‘Is this thy body’s end?’

There are all sorts of ways in which the war on Syria has been a throwback to the First World War – and all sorts of differences too – but today brought news of yet another (and, unusually, a welcome one).  Peter Walker reports for the Guardian:

The UK government is taking part in a pioneering international aid project which could see consignments of maggots sent to crisis zones such as Syria as a simple and effective way to clean wounds, it has been announced.

So-called maggot therapy has been used since the first world war, when their efficacy in helping wounds heal was discovered by accident, and it is sometimes used in the NHS, for example to clean ulcers.

The initiative, co-sponsored by the Department for International Development (DfID), will develop techniques to help people in conflict zones or areas affected by humanitarian crises to use maggots where other medical facilities might not be available, such as Syria and South Sudan.

Over at the Telegraph Sarah Newey adds:

Modern larvae treatment was developed following WWI after an American scientist, William Baer, noticed the benefits of maggots on soldiers wounds. Today the therapy is used in hospitals in developed countries, including the NHS, but they are yet to be used in war zones.

While photos of the maggots at work are unsavory, the treatment is highly effective.

Flies are reared in a lab, where their eggs are sterilised. The hatched maggots are then grown for a day or two, before they are applied to skin and soft tissue wounds either directly or in a biobag, which is wrapped around the injury.

Not only do the maggots remove dead tissue and flesh, but they control infection as their spit and saliva act as a natural disinfectant and promote healing. The maggots can be used to treat anything from burns to bedsores to gunshot wounds, and are left on an injury for two to four days.

The martial history of maggots is an interesting one.

In ‘Trauma Geographies‘ I described the experience of one young soldier, John Stafford, who was wounded on the Somme in the early hours of 8 August 1916, and I’ll draw on that account here.  He managed to crawl (and fall) into a shell-hole, where he examined his wound:

‘A bullet had passed through the flesh of the upper left thigh and entered the extreme inner high point of the right leg.  The thigh bone was considerably shattered, the bullet having travelled downwards towards the knee.  My field dressing was used and I lay flat again…’

There was no sign of rescue.  His thirst increased as the sun climbed higher, but he knew nobody would venture out to rescue him until it was dark.

When night fell his hopes rose, though he was weak from loss of blood, but still nobody came.  The next day the bleeding had stopped so Stafford removed the field dressing and to his horror ‘discovered that it was one mass of white grubs … I saw that my wounds were infested with maggots.’ Sickened, he hurled the heavy dressing away, but worse was to come:

‘Eventually the maggots spread over my leg from hip to knee and then settled on the other leg which was not so badly wounded.  Occasionally I looked at their swelling rhythm, then finally turned away in disgust.’

He was eventually – and accidentally – rescued, but the maggots had probably already saved his life.  In eating the damaged flesh they had performed a ‘natural’ debridement of the wound,

Stafford’s experience was by no means unique.  It was not uncommon for wounded men to lie out in the open for days before they were recovered by stretcher-bearers, and often their wounds became infected – but the problem was bacterial infection not maggot infestation.

That same month (and in more or less the same place) Captain Lawrence Gameson was stationed with the RAMC’s 45th Field Ambulance in a shattered cellar at Contalmaison (above).  It was a bruising experience;, and he said there ‘was hardly a part of the body I did not see cut or exposed’:

Maggot invasion was common. I can recall an unconscious man who arrived with part of a frontal lobe protruding through a hole in his skull. The protruding portion of brain was moving with maggots. When men had had to be left out wounded for some time, often their shoulders, buttocks or whole back were invaded by the creatures in the areas of skin compressed by the weight of their immobilised bodies. One man I saw had been lying out because both his legs were wounded. Prolonged pressure had caused necrosis of the skin over his buttocks and of the superficial portions of muscle beneath it. Maggots had invaded the deeper tissues. I had to pick them out with long forceps. The man was unaware of his condition. Maggot invasion was always accompanied by a foul smell, since it flourished only in tissues undergoing some degree of decomposition. As a rule, the victim did not notice the stink, or did not know that it came from his own body if sensitive enough to notice it.

The association of maggots with death, decay and decomposition was pervasive.  Gameson described how he was called to extricate the body of a dead German soldier from a captured dugout:

He had fallen head foremost and was stuck there. On my preliminary examination in the dim light I could see only his field boots. I had come without my torch. Subsequently, on looking closer, I found that his flesh was moving with maggots. More precisely, I noticed that portions of his uniform were heaving up and down at points where they touched the seething mass below.

The smell was pretty awful. None of the men would touch him, although troops as a rule are not noticeably fastidious. The job was unanimously voted to me, because it’s supposed, quite wrongly, that doctors don’t mind. I went down the stairway with a length of telephone wire and lashed it round the poor chap’s feet. We hauled him up and dragged him away for some distance. The corpse left behind it a trail of wriggling, sightless maggots…

And yet, writing in the British Medical Journal on 3 March 1917 about the treatment of compound fractures, Captain Basil Hughes observed that ‘the presence of maggots in … wounds seems to exert an inhibitory action on the growth of the most virulent bacteria, and so acts beneficially.  Maggots only thrive in dead tissue and seem to hasten its removal.’

This should have been – could have been – a crucial finding, for Hughes also emphasised that ‘all shell wounds are bound to become infected, whatever care be taken’, and listed ‘the bacteria most to be feared’.  But it was those other associations – the smell of decay and the seething sight of the maggot-riddled bodies – that inhibited an appreciation of the therapeutic agency of maggots.

As Sarah notes, William Baer (left) had made a similar observation while treating two soldiers also with compound fractures of the femur.  These were among the most serious wounds of the war because the penetration of the skin by the bone made them peculiarly vulnerable to sepsis.  In 1917, he wrote,

‘two soldiers with compound fractures of the femur and large flesh wounds of the abdomen and scrotum [shades of Trey Parker] were brought into the hospital. These men had been wounded during an engagement and in such a part of the country, hidden by brush, that when the wounded of that battle were picked up they were overlooked. For seven days they lay on the battlefield without water, without food, and exposed to the weather and all the insects which were about that region. On their arrival at the hospital I found that they had no fever and that there was no evidence of septicaemia or blood poisoning. Indeed, their condition was remarkably good, and if it had not been for their starvation and thirst, we would have said they were in excellent condition. When I noticed the extent of the wounds, of the thigh particularly, I could not but marvel at the good constitutional condition of the patients. At that time the mortality of compound fractures of the femur was about seventy-five to eighty per cent…’

He continued:

‘I could not understand how a man who had lain on the ground for seven days with a compound fracture of the femur, without food and water, should be free of fever and of evidences of sepsis. On removing the clothing from the wounded part, much was my surprise to see the wound filled with thousands and thousands of maggots, apparently those of the blow fly. These maggots simply swarmed and filled the entire wounded area. The sight was very disgusting and measures were taken hurriedly to wash out these abominable looking creatures. Then the wounds were irrigated with normal salt Solution and the most remarkable picture was presented in the character of the wound which was exposed. Instead of having a wound filled with pus, as one would have expected, due to the degeneration of devitalized tissue and to the presence of the numerous types of bacteria, these wounds were filled with the most beautiful pink granulation tissue that one could imagine. There was practically no bare bone to be seen and the internal structure of the wounded bone, as well as the surrounding parts, was entirely covered with the pink, rosy granulation tissue which filled the wound. Bacterial cultures were made and, while one found a few Staphylococci and Streptococci still remaining, they were very few in number and not sufficient at that time to cause a pus formation. These patients went on to healing, notwithstanding the fact that we removed their friends which had been doing such noble work.’

Bauer drew on these findings to pioneer the use of ‘maggot therapy’ (myiasis) –  but he did so at the Children’s Hospital in Baltimore ten years after the war ended.  His first step was to grow maggots on raw meat ‘so he could observe their effect on destroying tissues,’ a colleague recalled, setting up the experiment in the hospital’s dining hall—’an unfortunate location for unwitting visitors’.

In fact, the use of maggot to treat wounds has an even longer history.  They have been a common resource in many forms of indigenous medicine for thousands of years, and within a recognisably Western tradition Baron Dominique Larrey, Napoleon’s field surgeon (above), had observed their beneficial effects a hundred years before Bauer:

‘While the process of the suppuration of their wounds was going on, the wounded were much annoyed by the worms or larvae of the blue fly… These larvae are indeed greed only after putrefying substances, and never touch the parts which are endowed with life.’

Ironically, this was during the Syrian campaign (1798-1801).

(If you want more after all that, try here and here).

Project(ion)s

Happy New Year!  With this, as with so much else, I’m late – but the greeting is none the less sincere, and I’m grateful for your continued interest and engagement with my work.

I’ve resolved to return to my usual pace of blogging in 2019; it slowed over the last several months, not least because I’ve been deep in the digital archives (apart from my merciless incarceration in Marking Hell and my release for Christmas).

My plan is to finish two major essays in the next couple of months, one on “Woundscapes of the Western Front” and the other the long-form version of my Antipode Lecture on “Trauma Geographies” (see also here). Both have involved close readings of multiple personal accounts of the journeys made (or not made) by the wounded, and the first essay informs the second, as you can see here.

I also want to bring together my research on attacks on hospitals, casualty clearing stations and aid posts during the First World War in a third essay – I’ve been talking with the ICRC about this one.  Paige Patchin managed to track down a series of files on the Etaples bombings in the National Archives for me, including an astonishing map plotting the paths of the enemy aircraft and the locations of the bombs: I’ll share that once I’ve managed to stitch together the multiple sheets.  But I’ve widened the analysis beyond the attacks on base hospitals on the coast, to include other attacks – notably the bombing of the hospital at Vadelaincourt near Verdun – and a more general discussion of the protections afforded by the Red Cross flag and the Hague Conventions.

This will in turn thread its way into a fourth essay providing a more comprehensive view on violations of what I’ve called ‘the exception to the exception’: the disregard for the provisions of International Humanitarian Law evident in the attacks on hospitals and clinics in Afghanistan, Gaza, Syria and elsewhere, in short “The Death of the Clinic“.

That project interlocks with my developing critique of Giorgio Agamben‘s treatment of the “space of exception”.  In brief:

  • I think it’s a mistake to treat the space of the camp as closed (there is a profoundly important dispersal to the space of exception, evident in the case of Auschwitz that forms the heart of Agamben’s discussions – I’m thinking of the insidious restrictions on the movement of Jews in occupied Europe, the round-ups in Paris and other cities (see my lecture on Occupied Paris under the TEACHING tab), and the wretched train journeys across Europe to Poland – and this matters because if we don’t recognise the signs of exception at the peripheries they will inexorably be condensed inside the enclosure of the camp).
  • It’s also unduly limiting to restrict the space of exception to the camp, because the war zone is also one in which people are knowingly and deliberately exposed to death through the removal of legal protocols that would otherwise have offered them protection (and here too what Frédéric Mégret calls ‘the deconstruction of the battlefield‘ emphasises the complex topology of the exception).  I’ve written about this in relation to the Federally Administered Tribal Areas of Pakistan (see “Dirty Dancing” under the DOWNLOADS tab) and the conduct of siege warfare in Syria (multiple posts, listed under the GUIDE tab), but it’s a general argument that I need to develop further).

  • In neither case – camp or war zone – is there an absence of law; on the contrary, these spaces typically entail complex legal geographies, at once national and – never discussed by Agamben – international (though part of my argument addresses the highly selective enforcement of international humanitarian law and the comprehensive contemporary assault on its provisions by Russia and Syria and by the United States, Israel and the UK, amongst others).

  • In both cases, too, the space of exception is profoundly racialised (I’ve written about that in relation to the bombing of Japan in World War II and the contemporary degradations inflicted on prisoners at Abu Ghraib and Guantanamo  – you can find the relevant essays under the DOWNLOADS tab – but I’ve found Alexander WeheliyeHabeas Viscus: Racializing Assemblages, Biopolitics, and Black Feminist Theories of the Human immensely helpful in deepening and generalising the argument).

I’ll be developing these arguments in my KISS Lecture at Canterbury in March, which ought to form the basis for a fifth essay (and it’s also high time I revisited what I said in “The everywhere war”!).

More on those projects soon, all of which will feed in to two new books (once I’ve decided on a publisher – and a publisher has decided on me), but in the interim I’ll be sharing some of the drafts and jottings I’ve prepared en route to the finished essays.

So lots to keep my busy, and I hope you’ll continue to watch this space – and, as always, I welcome comments and suggestions.

1418 strikes and you’re still in…

The Syrian Archive has announced the release of a database of Russian-led airstrikes on civilian targets in Syria between September 2015 and September 2018.

Several years of monitoring alleged Russian airstrikes in Syria reveals a pattern of indiscriminate targeting of civilians and civilian infrastructure. In an analysis of 3303 videos documenting alleged Russian airstrikes from 116 sources between 30 September 2015 and 9 September 2018, Syrian Archive has identified 1418 incidents in which Russian forces allegedly targeted civilians or civilian infrastructure of little to no military value. Content included in this database can be viewed, analysed and downloaded.

While data presented in this collection does not include all incidents of alleged Russian airstrikes on civilians between 2015 and 2018 [my emphasis], it presents all incidents for which visual content was available and verifiable as of the date of publication. Syrian Archive hopes this will support reporting, advocacy, research, and accountability efforts…

This open source database is fully searchable and queryable by date, location, keyword, relevance, and confidence score..

The database includes more than 3,000 videos of 1,400 incidents (some taken by citizens and activists, some by human rights organisations, and some by the Russian Ministry of Defence); its compilation involved a series of negotiations with YouTube over the removal of some of the video evidence (see here and my extended discussion of visual evidence here).

Airwars continues to do stellar work documenting civilian casualties from the US-led coalition’s military operations in Syria and elsewhere, but the Syrian Archive’s contribution is particularly valuable since, as Airwars notes:

Airwars maintains an extensive database of all known allegations in which civilians have been reported killed by Russian forces in Syrian casualty events since September 30th 2015. Our published month by month records include a case report on each known alleged event; photographs, videos, names of the dead where known; archived links to all known sources; and our provisional assessment as to whether Russian forces were likely responsible.

Due to the scale of the Russian campaign and the number of reported civilian casualty allegations, our team rolls out monthly assessments as we are able to complete them. Much of our deep assessment work had to be suspended in early 2017 given the high number of alleggations against the US-led Coalition.

Chemical weapons in Syria

A new, detailed report from the BBC investigates the Assad regime’s strategic deployment of chemical weapons.  The joint investigation by the Panorama team and BBC Arabic determined ‘there is enough evidence to be confident that at least 106 chemical attacks have taken place in Syria since September 2013, when [President Assad] signed the international Chemical Weapons Convention (CWC) and agreed to destroy the country’s chemical weapons stockpile‘ (my emphasis).

The BBC team considered 164 reports of chemical attacks from September 2013 onwards. The reports were from a variety of sources considered broadly impartial and not involved in the fighting. They included international bodies, human rights groups, medical organisations and think tanks.

In line with investigations carried out by the UN and the OPCW, BBC researchers, with the help of several independent analysts, reviewed the open source data available for each of the reported attacks, including victim and witness testimonies, photographs and videos.
The BBC team had their methodology checked by specialist researchers and experts.
The BBC researchers discounted all incidents where there was only one source, or where they concluded there was not sufficient evidence. In all, they determined there was enough credible evidence to be confident a chemical weapon was used in 106 incidents.

Almost half the documented attacks were in Idlib and Hama; most casualties were recorded in Kafr Zita (in Hama) and Douma (in East Ghouta).  Aircraft were used in almost half the attacks, and the experts consulted by the BBC concluded that in the majority of cases it was overwhelmingly likely that the Syrian Arab Air Force was responsible.  In this connection, it is telling that:

Many of the reported attacks occurred in clusters in and around the same areas and at around the same times. These clusters coincided with government offensives – in Hama and Idlib in 2014, in Idlib in 2015, in Aleppo city at the end of 2016, and in the Eastern Ghouta in early 2018.

The report pays particular attention to the use of chemical weapons during the offensive against East Ghouta earlier this year – see my detailed analysis here; see also here – and provides a detailed map:

Panorama: Syria’s Chemical War will be broadcast in the UK on Monday 15 October on BBC One at 20:30. It will be available afterwards on the BBC iPlayer. It will also be broadcast on BBC Arabic on Tuesday 23 October at 19:05 GMT.

Trauma Geographies online

My Antipode Lecture on Trauma Geographies is now available online via YouTube.

(If you wonder why I’m hunched over my laptop, the microphone was fixed to the podium….).  Since I’m now turning this into an essay, I’d welcome any questions, comments or suggestions.

You can find more details  including open access to a series of related articles – at the Antipode Foundation website here.

Trauma geographies, woundscapes and the clinic

I returned from the RGS/IBG Conference in Cardiff to the start of term (which explains and I hope excuses my silence: I’ve updated my two course outlines for this term, and you can find them under the TEACHING Tab if you are interested; if you have any comments or suggestions I’d be happy to have them).

My next order of business is to turn my Antipode Lecture on “Trauma Geographies” into a text (the video will be online soon, I hope); I’ve already started on the translation, helped by questions and feedback from the presentation, and I’ll post the draft when it’s ready.

The argument moves from medical care and casualty evacuation in Belgium and France, 1914-1918 through Afghanistan 2001-2018 to Syria 2011-2018, and in each case I address both combatants and civilians.  Much of this trades on (and develops) posts that will be familiar to regular readers – and if you’re not the GUIDE tab ought to help direct you to the most relevant ones – but I’ve also returned to my ideas about corpography and used them to flesh out (sic) the concept of a ‘woundscape‘.  I decided to that because one of the themes of the conference was landscape, and the idea of a woundscape seemed to take that debate in a fruitful new direction.  I first encountered it in Jennifer Terry‘s brilliant Attachments to War, and she in turn found it in the work of Gregory Whitehead (particularly Display Wounds).

I’m drawn to the way in which both authors/performers try to coax wounds to speak, to read their violent ruptures of the body, and to transcend the typically narrowly bio-medical discourse that frames them.  At the same time, I don’t want to ignore that scientific framing, not least because it is profoundly performative and has such vital consequences (both physical and affective), so in my rendering a ‘woundscape’ is constituted through the explosive intersection of the military gaze (‘the target’) and the medical gaze (the injured body) but immediately spirals beyond those visual registers – and indeed beyond visuality – to include a range of other senses and sensibilities. A woundscape thus includes the bio-physical, cognitive and affective landscapes in which casualties are created, moved and treated.  The affective envelope that surrounds and invades the injured body is a constant concern; this extends beyond the casualty to a host of other actors – as Omar Dewachi shrewdly observes, when wounds travel they ‘enter new social worlds and multiple histories of violence’ – but I I focus on physical injury (rather than PTSD) because so many accounts of later modern war have represented it as what James Der Derian dubbed ‘virtuous’ war whose seeming remoteness is rendered as at once increasingly virtual, fought on and through screens and algorithms, and at the limit radically, absurdly disembodied. Against this, I’m trying to respond to John Keegan’s dismayed observation that the wounded – he included the dead too – ‘apparently dematerialize as soon as they are struck down…’

So here are the slides from my presentation that summarise my interim propositions about woundscapes, drawn from the three case studies; I’ll be revising and elaborating them as I proceed, but I hope this might start a conversation:

Finally, Omar’s wonderful essay that I cited earlier appeared in MATMedicine, Anthropology, Theory – and I would be remiss not to draw attention to its most recent issue.  The editorial on ‘Clinic and Crisis‘ by Eileen Moyer and Vinh-Kim Nguyen sends me back to the other essay I’m currently trying to finish, on “The Death of the Clinic“, which plainly intersects with ‘Trauma Geographies’:

A common thread runs through the articles of this issue of MAT: the conjoining of clinic and crisis. Here we refer, in the manner of Foucault (1963) to the clinic as both an epistemology (a way of knowing) as well as a material space where the ill seek care. Crises are moments of rupture, where the surface of everyday life splinters to reveal what lies underneath and new dangers can appear; they are also turning points where futures can be grasped and foretold. Moments of social crisis manifest in bodies, and therefore in the clinic. Das’s notion of ‘critical events’, as discussed in Affliction: Health, Disease, and Poverty and also taken up in MAT’s September 2017 issue, furnishes perhaps the most thorough consideration of crisis. As she and others have pointed out, crisis is an everyday reality for many who live in conditions of precarity and existential instability. More generally, the current geopolitical climate and the growing urgency of climate change contribute to the sense of crisis. The clinic is symptomatic of crisis, a place where a state of emergency becomes finally visible.

More soon – and I haven’t forgotten that I need to return to my series of posts on Ghouta and, in particular, to address the issue of medical care and casualty evacuation (or lack of it) there too.

Siege and forcible displacement

I’m now back at work on Syria and in particular the attacks on hospitals and healthcare (I’ll be drawing on some of this for my Antipode lecture in Cardiff next month).  More on that soon, but in the meantime there are two reports that (more than) deserve notice.

First, Siege Watch has produced its tenth quarterly report, and Part I is devoted to East Ghouta (February-April 2018).  Its 84 pages make for chilling reading:

Data collected during the quarter from a network of Eastern Ghouta contacts and other sources showed that:

At least 1,700 people were killed, 5,000 injured, and 158,000 displaced, leaving entire towns empty. In some areas, upwards of 90% of the structures were destroyed.

The brutal campaign created a ‘demonstration effect’ and was used to push other besieged areas to surrender with significantly less force.

At least eight suspected chemical attacks were launched against civilians and ghters in Eastern Ghouta during the reporting period. In total, an estimated 45 civilians were killed and nearly 700 injured in these attacks.

More than 65,000 people, most of them civilians, were forcibly displaced to Idlib and Aleppo in northern Syria as part of the final surrender agreements.

In the wake of the capture of Eastern Ghouta and Jobar by pro-government forces, there were reports of field executions, detentions, threats, and widespread looting. Thousands of men from Eastern Ghouta were forced into mandatory military service.

The end of the siege of Eastern Ghouta highlights the government’s demographic engineering strategy. Roughly 200,000 people remained in the enclave by the end of the reporting period – around half of the estimated population from before the offensive began, and just 18% of the area’s pre-war population.

I’ll draw on some of the details from the report in my later post.

Notice those forced displacements to Idlib, described as ‘an elaborately constructed killbox.’  The International Crisis Group recently published its first illustrated commentary, Voices of Idlib, which you can find here.