalism’s claims and the outcomes that so often waste blood and treasure in the pursuit of an unattainable “total” security. Porter reexamines the notion of the endangered global village by examining Al-Qaeda’s global guerilla movement, military tensions in the Taiwan Strait, and drones and cyberwar, two technologies often used by globalists to support their views. His critique exposes the folly of disastrous wars and the loss of civil liberties resulting from the globalist enterprise. Showing that technology expands rather than shrinks strategic space, Porter offers an alternative outlook to lead policymakers toward more sensible responses—and a wiser, more sustainable grand strategy.

You can get a preliminary preview of Patrick’s basic argument at War on the Rocks here.

The prosthetics of military violence

Neve Gordon‘s review of Grégoire Chamayou‘s A theory of the drone on Al-Jazeera is now available in a more extended form at Counterpunch here.  It’s a succinct summary of the book’s main theses, though there’s not much critical engagement with them (you can access my own series of commentaries here [scroll down]).  He closes his review like this:

Because drones transform warfare into a ghostly teleguided act orchestrated from a base in Nevada or Missouri, whereby soldiers no longer risk their lives, the critical attitude of citizenry towards war is also profoundly transformed, altering, as it were, the political arena within drone states.

Drones, Chamayou says, are a technological solution for the inability of politicians to mobilize support for war. In the future, politicians might not need to rally citizens because once armies begin deploying only drones and robots there will be no need for the public to even know that a war is being waged. So while, on the one hand, drones help produce the social legitimacy towards warfare through the reduction of risk, on the other hand, they render social legitimacy irrelevant to the political decision making process relating to war. This drastically reduces the threshold for resorting to violence, so much so that violence appears increasingly as a default option for foreign policy. Indeed, the transformation of wars into a risk free enterprise will render them even more ubiquitous than they are today.

Neve is the author of the indispensable Israel’s occupation, and while these paragraphs closely follow A theory of the drone the title of the book is in the singular – and so I’m left wondering about military violence that isn’t orchestrated from Nevada or Missouri and what other ‘theories of the drone’ are needed to accommodate a ‘drone state’ like Israel (not that I’m sure what a ‘drone state’ is…)?

Shoot and Strike

The Israeli military is no stranger to what, following Joseph Pugliese, I’ll call prosthetic violence. While Israel remains a leading manufacturer of drones (see here and here), and routinely deploys them over the occupied territories, it also enforces its ‘Death Zone‘ in Gaza through an automated, ground-based ‘Spot and Strike’ shooting system:

The soldiers, trainees in the course for the “Spot and Strike” system, sit in a tower facing the wilderness of the southern Negev, at the far edge of the Field Intelligence School at the Sayarim base, not far from Ovda. Between their tower and the wide-open desert stands another tower topped by a metal dome. With the press of a button the dome opens to reveal a heavy machine gun. Small tweaks of the joystick aim the barrel. To the right of the gun is a camera, which transmits a clear picture of the target onto a screen opposite the soldier. A press of the button and the figure in the crosshairs is hit by a 0.5-inch bullet.

This dovetails (wrong bird) with a discussion of online shooting in A theory of the drone, but here is risk-transfer war waged over extremely short distances.  ‘Remoteness’ is as much an imaginative as a physical condition, and one that is constantly manipulated so that the threat from Hamas’s rockets and tunnels becomes ‘danger close’ even as the hideous consequences of Israel’s own military offensives become distanced (unless, of course, you choose to turn killing into a spectator sport).  In Israel, it seems, these prosthetic assemblages – of which drones are a vital part – serve to animate a deeply militarised society in which evidence of a martial stance is precisely a prerequisite for its claims to legitimacy.

PUGLIESE State violence

So we clearly need a more inclusive analysis of the prosthetics of military violence – the bio-technical means by which its range is extended – that acknowledges the role of drones for more than ‘targeted killing’ and which incorporates other emergent modalities altogether, including cyberwarfare.  One of the best places to start thinking through these issues, in relation to drones at any rate, is Joseph’s tour de force, State violence and the execution of law (2013), which emphasises how ‘through a series of instrumental mediations, the biological human actor becomes coextensive with the drone that she or he pilots from the remote ground control station’ (p. 184) (I connected this to Grégoire’s theses here).

The experience may be more conditional than this allows, though.  Timothy Cullen‘s study of USAF crews training to operate the MQ-9 Reaper found that the sense of ‘co-extension’ – or bioconvergence – was much stronger among sensor operators than pilots:

After a couple hundred hours of flight experience and a sense of comfort with the modes, interfaces, and capabilities of the sensor ball, sensor operators began to feel like they were a part of the machine. With proficiency as a “sensor,” sensor operators found themselves shifting and straining their bodies in front of the [Heads Up Display] to look around an object.  As pilots flew closer to a target, the transported operators tilted their heads in anticipation of the camera’s [redacted].  Feelings of remote presence helped sensor operators move their bodies, and instructors believed that operators who felt as if they were “flying the sensor” could hold their attention longer on a scene…

Both pilots and sensor operators said pilots did not transport themselves conceptually into the machine to the same extent as a sensor operator. Nor did pilots attain similar feelings of connection and control with Reaper as they did with their previous aircraft.

The term ‘prosthetics’ implies these are at once extensions and embodiments of a military violence whose prosthetics also assume more mundane bioconvergent forms.  This is an obvious but in most cases strangely overlooked point.  Joseph mentions it in passing, juxtaposing his ‘mobilisation of the prosthetic trope’ with ‘the material literality of prosthetics: drones as the militarized prosthetics of empire inherently generate civilian amputees in need of prosthetic limbs’ (p. 214).  There’s also a suggestive discussion in Jennifer Fluri‘s ‘States of (in)security’, which devotes a whole section to what she calls ‘prosthetics biopower’ and the multiply corporeal geographies of contemporary wars [Environment and Planning D: Society & Space 32 (2014) 795-814].  Although Jennifer doesn’t directly connect these intimacies to distant vectors of military violence, the implication (and invitation) is clearly there.

So let me try to supplement her observations, drawing in part on my project on military-medical machines that treats (among other theatres of war) the evacuation of injured soldiers and civilians in Afghanistan.  It’s important to trace the two pathways, as I’ll show in a moment (and I’ll say much more about this in a later post), but it’s also necessary to remember, as Sarah Jain crisply observes in her classic essay on ‘The prosthetic imagination‘ (p. 36), that ‘it usually is not the same body that is simultaneously extended and wounded’  [Science, technology and human values 24 (1) (1999) 31-54].  That said, there is a distinctively corporeal geography to those that are.

US military Limb amutations in Afghanistan and Iraq PNG

Major limb amputations (US military) in Iraq (OIF) and Afghanistan (OEF) 2001-2014 (Source: Congressional Research Services US Military Casualty Statistics, November 2014)

The incidence of devastating injuries to the limbs of troops in Iraq and Afghanistan (see the graph above; for comparable UK figures, see here) – mainly from IEDs – has been acknowledged in the role played by amputees in mission rehearsal exercises and pre-deployment training since 2005 (see here for an excellent general account).

Peter Bohler:Fort Irwin training

Private contractors like Amputees in Action pride themselves on providing ‘de-sensitising’ exposure to ‘catastrophic injury amputations’ and replicating the latest field injuries for these exercises.  There is a risk in re-enrolling war veterans, as the company concedes:

Every amputee is vetted and put through specialist training beforehand to see if they are up to the job. For some it is too close to the mark, too realistic. The last thing we want to do is traumatize someone, stymie their rehabilitation.

These simulations have been used to prepare ordinary soldiers for the situations they will face – today it’s not only the ‘golden hour’ between injury and surgery that is crucial but also (and much more so) the ‘platinum ten minutes’ immediately following the incident, so the first response is vital. They have also been used to ready trauma teams for the war zone: the BBC has a report on the Royal Army Medical Corps’s mock ‘Camp Bastion’ at Strenshall in Yorkshire here.

These various exercises incorporate the latest advances in evacuation and trauma care, which have meant that today’s soldiers are far more likely to survive even the most life-threatening wounds than those who fought in previous conflicts, but the horrors experienced by young men and women in the military who lose arms and legs – sometimes all of them – are truly hideous:  read, for example, Anne Jones‘s mesmerising and deeply moving account of  They Were Soldiers: How the wounded return from America’s wars (you can get an idea from her ‘Star-spangled Baggage’ here).  Their road to rehabilitation is far longer, and infinitely more painful, than the precarious journey through which they returned to the United States (see also my ‘Bodies on the line‘).

Zac Vawter at the Rehabilitation Institute of Chicago

Researchers unveiled the world’s first thought-controlled bionic leg  on 25 September 2013  funded through the US Army Medical Research and Materiel Command’s (USAMRMC) Telemedicine and Advanced Technology Research Center (TATRC) and developed by researchers at the Rehabilitation Institute of Chicago (RIC) Center for Bionic Medicine. 

There is some light in the darkness – ongoing experiments with state-of-the-art, ‘bionic’ prosthetics animated by microprocessors in the US, the UK and elsewhere that restore far more stability, mobility and movement than would have been possible even five years ago (see above, and here and here for the US, here and here for the UK).  In the 1980s less than 2 per cent of US soldiers who had suffered major limb amputations returned to duty; by 2006 that had increased to over 16 per cent (see also here and here).  There are several reasons for the change, but in 2012 Jason Koebler reported:

According to the Army, at least 167 soldiers who have had a major limb amputation (complete loss of an arm, leg, hand, or foot) have remained on active duty since the start of the Afghanistan and Iraq wars, with some returning to battle. Many others have returned overseas to work in support roles behind the lines.

“When we have someone we know wants to return, their rehab is geared that way,” says John Fergason, chief of prosthetics at the Army Center for the Intrepid at Fort Sam in Houston, Texas.

Kevin Carroll, vice president of Prosthetics at Hanger, a company that makes artificial limbs, says prosthetics have become more comfortable to wear and closer in range of motion to natural limbs.  “Unfortunately, when you have war, you have casualties, but with that comes innovation,” he says. Artificial joints are getting better at approximating the knee, elbow, wrist, and ankle, and microprocessors embedded in prostheses are able to pick up and adjust for impacts from walking, running, jumping, and climbing.

“The person doesn’t have to worry about the prosthetic device, they’re worrying about the task in front of them,” Carroll says. “If they want to go back to be with their troops, that’s an option for many soldiers these days.”

Notice, though, that these advances in prosthetic design and manufacture are part of an intimate conjunction between military violence and military medicine, in which materials science, bio-engineering, electronics and computer science simultaneously provide new means of bodily injury and new modalities of bodily repair.  This is captured in the title of David Serlin‘s thought-provoking essay, ‘The other arms race’ [in Lennard Davis (ed), The Disability Studies Reader (second edition, 2006) 49-65; this essay is not included in the latest edition, but see also the collection David edited with Katherine OttArtificial parts, practical lives: modern histories of prosthetics (2002) and his own Replaceable You: engineering the body in postwar America (2004)].  You can also find an excellent brief historical review of ‘Prosthetics under trials of war’ here.

War XAnd, given the circuits within the military-medical machine, there may be more to come.  There are those who anticipate a future in which prosthetics will not only reinstate but also increase a soldier’s capabilities.  Koebler cites Jonathan Moreno, a bioethicist at the University of Pennsylvania, who ‘talks about a future where prosthetics are “enhancers” that allow soldiers to be stronger, faster, and more durable than their peers.’  These fantasies feed through the masculinist imaginary of the post-human cyborg soldier (sketched an age ago by Chris Hables Gray and revisited here) to the prosthetics of military violence with which I began. Here Tim Blackmore‘s War X: Human extensions in battlespace (2011) is also relevant.

But Koebler is quick to add that all this is still a distant prospect:

“I know the question is often, ‘How close are we to true bionic or having artificial limbs that are more versatile than natural ones?'” Fergason says. “Frankly, we’re not that close. You’re not going to see anyone decide, ‘Boy, I think I’d like to get a bionic leg because they’re so fantastic.’

“We love to read about the super-soldier, but that’s not the case right now. Amputation is so complex in what it does to your body that it’s a very long recovery,” he adds.

So what, then, of civilians?  Under ISAF’s Medical Rules of Eligibility Afghan civilians who were injured during military operations and/or needed ‘life, limb or eyesight saving care’ could be admitted to the international medical system, and were eligible for emergency casualty evacuation and treatment at one of the Category III advanced trauma centres at Bagram or Camp Bastion.

Medical Rules of Eligibility PNG

As soon as possible, however, Afghans were to be treated by Afghans and so, after surgical intervention they had to be transferred to the local healthcare system.  The same applied to the Afghan National Army and police.  In consequence, the drawdown of international forces – which also includes their medevac and trauma teams – has left the local population desperately vulnerable to the after-effects of continuing and residual military and paramilitary violence (see here and here).

The inadequacies and insufficiencies of the Afghan healthcare system have prompted a number of NGOs to fill the gap between the radically different systems, and they have done – and continue to do –  immensely important work.

But compare the prosthetics available to US soldiers with those supplied to Afghan civilians.  I don’t mean to minimise the invaluable work done by hard-pressed and underfunded NGOs, but the image below is from the ICRC‘s Orthopedic Center in Kabul (see also here).  There are other centres supported by the ICRC in Faizabad, Gulbahar, Herat, Jalalabad, Lashkar Gah, and Mazar-e-Sharif, together with a manufacturing facility in Kabul, and other NGOs are active elsewhere  – Médecins sans Frontières runs a similar facility in Kunduz, for example.

ICRC Orthopedic Center Kabul PNG

In addition to these facilities, there have been some ingenious work-arounds.  Carmen Gentile describes how US soldiers at Forward Operating Base Kasab in Kandahar were moved by the plight of Mohammed Rafiq, an eight-year old boy whose legs were blown off by an IED.  ‘Since we couldn’t get a supply of commercially made legs, we decided that maybe we could make them ourselves,’ explained Major Brian Egloff, a US Army surgeon at the base.

Using scrap tubing and some ingenuity, Egloff fitted Rafiq with small prosthetic legs. Rafiq was now able to get around the village…

Egloff did not end his work with Rafiq. He knew there must be other amputees living in the area…  Soldiers on patrol had noticed “a lot of guys with amputations that had no prosthetic legs and were reduced to crawling around on the ground and relying on the charity of strangers just to get by,” he says.  Afghans heard about what was done for Rafiq and asked for help for others. Egloff made the legs from material readily available in any welding shop, he says, mostly scrap aluminum tubing for the legs and aluminum plates for the prosthetic feet. A spring-loaded hinge served as the ankle joint.  “It’s a very simple design, nothing complicated,” he says.

These legs were intended to be temporary replacements until ‘a professionally fitted prosthetic’ was available, but the same report notes that ‘getting to a provincial capital, where most hospitals are located, is not easy for many Afghans and the routes are dangerous.’  There’s much more about inaccessibility in MSF’s Between rhetoric and reality: the ongoing struggle to access healthcare in Afghanistan (February 2014).

Like Mohammed – and many ISAF and Afghan soldiers – many of these amputees are the victims of IEDs or even land mines left over from the Soviet occupation (for a global review of the rehabilitation of people maimed by the explosive remnants of war [ERW], see this 2014 report from the International Campaign to Ban Landmines–Cluster Munition Coalition).

But some of them will be the victims of air strikes from or orchestrated by Predators and Reapers: in recent years Afghanistan has been the most heavily ‘droned’ theatre of operations in the world.  In some cases they were caught in the blast, but in others they were the victims of what Rob Nixon calls ‘slow violence‘.  According to a report by Sune Engel Rasmussen in the Guardian:

Since 2001, the coalition has dropped about 20,000 tonnes of ammunition over Afghanistan. Experts say about 10% of munitions do not detonate: some malfunction, others land on sandy ground. In rural areas, children often bring in vital income to households, but collecting scrap metal or herding animals can be fraught with unpredictable risks. Of all Afghans killed and maimed by unexploded ordnance, 75% are children…

Their future is usually bleak.  Erin Cunningham reports that ‘even as the population of Afghans who are missing limbs grows, amputees face discrimination and the harsh stigma of being disabled.’

“Socially and financially, their lives are destroyed,” Emanuele Nannini, program director at the Italian nonprofit Emergency, which operates health-care centers across Afghanistan, said of Afghan amputees.

From January to June [2014], Emergency’s Center for War Trauma Victims in Lashkar Gah, the capital of Helmand province in southern Afghanistan, performed 69 amputations. The fiercest fighting between the two sides usually takes place in the warmer summer months.

Emergency then sends the amputees to the nearby International Committee for the Red Cross orthopedic facility for long-term rehabilitation. The patients receive vocational training and other support to reintegrate them into society. The ICRC said that between April and June this year, it admitted 351 amputee patients to its facilities across Afghanistan.

But for the most part, amputees “are completely dependent on their families, and they become a huge burden,” said Nannini, who is based in Kabul. “The real tragedy starts when they go home. If they don’t have a strong family, they become beggars.”

Emergency runs two other surgical centers, in Kabul and Anabah, as well as a number of clinics and first aid posts in the villages; at Lashkar Gah six out of every ten admissions are victims of bombs, land mines or bullets.

The story is, if anything, even worse across the border in Pakistan’s Federally Administered Tribal Areas, whose inhabitants are also subject to explosive violence from the Taliban and other groups, and from CIA-directed drone strikes and air and ground attacks by Pakistan’s military.  As Madiha Tahir has shown, the victims usually disappear from public attention, at least in the United States:

What is the dream?

I dream that my legs have been cut off, that my eye is missing, that I can’t do anything … Sometimes, I dream that the drone is going to attack, and I’m scared. I’m really scared.

After the interview is over, Sadaullah Wazir pulls the pant legs over the stubs of his knees till they conceal the bone-colored prostheses.

The articles published in the days following the attack on September 7, 2009, do not mention this poker-faced, slim teenage boy who was, at the time of those stories, lying in a sparse hospital in North Waziristan, his legs smashed to a pulp by falling debris, an eye torn out by shrapnel….

Did you hear it coming?

No.

What happened?

I fainted. I was knocked out.

sadulla1As Sadaullah, unconscious, was shifted to a more serviceable hospital in Peshawar where his shattered legs would be amputated, the media announced that, in all likelihood, a senior al-Qaeda commander, Ilyas Kashmiri, had been killed in the attack. The claim would turn out to be spurious, the first of three times when Kashmiri would be reported killed.

Sadaullah and his relatives, meanwhile, were buried under a debris of words: “militant,” “lawless,” “counterterrorism,” “compound,” (a frigid term for a home). Move along, the American media told its audience, nothing to see here. Some 15 days later, after the world had forgotten, Sadaullah awoke to a nightmare.

Do you recall the first time you realized your legs were not there?

I was in bed, and I was wrapped in bandages. I tried to move them, but I couldn’t, so I asked, “Did you cut off my legs?” They said no, but I kind of knew.

Zeeshan-ul-hassan Usmani and Hira Bashir listed some of the long-term implications in a report completed last December for the Costs of War project:

Drone injuries are catastrophic ones.  Wounded survivors of drone attacks have often lost limbs and are usually left with intense and unmanaged pain, and some desire death. Those who survive with severe disabilities face a difficult situation given lack of accommodation for people with disabilities in Pakistan. FATA is an extremely difficult terrain for a disabled person. A walk out for the morning naan (traditional bread) may require navigating through a twisty mud track, with regular dips and bumps. The traditional mud houses of the area themselves have a mud floored haweli (an open-air area onto which all the rooms usually open up). A person with a leg amputation cannot use a regular wheel chair, go to school or hospital, or even use a toilet on his own. Disability of the primary breadwinner can change the course of life for an entire family, since most village jobs are physical ones.

Here too the barriers are more than physical.  In 2011 Farooq Rathore and Peter New described how disability remains a stigma in many sectors of Pakistani society, and rehabilitation medicine is still underdeveloped.

The leading prosthetics center is the Armed Forces Institute for Rehabilitation Medicine at Rawalpindi – whose rehabilitation services for injured soldiers are reportedly ‘the best in the country‘ – but it ‘still manufactures prostheses and orthoses with wood, leather, and metal.’  For injured civilians, the outlook is still more grim.  In 2012 a plan was announced to appoint orthotic specialists and physiotherapists at district hospitals throughout the FATA:

The prolonged United States-led war against terrorism has left a large number of people disabled in Pakistan, compelling the government to institute a rehabilitation plan that will include imparting vocational skills…

“We plan to enhance the physical rehabilitation services for the victims of terrorism to save them from permanent disability,” [Mahboob ur Rehman, head of the physiotherapy department at the Hayatabad Medical Complex (HMC)in Peshawar] told IPS.

The decade-long armed conflict has resulted in injuries to thousands of people from blasts, shelling and drone attacks, with the majority of the victims needing prosthetic and orthotic management to help regain the ability to walk, he said.

But it turns out that the emphasis is as much on ‘wheelchairs and sewing machines’ as it is on even the most basic prosthetics.

Once again, NGOs have provided vital services in the most difficult circumstances.  In 1979 the ICRC established a Paraplegic Rehabilitation Center in Peshawar for victims of the Afghan war, for example, which was subsequently transferred to the control of the Khyber-Pakhtunkhwa provincial government.  It has achieved some notable successes, but here too the focus is on physical therapy and it is outside the FATA so that access is difficult for many people.

And so, finally, to Gaza.  Here the differences with Afghanistan and Pakistan are striking.  Throughout the Israeli assault last summer, as I showed in detail here, medical services were severely compromised, and hospitals and medical centres actively targeted.  The only rehabilitation hospital, El-Wafa, was destroyed.  The injuries were also aggravated by the use of Dense Inert Metal Explosives (DIME) – developed for the US Air Force in 2006 – and which, according to a Briefing Note issued by the Palestinian human rights organisation Al-Haq, were fired from Israeli drones.

DIME blast injuries

These experimental weapons are supposed to decrease collateral damage by constricting the lethal blast radius.  But inside that perimeter the explosive blast is concentrated and magnified:

The injuries of victims who have been in contact with experimental DIME weapons are distinguishable from injuries sustained by non-experimental weapons. While signs of solid shrapnel or metal fragments are typical of amputations sustained from traditional explosives, physicians in the Gaza Strip are witnessing gruesome amputations caused by a metal vapor or residue which indicate the detonation of an extreme force in a small radius. In fact, as a result of these weapons, reported cases in the Gaza Strip include entire bodies cut in half, shattered bones, and skin, muscle and bones turned into charcoal due to the destructive burns associated with the weaponry’s extreme force and high temperature.

The lacerations are so severe that many victims bleed out and die.

The scale of destruction in Gaza also presents a radically different landscape for survivors of blast injuries.  If the terrain in FATA is formidably difficult for anyone using prosthetics or in a wheelchair, imagine what it must be like to be confronted with this:

al Shejaiya Gaza 2014

When you look at that, bear in mind that when the assault came to an end there were still around 7,000 unexploded bombs and other explosive remnants of war beneath the rubble.

These are all dreadful effects and yet, compared to Afghanistan and Pakistan, the situation for prosthetics and rehabilitation seems somewhat better.  The prosthetics are more advanced, and some patients have been able to travel to Beirut, Amman and on occasion into Israel for treatment.  But there are still formidable obstacles in the essential provision of continuing local care.  Bayan Abdel Wahad reports from the Artificial Limb Centre, the only one of it kind in Gaza:

The number of patients who have benefited from the service of prosthetic replacement which the Centre provides for free is about 300 people who have been injured as a result of the Israeli bombardments in the past five years. However, a number of people injured in the last war – Operation Protective Edge – have not been able to come to the center yet because they are still bed-ridden due to several injuries whose treatment takes precedence over prosthetic replacement…. The technical coordinator at the center, Nivine al-Ghusain, said that “despite all the difficulties we face in funding and getting the materials necessary to manufacture the artificial limbs, we will continue in our work.” She [said] that the Centre takes upon itself the maintenance of the prosthesis from time to time “in addition to changing it based on the patients’ needs.”

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The Centre relies on the ICRC for components and raw materials from France, Germany, Switzerland and the United States, but there are continuing difficulties in importing these via Israel or Egypt.  In December 2014 the Center was treating around 950 amputees.

Reports about the cultural and social response to these visible victims of military violence are mixed. Guillaume Zerr, who directs Handicap International’s operations in Gaza, told Reuters that ‘there can be less acceptance of their condition than in other regions of the world’, whereas one young man – a double amputee – insisted that ‘I feel more love, support and sympathy from people now than before my injuries, and Gazan society is non-discriminating toward me.’  Perhaps this is, at least in part, because he, like others wounded in Gaza, can provide an unambiguous narrative, ‘to tell the story behind the loss of his legs’.  I remember Omar Dewachi explaining to me how patients from Iraq, Libya or Syria who are treated in Beirut for their wounds have to return home with a narrative that can explain what happened to them in terms that will satisfy whichever side in those civil wars might call them to account.  Such narratives are important not only for their rehabilitation (and here they are vital) but also for their very survival.  This is presumably more straightforward in Gaza, but this ‘politics of the wound’ is also always a geopolitics of the wound.

One last thought.  I’m struck by how often the term ‘asymmetric war’ is used to imply that conflicts of this sort are somehow unfair – to those who possess overwhelming firepower.  But war is about more than firepower, more even than killing, and I hope I’ve shown that the differences between the continuing care and rehabilitation available to those who are maimed in these wars reveal not only a different prosthetics of military violence but also a new and grievous asymmetry in its enduring consequences.

Flesh on the Bones

Skeleton RoadOne of my pleasures is good – and I mean seriously good – crime fiction, and I’ve just finished Val McDermid‘s latest, Skeleton Road.  It’s a finely wrought reflection on the wars that destroyed the former Yugoslavia, notably the conflict between Serbia and Croatia, but it’s also shot through with ferociously smart insights into geopolitics.

In fact, the epigraph is from Gerard Toal‘s Critical Geopolitics (the book not the blog) and in her acknowledgements Val thanks both Linda McDowell and Jo Sharp.

I was particularly taken by the way in which the shadows (and lights) of international law and human geography fall across its pages. Neither becomes an abstraction; both are fully embodied.  Two of the protagonists are lawyers working for the International Criminal Tribunal for the Former Yugoslavia and another is a Professor of Geography at Oxford (who ‘forced herself to consider the entries she was due to contribute to the forthcoming Dictionary of Human Geography‘ – a perfectly reasonable motive for murder).

All of which may explain my favourite quotation from what is now one of my favourite novels.  I’ve always despaired of those approaches to ‘geography and literature’ that gut novels by ripping out the supposedly ‘geographical’ bits, so I hope I’ll be forgiven for this autopsic deviation.  This is Maggie Blake, Professor of Geography, describing the results of her fieldwork in Dubrovnik:

‘The work I ended up doing on the region and its wars … is rooted, as human geography should be, in an embodiment of the conflict.’

The war on Ebola

ECONOMIST The war on Ebola

We’ve been here before – ‘wars’ on this and ‘wars’ on that.  It’s strange how reluctant states are to admit that their use of military violence (especially when it doesn’t involve ‘boots on the ground‘) isn’t really war at all – ‘overseas contingency operations’ is what the Pentagon once preferred, but I’ve lost count of how many linguistic somersaults they’ve performed since then to camouflage their campaigns – and yet how eager they are to declare everything else a war.

These tricks are double-edged.  While advanced militaries and their paymasters go to extraordinary linguistic lengths to mask the effects of their work, medical scientists have been busily appropriating the metaphorical terrain from which modern armies are in embarrassed retreat.

Yet all metaphors take us somewhere before they break down, and the ‘war on Ebola’ takes us more or less directly to the militarisation of the global response.  In an otherwise critical commentary, Karen Greenberg draws parallels between the ‘the war on terror’ and the ‘war on Ebola’:

‘The differences between the two “wars” may seem too obvious to belabor, since Ebola is a disease with a medical etiology and scientific remedies, while ISIS is a sentient enemy. Nevertheless, Ebola does seem to mimic some of the characteristics experts long ago assigned to al-Qaeda and its various wannabe and successor outfits. It lurks in the shadows until it strikes. It threatens the safety of civilians across the United States. Its root causes lie in the poverty and squalor of distant countries. Its spread must be stopped at its region of origin — in this case, Guinea, Liberia, and Sierra Leone in West Africa — just as both the Bush and Obama administrations were convinced that the fight against al-Qaeda had to be taken militarily to the backlands of the planet from Pakistan’s tribal borderlands to Yemen’s rural areas.’

There are other parallels too, not least the endless re-descriptions of terrorism and even insurgency as life-threatening diseases, ‘cancers’ on the body politic.  And, as Josh Holmes shows, there is also an entirely parallel (geo)politics of fear in both cases (see also Rebecca Gordon on the racialization of ‘the fear machine’ here).  Given the threat supposedly posed by ‘the enemy within’, it’s not surprising that US Northern Command has already set up a 30-person ‘military rapid response team‘ for domestic Ebola cases, and that the Department of Homeland Security has been issuing Biosurveillance Event Reports on the Ebola outbreak in West Africa from the National Biosurveillance Integration Center.

National Biosurveillance EBOLA DHS 1 Oct 2014

But as I’ve said, Karen’s is a critical commentary and so, before the military metaphors carry us away,  her conclusion bears repeating:

The United States is about to be tested by a disease in ways that could dovetail remarkably well with the war on terror. In this context, think of Ebola as the universe’s unfair challenge to everything that war bred in our governmental system. As it happens, those things that the U.S. did, often ineffectively and counterproductively, to thwart its enemies, potential enemies, and even its own citizenry will not be an antidote to this “enemy” either. It, too, may be transnational, originate in fragile states, and affect those who come in contact with it, but it cannot be stopped by the methods of the national security state.

To make sense of all this, I think we need to stand back and start with four general observations:

(1) Modern military medicine has long involved more than evacuating and treating the wounded from the field of battle.  It has always had a substantial public health component.  Until the early twentieth century, ‘infectious diseases unrelated to trauma were responsible for a much greater proportion of the deaths during war than battle-related injuries‘.  As militaries started to pay much closer attention to hygiene and disease prevention, Matthew Smallman-Raynor and Andrew Cliff estimate that the ratio of ‘battle deaths’ to deaths from disease amongst the military population fell from 1:0.4 in the First World War to 1:0.1 in the Second World War; then it rose to 1:0.13 in the Vietnam War but in the first US-led Gulf War (1991) it fell to 1:0.01.

Beyond Anthrax(2) Modern militaries are no strangers to biowarfare either.  Both sides in the First World War experimented with chemical weapons, and although the US Army’s explicitly offensive Biological Warfare Weapons Laboratories closed in 1969 the commitment to ‘bio-defense’ and bio-security has ensured a continuing military investment in the weaponisation of infectious diseases (see right).  I don’t subscribe to the view that the Ebola epidemic in West Africa is the result of a rogue US biowarfare program – see for example the claims made by ‘Robert Wenzel’ here: and if you want to know why his name is in scare-quotes, appropriately enough, read Chris Becker‘s takedown here –  nor to the fear that what Scientific American calls ‘weaponised Ebola’ is poised to become a ‘bio-terror threat’.  But I do think it worth noting the work of the US Army Medical Research Institute of Infectious Diseases which has had field teams on the ground in West Africa since 2006, and the importance placed on surveillance and monitoring.

(3) I also think it’s necessary to think through the biopolitics of public health in relation to military and paramilitary violence.  This takes multiple forms.  It’s become dismally apparent that in many conflict zones hospitals, doctors and other health-care workers have become targets: in Gaza, to be sure, but in Syria and elsewhere too.  The treatment of disease has also become a tactical vector: think of the CIA’s use of polio vaccination campaigns as a cover for its intelligence operations and – the conjunction is imperative – the Taliban’s manipulation of polio vaccinations in Pakistan’s Federally Administered Tribal Areas.  Think, too, of the way in which the Assad regime has inflicted a resurgent, even counterinsurgent geography of polio on the Syrian people.  As Annie Sparrow shows (see also here):

‘This man-made outbreak is a consequence of the way that Syrian President Bashar al-Assad has chosen to fight the war—a war crime of truly epidemic proportions. Even before the uprising, in areas considered politically unsympathetic like Deir Ezzor, the government stopped maintaining sanitation and safe-water services, and began withholding routine immunizations for preventable childhood diseases. Once the war began, the government started ruthless attacks on civilians in opposition-held areas, forcing millions to seek refuge in filthy, crowded, and cold conditions. Compounding the problem are Assad’s ongoing attacks on doctors and the health care system, his besieging of cities, his obstruction of humanitarian aid, and his channeling of vaccines and other relief to pro-regime territory.

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Late this summer she provided this update:

‘… nearly all the cases of polio have occurred in areas of northern Syria under rebel control, where the government is seemingly doing everything in its power to prevent vaccination. The Syrian government has appealed to the UN for hundreds of medicines for areas of the country it controls, while largely ignoring the far more dire needs of opposition-held areas. Many children, especially newborns, still do not have access to polio immunization. Daily government airstrikes target the very health facilities that should be the foundation of vaccination efforts, as well as the children who should be protected from polio, measles, and other preventable childhood diseases. As Dr. Ammar, a doctor from Aleppo, said to me bitterly after an April 30 airstrike killed twenty-two schoolgirls, “The government’s polio control strategy for children is to kill them before they can get polio.”’

(4) Finally, biopolitics threads its way from the sub-national and the national to the trans-national and so to what Sara Davies calls, in a vitally important essay, ‘securitizing infectious disease‘. (The link will take you to an open access version, which was originally published in International affairs 84 (2008) 295-313; see also her ‘The international politics of disease reporting: towards post-Westphalianism?‘, International politics 49 (2012) 591-613, and the collection she has edited with Jeremy Youde, The politics of surveillance and response to disease outbreaks: the new frontier for states and non-state actors – due out next year).

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In her original essay, Sara shows how powerful states in the global North joined forces with the World Health Organisation to construct infectious disease as an existential security threat that demanded new rules and protocols for its effective containment.  Crucially:

‘The outcome of this has been the development of international health cooperation mechanisms that place western fears of an outbreak reaching them above the prevention of such outbreaks in the first place. In turn, the desire of the WHO to assert its authority in the project of disease surveillance and containment has led it to develop global health mechanisms that primarily prioritizes the protection of western states from disease contagion.’

This has a genealogy as well as a geography (or what Alan Ingram once called a ‘geopolitics of disease’).  Peter Dörrie notes that on 18 September 2014 the U.N. Security Council declared the current Ebola outbreak in West Africa ‘a threat to international peace and security’, and that this was ‘the first time the U.N. had taken this step in a public health crisis‘ (in fact the Council had previously expressed similar concerns about the impact of HIV/AIDS on ‘stability and security’).  Under Chapter VII of the UN Charter this declaration has significant legal implications, as Jens David Ohlin notes here, but what most concerns Peter is how long it took for the Security Council to stir itself.  It issued its statement 180 days after the WHO confirmed the outbreak, and over a month after the WHO had declared Ebola a ‘Public Health Emergency of International Concern’, and in his eyes the international system ‘ignored the problem until it was too big for any solution other than full-scale military intervention.’   But I’ve already suggested, it’s wrong to treat the militarisation of epidemic disease as somehow new.  Of direct relevance to the present ‘war on Ebola’ is this passage from Sara’s essay:

The United States has been a keen participant in disease surveillance and response since the mid-1990s. The United States Department of Defense (US DoD) has had overseas infectious disease research laboratories located in over 20 countries for nearly ten years. The Global Emerging Infectious Surveillance and Response System (DoD-GEIS) mobile laboratories were set up for the purpose of ‘responding to outbreaks of epidemic, endemic and emergent diseases’, and their location in the DoD, as opposed to the United States Agency for International Development (USAID) or Centre for Disease Control (CDC) demonstrates how seriously the United States views the response to infectious disease as a key national security strategy.

So, four observations about the military-medical-security nexus that provide a context for the ‘war on Ebola’.  There are two other issues that should also be on the table before proceeding.

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The first involves the imaginative geographies circulating in the global North that (mis)inform public response to the epidemic.  Many of them can be traced back to colonial descriptions of the coast of nineteenth-century West Africa (and Sierra Leone in particular) as ‘the white man’s grave’, a form of what in a different context Dan Clayton calls a ‘militant tropically’.  The contemporary reactivation of these tropes is clearly a serious concern because it corrodes an effective political response.  As geographer Kerrie Thornhill writes,

African and diaspora scholars, already accustomed to the ‘thousand tiny paper cuts’ of casual racism, demonstrate how these (metaphorical) cuts escalate into real fatalities. Writers such as Nanjala Nyabola and Lola Okolosie point out the abundance of racist tropes depicting West African societies as inherently unclean, chaotic, uncooperative, ungrateful, and childlike. This racism reinforces a global culture of disregard for black African lives, and the perception that they are a source of social and biological contamination.

You can find much more on this in Cultural Anthropology‘s brilliant Ebola in Perspective series.

Health care systems in West Africa Economist

The second is the precarious condition of health care systems in West Africa (Ebola in Perspective is good on this too).  Brice de la Vigne, the operations director of MSF, reminds us that ‘both Sierra Leone and Liberia were at war ten years ago and all the infrastructure was destroyed. It’s the worst place on earth to have these epidemics.’  Other critics suggest that these uncivil wars were not the only culprits.  In their view, it was the neoliberal economic model forced on West Africa by the global North that was primarily responsible for gutting public health systems:

While years of war played a role in weakening public systems, it is the “war against people, driven by international financial institutions” that is largely responsible for decimating the public health care system, eroding wages and conditions for health care workers, and fueling the crisis sweeping West Africa today, says [Emira] Woods. “Over the past six months to a year there have been rolling health care worker strikes in country after country—Nigeria, Sierra Leone, and Liberia,” said Woods. “Nurses and doctors are risking and losing their lives but don’t have protective gear needed to serve patients and save their own lives. They are on the front lines and have not had their voices heard.”

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So – back to the front lines.  Despite the geopolitical-military-security back story, it was Médecins Sans Frontières that made the first public call (on 2 September) for military assistance in combatting Ebola.

‘States with biological-disaster response capacity, including civilian and military medical capability, must immediately dispatch assets and personnel to West Africa… 

‘Many countries possess biological threat response mechanisms. They can deploy trained civilian or military medical teams in a matter of days, in an organised fashion, and with a chain of command to assure high standards of safety and efficiency to support the affected countries…

‘In the immediate term, field hospitals with isolation wards must be scaled up, trained personnel must be dispatched, mobile laboratories must be deployed to improve diagnostics, air bridges must be established to move personnel and material to and within West Africa, and a regional network of field hospitals must be established to treat medical personnel with suspected or actual infections.’

MSF call 2 Sept 2014

Ten days later Peter Piot, the Director of the London School of Tropical Medicine and Hygiene and the microbiologist who helped identify the Ebola virus in 1976, also called for a ‘quasi-military intervention’.  Although he spoke about a ‘state of emergency’, he too wanted to reverse the response prefigured by Giorgio Agamben in such situations and contract the spaces of exception that were multiplying across West Africa.  He had in mind ‘beds, ambulances and trucks as well as an army of clinicians, doctors and nurses.’

What materialised was rather different.

Africom_emblemOn 16 September President Obama flew to the Centers for Disease Control and Prevention in Atlanta to announce Operation United Assistance.  He committed 3-4,000 US troops and $750 million in defence funding to the mission, which is being orchestrated by US Africa Command (AFRICOM) through US Army Africa in concert with USAID.  The focus of the US military-medical mission is Liberia. There are close historical connections between the US and Liberia, which originally offered to host AFRICOM’s headquarters in the capital Monrovia; now a Joint Force Command has been set up there.  You can find the 75-page AFRICOM operational order here, dated 15 October 2014, from which I’ve taken the ‘common operating picture’ below.  The title puzzles me – the only ‘Operation United Shield’ (singular) I’ve been able to find was a multinational operation to evacuate peacekeeping forces from Somalia in 1995.  Appendix B is particularly worth reading, incidentally, because it identifies ‘the enemy’: ‘Ebola Virus Disease is the enemy, aided by poor preventive medicine practices in areas where EVD cases are prevalent and difficulties in identifying and treating EVD patients.’

USAFRICOM-EbolaResponseOPORD (dragged)

The US deployment is complemented by the deployment of UK forces to Sierra Leone (Operation Gritrock)and French forces to Guinea.  In both cases there are also close, colonial connections, and the British-led International Military Advisory Training Team Sierra Leone has been on the ground since 2000 (since last year this has been re-tasked as the International Security Advisory Team Sierra Leone).

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(The map above is borrowed from the BBC; in addition, the Guardian has an interactive map tracing the historical geography of Ebola from the first known case in the Democratic Republic of Congo in 1976 to the present epidemic in West Africa here).

These forces differ in more than geographical deployment; their capabilities differ significantly too.  The UK is sending 750 troops, including contingents from the Royal Army Medical Corps (notably 22 Field Hospital), who will construct treatment centres (the aim is to add 700 beds to triple Sierra Leone’s existing capacity) and treat doctors and other health-care workers who contract the disease; they are supported by the Royal Navy’s ‘Primary Casualty Receiving Ship’ RFA Argus (which will provide a further 100 beds), and by another 780 volunteer health care staff.

AFRICOM update 29

The US has mobilised troops from the 101st Airborne, whose primary mission is to set up 17 Ebola Treatment Units (each with 100 beds); meanwhile the US Air Force’s 633rd Medical Group is establishing a 25-bed Expeditionary Medical Support System field hospital for doctors and other health care workers who contract the disease (below).  The US Army has also fielded three mobile laboratories to test samples for the virus, reducing the time to diagnosis from days to hours. According to Pardis Sabeti, who leads viral-genome research at the Broad Institute of M.I.T. and Harvard, ‘the faster you can get a diagnosis of Ebola, the faster you can stop it.’

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‘Our enemy is a disease’, declared Lt Col Brian De Santis, echoing AFRICOM’s operational order – but it was quickly made clear that the vast majority of troops will not come into contact with the enemy or any of its victims at all.  This is just as well; most of the soldiers have minimal medical training – just four hours from the US Army Medical Research Institute of Infectious Disease – and the Pentagon’s Press Secretary Rear Admiral John Kirby explained that there is ‘no intention right now that [troops] will interact with patients or be in areas where they would necessarily come into contact with patients’:

‘They’re not doctors. They’re not nurses. They’re not trained for that and not equipped for that. That’s not part of the mission. They will be kept in locations where they can do their jobs without coming into contact with patients.’

Andrew Bacevich thinks all this absurd:

‘It’s like the city that spends all its money to raise up a formidable police force only to discover that what it really needs is a bigger sewage treatment plant. Of course, you can always put cops to work burning human excrement but there are better — that is, more effective and cheaper — ways to solve the problem.’

In effect, this is another case of the military preferring remote operations.  Here is a telling passage from Sophie Arie’s interview with MSF’s president Joanne Liu:

‘“Countries are approaching this with the mindset of going to war,” she says. “Zero risk. Zero casualties.” Liu describes the current military efforts as the equivalent, in public health terms, of airstrikes without boots on the ground. Pledges of equipment and logistical support are helpful—“The military are the only body that can be deployed in the numbers needed now and that can organise things fast.” But there is still a massive shortage of qualified and trained medical staff on the ground. “You need to send people not stuff and get hands on, not try to do this remotely,” Liu says…’

The primary areas for military operations in the ‘war on Ebola’  to date are surveillance, logistics and containment.  I’ll consider each in turn.

Last week Public Intelligence released a series of weekly Security Updates and daily Intelligence Summaries produced by AFRICOM to support Operation United Assistance.  These rely largely on WHO reporting to track the spread of the disease.

USAFRICOM Ebola Security Oct 2014

This is to work at a highly aggregate level.  Most public health experts suggest that the key to stopping the spread of the disease is contact tracing – which, in its essentials, is the same methodology used by the military and the intelligence services to track individuals through terrorist and insurgent networks – and has been used successfully in both the United States and in Nigeria (which was declared free of Ebola on 20 October).  Ezra Klein describes it as ‘almost ludicrously simple’ and ‘as low-tech as medicine gets’, and so it is in principle.

But its application in much of West Africa is immensely difficult: the UN estimates that only 16 out of 44 zones have adequate procedures and personnel in place.  And since many local people are understandably fearful of the consequences of their answers, it is unlikely that military involvement would improve the situation.  Here is Elizabeth Cohen and John Bonifield:

‘People are often uncooperative with the tracers, sometimes even throwing stones at health care workers. They fear that they or their loved ones will be put in the hospital; they’ve seen firsthand that people who go there often don’t return.

“The community perceives this as a death sentence,” [Donald Thea, an infectious disease epidemiologist] said. “Relinquishing your loved one is tantamount to death.”

And health care workers have very little to offer people as an incentive to cooperate. “With smallpox, we could offer people a vaccine, a carrot in essence to induce them to be cooperative. With Ebola, we have nothing,” Thea said.’

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Logistics is the area where the military comes into its own.  MSF had emphasised that its priorities included ‘the mass expansion of isolation centers, air bridges to move personnel and equipment to and within the most affected countries, mobile laboratories for testing and diagnosis, and building a regional network of field hospitals to treat suspected or infected medical personnel.’ Much of the military effort is currently concentrated in these areas, but the other side to mobilising medical personnel, equipment and testing and treatment facilities is, in effect, immobilising the population.

Containment runs the gamut from quarantine through curfews and lockdowns to border closures.  Most observers believe that border closures would be counter-productive: if you want to know why, see Debora MacKenzie‘s short essay here.  The other, seemingly lesser measures also have their dangers.  In its original call for assistance, MSF insisted that ‘any military assets and personnel deployed to the region should not be used for quarantine, containment, or crowd control measures’, and it emphasised that ‘forced quarantines have only bred fear and unrest, rather than stem the virus.’

But others have other ideas.  Major Matt Cavanaugh, from the US Army War College, has made an unofficial, back-of-the-envelope calculation of what a successful ‘containment strategy’ for Ebola would require.  He is adamant that only ‘boots on the ground’ could do the job, though the nature of that ‘job’ remains elusive in his account.  He talks about military logistics – the ability to ‘fix “the last mile” problem’ – but he also notes the need ‘to fill the basic state functions related to health, security, and public order in order to adequately respond to the threat.’  In case that triptych isn’t clear enough, in his subsequent ‘Ebola Manifesto‘ the major declares that ‘There is exactly one organization designed to rapidly hold and control territory and the people on it: the military.’ The figure he eventually arrives at – somewhere between 36,600 to 73,200 troops – is derived from the wars in Afghanistan and Iraq, and suggests that, for some commentators at least, the Ebola crisis is an opportunity to deepen AFRICOM’s investment in what Jan Bachmann calls ‘policing Africa’ [see his ‘Policing Africa: the US military and visions of crafting “good order”‘, Security Dialogue 45 (2) (2014) 119-36]:

‘The spectrum of [AFRICOM’s] activities can be understood most comprehensively through an analytical perspective of policing, in which the aim of establishing ‘good order’ through an expansive regulatory engagement in issues of welfare is applied to contexts of ‘fragile’ statehood and ‘ungoverned spaces’.’

This is not a uniquely American view.  The Daily Mail (where else?) reports that one of the options being considered by Britain’s Chief of the General Staff is a full-scale military lockdown of Sierra Leone:

‘From a military perspective ebola is like a biological warfare attack and should be countered accordingly. There needs to be a clampdown on human movement inside Sierra Leone and possibly to and from the country between now and late 2015 when it is hoped that an antidote will have been developed.’

ByKlg1IIEAAmBwnIt’s hard to know how much credence this should be given, of course, though the very existence of proposals like these suggests that the ‘soft power’ which Joeva Rock sees in the militarisation of Ebola conceals an iron fist.  And Niles Williamson believes that the military-medical missions are a smokescreen:

‘The main purpose of this military operation is not to halt the spread of Ebola or restore health to those that have been infected. Rather the United States is seeking to exploit the crisis to establish a firm footing on the African continent for AFRICOM.’

That may be one of the objectives, but I think it’s a bridge too far to claim it as the main purpose: as I’ve tried to show, the militarisation and securitisation of Ebola has many other geopolitical and biopolitical dimensions.  And Nick Turse has revealed that AFRICOM, far from having a ‘light footprint’, has already achieved a remarkably rapid tempo of operations across the whole continent.

Still, even in its less extreme versions, the ‘war on Ebola’ clearly raises urgent questions about the militarisation of humanitarian aid, about what Kristin Bergtora Sandvik  calls a ‘crisis of humanitarian governance’, and about the violence that is involved in the production of the humanitarian present.