Health and the body politic

This fall Middle East Report – described by Rashid Khalidi as ‘the best periodical (in English) on the Middle East—bar none’ – from the truly outstanding Middle East Research and Information Project became open access..\

Its latest issue, Health and the Body Politic, (Winter 2020), is available now:

Health and health care have become increasingly ungoverned over the past few decades, in tandem with a broader breakdown of the body politic. Health care workers are finding it increasingly difficult to work in settings of violent conflict and insecurity, rapidly declining health care systems, pervasive corruption and widespread economic mismanagement—all amidst the waning capacity of states to improve the health and wellbeing of their populace. While the Middle East region trains a lot of doctors, few end up staying. The winter issue of Middle East Report explores the interactions of the body politic with health and medicine and examines the entanglements of physical bodies in the institutional and political processes that govern them. The articles in this issue explore a range of different landscapes and ecologies of politics and health care, bringing the questions and problems of health and illness into the analysis of geopolitics and political economy.

Contents:

The Evolution of Conflict Medicine in the Middle East – An Interview with Ghassan Abu Sittah
Ghassan Abu Sittah, Omar Dewachi, Nabil Al-Tikriti
The Long Shadow of Iraq’s Cancer Epidemic and COVID-19 Mac Skelton
Syrian Refugees Navigate Turkey’s Shifting Health Care Terrain Nihal Kayali
Hepatitis C, COVID-19 and the Egyptian Regime’s Approach to Health Care Jennifer Derr
The Dilemmas of Practicing Humanitarian Medicine in Gaza Osama Tanous
Illness as Metaphor and Reality in Syria Noura Chalati
COVID-19 Exposes Weaknesses in Syria’s Fragmented and War-Torn Health System Aula Abbara

Nature and Politics in the Middle East

A new edition of the Middle East Research and Information Project (MERIP)’s Middle East Report is now available online and OPEN ACCESS here:

The coronavirus pandemic is vividly highlighting the fundamental links between people, health and the environment. This issue on nature and politics probes the essential but also sometimes fraught relationships between people and their environments in the Middle East. It provides insights into crucial issues of energy, water and climate change and the political struggles between states and their citizens over environmental stewardship, sovereignty and the allocation of resources. It also takes us into spaces of human-environment interaction that are not so commonly discussed—bird markets, Iraqi landscapes contaminated with toxins, sinkholes around the Dead Sea and Turkish wetlands teeming with wildlife. Through these contributions, “Nature and Politics” offers a critical take on contemporary challenges across the Middle East.

Issue Editors: Jessica Barnes and Muriam Haleh Davis with Guest Editor Sophia Stamatopoulou-Robbins


Water in the Middle East: A Primer
Jessica Barnes
On Blaming Climate Change for the Syrian Civil War
Jan Selby
Global Aspirations and Local Realities of Solar Energy in Morocco
Atman Aoui, Moulay Ahmed el Amrani, Karen Rignall
Birth Defects and the Toxic Legacy of War in Iraq
Kali Rubaii
Bird Markets, Artisanal Pigeons and Class Relations in the Middle East
Bridget Guarasci
The Unintended Consequences of Turkey’s Quest for Oil
Zeynep Oguz
Terra Infirma – Dead Sea Sinkholes – A Photo Essay
Simone Popperl
The Lost Wetlands of Turkey
Caterina Scaramelli
“Algeria is not for Sale!” Mobilizing Against Fracking in the Sahara
Naoual Belakhdar
An Interview with Sophia Stamatopoulou-Robbins
Tessa Farmer
“Turkey Wants to be Part of the Nuclear Club” An Interview with Can Candan
Kenan Behzat Sharpe

The Arab Archive

News via the War & Media Network of an important collection of essays edited by Donatella Della Ratta, Kay Dickinson and Sune HaugbolleThe Arab Archive: Mediated Memories and Digital Flows.  It’s available as a free pdf or e-book download here.

As the revolutions across the Arab world that came to a head in 2011 devolved into civil war and military coup, representation and history acquired a renewed and contested urgency. The capacities of the internet have enabled sharing and archiving in an unprecedented fashion. Yet, at the same time, these facilities institute a globally dispersed reinforcement and recalibration of power, turning memory and knowledge into commodified and copyrighted goods. In The Arab Archive: Mediated Memories and Digital Flows, activists, artists, filmmakers, producers, and scholars examine which images of struggle have been created, bought, sold, repurposed, denounced, and expunged. As a whole, these cultural productions constitute an archive whose formats are as diverse as digital repositories looked after by activists, found footage art documentaries, Facebook archive pages, art exhibits, doctoral research projects, and ‘controversial’ or ‘violent’ protest videos that are abruptly removed from YouTube at the click of a mouse by sub-contracted employees thousands of kilometers from where they were uploaded. The Arab Archive investigates the local, regional, and international forces that determine what materials, and therefore which pasts, we can access and remember, and, conversely, which pasts get erased and forgotten.

It includes several vital, thoughtful and thought-provoking essays that address the political and ethical questions surrounding the use, abuse and circulation of images from the Syrian war.  I particularly recommend Mohammad Ali Atassi, ‘The digital Syrian archive between videos and documentary cinema’ – which en route draws on Judith Butler‘s critical reading of Susan Sontag, and on Stefan  Tarnowski‘s ‘What Have We Been Watching? What Have We Been Watching?’ (which makes important distinctions between poetic images, forensic images and commodity images from Syria) – Enrico de Angelis, ‘The controversial archive: negotiating horror images in Syria’, Hadi al Khatib, ‘Corporations erasing history: the case of the Syrian Archive‘, and Donatella Della Ratta, ‘Why the Syrian archive is no longer (only) about Syria.’

Bringing the war home (with apologies to Martha Rosler)

We know how often the vocabulary of medicine has been hi-jacked to describe military violence (‘surgical strikes’ and the rest) – if you are unfamiliar with the trope, I recommend Colleen Bell’s two essays, ‘Hybrid warfare and its metaphors’, Humanity 3 (2) (2012) 225-247, and ‘War and the allegory of medical intervention’, International Political Sociology 6 (3) (2012) 325-8 – and, for that matter, the reverse: see Mark Harrison‘s classic essay, ‘The medicalization of war – the militarization of medicine’, Social History of Medicine 9 (2) (1996) 267–276.

The most obvious example of the latter is Trump’s grotesque self-inflation as a ‘war-time president‘ defeating the ‘Chinese virus’ (the racialization of epidemic disease has a long history too: think of European panic over the ‘Asiatic’ or ‘Indian cholera’ in the nineteenth century).  Another example, grotesque for entirely other reasons – which have to do with the mendacious incompetence of the US feral government – are descriptions of scenes in hospitals in New York City as war-zones where front-line doctors and nurses desperately struggle to treat and care for patients with Covid-19 while fighting for their own lives.  (For brief but insightful commentaries on these issues, on the performative work done by these metaphors, see Yasmeen Serhan at The Atlantic here and Eric Levenson at CNN here).

None of this is confined to the United States, I realise, and the questions that swirl through these metaphors (through which the virus becomes both a biopolitical and a social agent, infecting not only bodies and populations but also our imaginative geographies) reappear in still starker form once we think – in obdurately non-metaphorical terms – about the likely course of Covid-19 in war zones like Gaza, Iraq, Syria and Yemen where hospitals and clinics have been deliberately and systematically targeted, doctors and nurses killed, and the lives of desperately vulnerable populations inside and outside refugee camps made even more precarious (I’ll try to address this in detail in a later post, but see here and here).

All this is on my mind, a jumbled series of thoughts, impressions and emotions, as I sit at home – privileged and relatively safe – doing my best to practice physical distancing, and read this imaginative call for contributions from Warscapes.

We find ourselves in a truly challenging moment as this coronavirus pandemic becomes a long and difficult daily reality. Not only are our individual lives feeling severely compromised but the massive structural shifts are beyond despairing — the shocking death toll, the triumph of surveillance structures, the displacements, the police brutality, curfews, imminent starvation, mass unemployment…the list is long. We know that many of you have survived war, reported on war or lived through intensive periods of violence, scarcity and uncertainty. Perhaps you find yourself working through tangled memories of all kinds of warscapes. Perhaps some of you have no luxury of memory and have been thrown into the pandemic as doctors, social workers, aid workers, teachers, activists. Perhaps some of you have seen this as a welcome respite from a deeply pressured life and are enjoying time with family. Perhaps some are in an intellectual overdrive as our fight against inept governments and greedy capitalist systems intensifies. And perhaps some of you are quite ill and we wish you love and speedy healing. Whatever mood or situation you find yourself in, we are somehow all in this together processing our new reality, wittingly or unwittingly.

Unsurprisingly, there is an uptick in war rhetoric during this pandemic and since this is an online space dedicated to reflecting on the world through the “lens of war” we are launching a Warscapes video segment tentatively titled “Open Call: The Corona Notebooks.” If you are willing and able, we would love it if you could record a 2-3 minute video of yourself thinking about this pandemic, maybe accessing a previous memory, maybe reporting on an injustice, maybe narrating a sweet fragment from your daily life, maybe recounting a second chance that this pandemic gave you, maybe telling us about a loved one you reconnected with, maybe you’ve seen a movie or read a book that was powerful, maybe telling us about having the illness. The tone, the tale, the genre and the language is yours to choose. There is an overwhelming amount of news and information but we will together weave an emotionally vibrant and artistic tapestry.

We will simultaneously transcribe these and start publishing them online as well. And when/if/after this is all over, we can publish all the entries and either give them away as free chapbooks or see if it can go towards a relief effort. For those that are available and happy to do facebook/instagram live events, we will happily make this an event with audience interaction and allow for discussions centering around your piece.

Simple rules:

1. WIDESCREEN recording — Flip your phone to widescreen. Do NOT shoot in vertical.

2. CLEAR SOUND — Make sure the sound is clear, our world has been quiet so this should be easy.

3. PLAN IN ADVANCE — While informal, casual and intimate is great, it would be better write your piece down, work through it before recording, experiment with form, play with the visual. We would prefer to keep editing to the minimal.

4. TWO MINUTES MINIMUM — your entry should be at least 2 minutes long, no stipulations for maximum length.

5. Send videos to bhakti [dot]shringarpure[at]gmail [dot]com

If you too are sitting at home, weary of yet another Zoom meeting, and wondering what (else) you might do, then perhaps you might like to give this a try…

For Sama

For Sama – see my posts here and here – is now available on YouTube:

Sama is the daughter of the film-maker Waad al-Kateab and her husband Hamza, a hospital doctor and one of 32 who remained in East Aleppo.

For Sama was shot in East Aleppo; it begins in the early days of the rising against the Assad regime and focuses on life in and around two hospitals during the siege.

‘Sama’, we are told,

‘means the sky…. the sky we love, the sky we want… without airforces, without bombing… the sky with sun, with clouds, with birds…’

After their original hospital was destroyed in an airstrike – one of the doctors killed was Muhammad Waseem Maaz, who had delivered Sama (see also here and the slides for Death of the Clinic under the TEACHING tab) – they were able to move to a building ‘designed to be a hospital’ but never used and ‘not on any maps so the Russians and the regime wouldn’t know where to bomb…’

It would be the last hospital left functioning in East Aleppo, treating almost 300 patients a day.

‘Even when I close my eyes I see the colour red.  Blood everywhere.  On walls, floors, our clothes.  Sometimes we cry blood.’

 

The exception to the exception

There is a stunning report (including an extended video) in today’s New York Times providing detailed evidence of Russian jets systematically attacking four hospitals in Syria in just twelve hours on 5/6 May 2019.

As regular readers will appreciate, this is a fraction of the total number of attacks on hospitals and clinics by Russian and Syrian aircraft – see my analysis in ‘Your turn, doctor’ here,  ‘Death of the Clinic’ here and a stream of subsequent posts.

There have been other attempts to attribute culpability in the past – I’m thinking here of visual analysis by bellingcat and Forensic Architecture, for example – and, as the NYT notes, ‘recklessly or intentionally bombing hospitals is a war crime, but proving culpability amid a complex civil war is extremely difficult, and until now, Syrian medical workers and human rights groups lacked proof.’  What distinguishes this (brilliant) investigation is the incorporation of flights logs and intercepts of radio communications from the Russian Air Force that for the first time clearly and unambiguously show that these air strikes were deliberate, systematic and relentless attacks on known hospitals.

Here is the first attack analysed by the NYT; I’ve grabbed the images from the accompanying video..

Nabad al Hayat had been attacked three times since it opened in 2013 and had recently relocated to an underground complex on agricultural land, hoping to be protected from airstrikes.

At 2:32 p.m. on May 5, a Russian ground control officer can be heard in an Air Force transmission providing a pilot with a longitude and latitude that correspond to Nabad al Hayat’s exact location.

At 2:38 p.m., the pilot reports that he can see the target and has the “correction,” code for locking the target on a screen in his cockpit. Ground control responds with the green light for the strike, saying, “Three sevens.”

At the same moment, a flight spotter on the ground logs a Russian jet circling in the area.

At 2:40 p.m., the same time the charity said that Nabad al Hayat was struck, the pilot confirms the release of his weapons, saying, “Worked it.” Seconds later, local journalists filming the hospital in anticipation of an attack record three precision bombs penetrating the roof of the hospital and blowing it out from the inside in geysers of dirt and concrete.

The staff of Nabad al Hayat had evacuated three days earlier after receiving warnings and anticipating a bombing [which is how journalists came to be on site to film the strike].

Another attack – detailed in the accompanying video – was on the Kafr Zita Cave Hospital (see also here).

As I’ve explained elsewhere, spaces of exception are not confined to the camp (as Agamben and others claim); war zones are also spaces in which particular groups of people are knowingly and deliberately exposed to death by removing the legal protections that would ordinarily safeguard them.  But these are not legal ‘black holes’ either.  The removal of those protections is itself (in part) the product of legal manoeuvers and, in the case of Syria, sleight of hand: Assad’s counterterrorism laws criminalised all medical aid to the opposition.  That legal armature extends beyond domestic legislation: international humanitarian law and other quasi-legal formularies (including Rules of Engagement) are supposed to afford a modicum of protection to civilians.  But throughout, hospitals and clinics are supposed to be ‘exceptions to the exception’: attacks on them, their staffs and patients are explicitly proscribed under IHL.

I’m bringing all these materials together – from attacks on hospitals on the coast of France and the Western Front in the First World War through Afghanistan (here and here) and Syria – in a major new essay: more soonest, though like most of my essays these days it threatens to metamorphose into a small book….

That essay will also elaborate the claims set out in the summary image above.  One of the crucial points to sharpen, I think, is that the exception often appears earlier in time and distant in space from the enclosed contours of the camp or even the war zone that has replaced the traditional ‘battlefield’.  I’m thinking here (in the case of the camp in the Second World War) on the systematic denigration of the Jews, the restrictions imposed on their life and movement in occupied cities, the roundups and detentions (see my lecture on occupied Paris under the TEACHING tab), their confinement to ghettoes: all of this in advance of their brutal transportation to the death camps hundreds of miles distant.  If we don’t draw attention to those preliminary steps – if we fail even to recognise them – then it will be too late: the gates of the camp will clang shut.

What has this to do with hospital attacks?   Quite simply:  if the preliminary de-certification of hospitals and doctors in opposition-held areas is allowed to pass unchallenged, if we fail to contest the claim that these are ‘so-called hospitals’ and ‘so-called doctors’ (a familiar tactic of the Assad regime and its apologists), if we fail to respect medical neutrality,  then the exception to the exception will vanish: hospital attacks will have been normalised.

Underground medicine

In my work on attacks on hospitals in Syria I’ve drawn attention to the remarkable Central Cave Hospital (see also here and here) – and to what it says about a war when hospitals have to be excavated deep into the ground in a desperate attempt to protect them from airstrikes.

That hospital – formally, the Al Maghara (Dr Hasan al Araj) Hospital – was excavated in the side of a mountainside at Kafr Zita in Hama and opened in October 2015.  The Syrian-American Medical Society had originally proposed to build the hospital in the heart of the city, but local residents feared that doing so would turn them into targets for airstrikes.

Yet going outside and underground provided only limited protection: the hospital was repeatedly targeted by Russian and Syrian aircraft (see here and here and the videos shown by Jake Godin on Twitter here).

But as Saving Lives Underground noted (in a report co-produced with SAMS, dated May 2017), there were other cave hospitals in Syria.  Compared to basement hospitals, the cave hospital is

‘a more effective protective model, in which medical facilities are built into caves carved into the side of a mountain. This model provides reasonable protective measures, but has limited feasibility as it can only be constructed in environments that contain mountains. It requires securing the entrance to the hospital, creating an emergency exit, and ensuring ventilation, but is a comparatively inexpensive model as it relies on the existing base structure of the mountain. This model has proven to be effective when designed properly and laid out with attention to details… The largest cave hospital in Syria is the Central Cave Hospital, which is 500 – 600 meters large, contains three operating rooms, and houses a range of services…’

(The most expensive model involved ‘building a new, completely underground facility. A hospital is built several meters below the surface, has a thick, reinforced concrete frame, and is covered by protective ground backfill to create the additional layer of safety. The advantage of this model is that it can be replicated anywhere with few modifications because of its standard design. However, as it involves the construction of a completely new structure, it is the most expensive model and requires the longest time to completion.’)

So there have been other cave hospitals.  Now the Toronto International Film Festival features a new documentary by the co-director of the award-winning Last Men in Aleppo, writer-director Feras Fayyad, called The Cave.  This was shot at another Cave Hospital in East Ghouta between 2016 and 2018 (for background, see my posts on the siege of Ghouta here and here).

Here is the Q&A with the cast and crew at TIFF:

The Cave should be shown in theatres in the fall, and (as you can see from the trailer below) is co-sponsored by National Geographic and will appear in its new documentary line-up:

The Cave follows another documentary on the work of doctors, nurses and patients under siege in Assad’s (and Putin’s) Syria, For Sama: see my notice here.

Like For Sama it too draws attention to the multiple ways in which gender and patriarchy play out in these desperate circumstances.  The Cave is run by a woman, Dr Amani Ballor, and one reviewer notes: ‘When one man shows up to get medicine for his wife, he lectures the staff that women should be “at home with the family,” not running a hospital. “We voted twice,” says a male doctor on staff. “She won both times.”’

Or again, in a detailed review of the film, Eric Kohn writes:

What makes this determined young woman tick? Speaking through a voiceover that guides the narrative along, Amani recalls growing up under “a racist and autocratic regime,” and how the war drove her to “respond to the terrible reality” through her work. At one point, a male relative of one of her patients confronts her, demanding a man be in charge. When one of Amani’s peers comes to her defense, the showdown serves as a keen snapshot of the doctor’s struggle on several fronts. Beyond encapsulating the city’s devastation, “The Cave” is an implicit critique of a war-torn society still at the mercy of antiquated values. Even in this desperate moment, her selfless acts face backlash from stern traditionalists. With nothing to lose aside from the hospital itself, Dr. Amani has no qualms about speaking her mind. “This religion is just a tool for men,” she says.

Writing in Variety, Tomris Laffly describes Dr Amani working with two other women, Dr Alaa and a nurse Samaher, as a vital thematic arc of the film:

In the end, it is the feminine camaraderie and understanding that stands tall as the backbone of the film and perhaps even the entire operation. Despite having their physical safety incessantly threatened — above the ground, there is nothing but a wasteland of a city nearly flattened by bombs — and capability repeatedly questioned by male patients, the trio of women somehow manages to carve out an alternative space for themselves. In that, they criticize religion as an enabler of falsely perceived male superiority and work side-by-side with male colleagues as equals, even if their parity comes as a consequence of the desperate aboveground circumstances.

Much to think about here, clearly: another of the essays on which I’m still working, converting these various posts into long form (and always, so it seems, into very long form!), recovers the genealogy and the geography of hospital attacks in modern war – from the bombing of hospitals on the Western Front in the First World War (there’s a preliminary version here, but I’ve since done much more work) right through to the US bombing of the MSF Trauma Centre in Kunduz (see here and here) and the continuing attacks on medical care in Syria.  I’ll do my best to keep you posted.

Siege on film

Two new films about sieges in later modern war…. tragically not the contradiction in terms you might think.

The first is a documentary about Syria, For Samawhich won the prize for Best Documentary at Cannes this year (and has garnered a host of other awards, including the Special Jury Prize for International Feature Documentary at the Hot Docs Festival).

Here is G. Allen Johnson in the San Francisco Chronicle – and, given my work on the Assad regime’s systematic attacks on hospitals and medical care you will see why this is so important to me:

The civil war in Syria is horrific, is killing innocent civilians and is an ongoing humanitarian crisis. It could make you lose your faith in humanity, and who could blame any residents there if they did?

And yet, out of the ashes of conflict comes “For Sama,” a remarkable documentary  … about a doctor struggling to care for civilian war casualties in a makeshift hospital in the Syrian rebel stronghold of Aleppo, his journalist wife who documents it, and their infant daughter.

It is hard-hitting and graphic — some scenes cause you to look away. Yet it’s also loving and warm, a remarkable blend of reporting, cinema verite and essay not to be missed.

Waad Al-Khateab, who sent footage and reports from Aleppo to Channel 4 in London, also shot much personal footage. She and British filmmaker Edward Watts, who is credited with her as director, shaped the footage into the story of her family in the form of an essay. Her narration speaks to her daughter Sama — an explanation of why she and her husband Hamza stayed instead of taking her to safety.

“I need you to understand why your father and I made the choices we did,” Waad says.

The answer is they believe in freedom and humanity. Waad began covering the outbreak of civil war as a student in 2011. Hamza is a doctor who must save every life he can. “This is our path, this is our life,” he tells Waad.

The bulk of the film takes place in 2016, when constant bombing by forces loyal to Syrian President Bashar Assad— which include Russian aircraft — turn much of the city into rubble. The dead and wounded number in the thousands.

So there are intense, bloody scenes in the E.R., where lives are lost and saved. Meanwhile, Sama is being raised with the constant sound of exploding bombs. Waad does her best to comfort and raise her.

The family loses their beautiful home in the shelling, and eventually Hamza’s hospital is also destroyed (Assad’s forces specifically targeted places such as hospitals). Hamza and his team locate a building that would not be on Assad’s maps that would be suitable as a makeshift hospital — and home, as they will all live there — buttressed by thousands of sandbags as buffer against bombs.

Teo Bugbee in the New York Times adds:

“For Sama” provides a coherent account of a humanitarian crisis from the perspective of the wounded and displaced.

But just as crucially, and perhaps more compellingly, al-Kateab’s reflexive filmmaking provides an uncannily relatable example of the mundane experience of war. Profound bravery exists alongside profound ordinariness; friends still gather for dinner, they still tell their children bedtime stories, they still have to cook and clean and sleep.

The activists of this film, including al-Kateab herself, don’t speak in the language of philosophers or politicians. Their quotidian aspirations — to build a garden, to send their children safely to school — demonstrate the brutality of the government’s response, but they also invite viewers to picture themselves in the shoes of these modest political dissidents. Unselfconsciously, “For Sama” prompts audience members to ask themselves: How long would you defy tyranny if your world was coming down around you?

You can find a conversation with the film-makers here and (especially) here, and more reviews at the Intercept here and from the great Roger Ebert here.

The second film is Garry Keane and Andrew McConnell’s Gaza:

It’s hard to imagine anybody living a normal life in the Gaza Strip. Frequently labeled as the world’s largest open-air prison, it makes an appearance on news reports every time a confrontation erupts between Israel and Hamas. From TV sets thousands of miles away, this tiny piece of land has been reduced to an image of violence, chaos and destruction. So what do the people do when they’re not under siege?

The Gaza which is seldom seen is ordinary, everyday Gaza, a coastal strip which measures just twenty-five miles by six and which is home to an eclectic mix of almost two million people. Gaza cannot be understood in a purely political context or by analyzing tragic sound bites during conflict. It can only be understood by immersion, by living amongst its people and by recognizing and exploring its rich social diversity and cultural subtleties.

 

GAZA will introduce the audience to the surprising and the unexpected, the unfamiliar stories that portray its true face. It takes an atypical approach to finding out what makes this remarkable place tick as it introduces to the world extraordinary stories of everyday characters leading ordinary lives.

GAZA depicts a people plagued by conflict but not defined by it and as we journey through the physically broken and battered landscape, we let our cast of characters speak for themselves. Through them we gain a nuanced understanding of what life is really like for its citizens and by extension, grow and foster a rare familiarity and affinity with this truly unique place, as we build towards a tender portrait of a beleaguered humanity.

 

More here and here and (especially) here.

I’ve written about siege warfare in an extended series of posts (here, here, here and here). You can find my posts on Gaza by using the GUIDE tab (above), and I really recommend Ron Smith‘s excellent work on siege warfare in Gaza: Healthcare under siege: ‘Geopolitics of medical service provision in the Gaza Strip’, Social science and medicine 146 (2015) 332-40; ‘Isolation through humanitarianism: Subaltern geopolitics of the siege on Gaza’, Antipode 48 (2016) 750-759; ‘Israel’s permanent siege of Gaza’. Middle East Report 290 (2019) here

Paper trails

For an update and succinct review of attacks on hospitals and medical facilities in Syria – see also my ‘Your turn, doctor’ here – I recommend the latest fact-sheet from Physicians for Human Rights:

Attacks on health care, in gross violation of humanitarian norms and the Geneva Conventions, have been a distinctive feature of the conflict in Syria since its inception. PHR has documented and mapped 553 attacks on at least 348 separate facilities from March 2011 through December 2018. The reduction in the number of attacks over the past year is a clear reflection of the diminishing intensity of the conflict, which came as a direct result of the Syrian government’s takeover of most opposition-held areas. The systematic targeting of health facilities has been a crucial component of a wider strategy of war employed by the Syrian government and its allies – who are responsible for over 90 percent of attacks – to punish civilians residing in opposition- held territories, destroy their ability to survive, and draw them into government-held areas or drive them out of the country. This strategy of unbridled violence – which in addition to attacks on healthcare has included chemical strikes, sieges, and indiscriminate bombing of predominantly civilian areas – has devastated the civilian population, weakened opposition groups, and translated into direct military gains for the Syrian government.

Of the total number of documented attacks on health facilities, nearly 73 percent were carried out from the air. Nearly 98 percent of attacks on health facilities perpetrated from the air are attributable to the Syrian government and its ally Russian, which entered the conflict in 2015.

The share of attacks on health facilities from the air has grown from 38 percent of the total in 2012 to 90 percent in 2018. The Syrian government became steadily more reliant on airpower as the conflict evolved. Through their air forces, the Syrian government and Russia extended their strategy of collective punishment deep into opposition-held territory and far beyond hardened front lines. The Syrian government and its allies disabled or destroyed hundreds of facilities through aerial bombardment, leaving countless civilians without access to vital medical services.

The latest 20-page report from the Independent International Commission of Inquiry on the Syrian Arab Republic to the UN’s Human Rights Council is here.  I’ve drawn on many of these reports for my continuing work on siege warfare in Syria (see for example here, here and here), and this report – based on investigations carried out from 11 July 2018 to 10 January 2019 – makes for grim reading.  Here is the summary (but you really need to consult the full report):

Extensive military gains made by pro-government forces throughout the first half of 2018, coupled with an agreement between Turkey and the Russian Federation to establish a demilitarized zone in the north-west, led to a significant decrease in armed conflict in the Syrian Arab Republic in the period from mid July 2018 to mid January 2019. Hostilities elsewhere, however, remain ongoing. Attacks by pro-government forces in Idlib and western Aleppo Governorates, and those carried out by the Syrian Democratic Forces and the international coalition in Dayr al-Zawr Governorate, continue to cause scores of civilian casualties.

In the aftermath of bombardments, civilians countrywide suffered the effects of a general absence of the rule of law. Numerous civilians were detained arbitrarily or abducted by members of armed groups and criminal gangs and held hostage for ransom in their strongholds in Idlib and northern Aleppo. Similarly, with the conclusion of Operation Olive Branch by Turkey in March 2018, arbitrary arrests and detentions became pervasive throughout Afrin District (Aleppo).

In areas recently retaken by pro-government forces, including eastern Ghouta (Rif Dimashq) and Dar’a Governorate, cases of arbitrary detention and enforced disappearance were perpetrated with impunity. After years of living under siege, many civilians in areas recaptured by pro-government forces also faced numerous administrative and legal obstacles to access key services.

The foregoing violations and general absence of the rule of law paint a stark reality for civilians countrywide, including for 6.2 million internally displaced persons and 5.6 million refugees seeking to return. For these reasons, any plans for the return of those displaced both within and outside of the Syrian Arab Republic must incorporate a rights- based approach. In order to address effectively the complex issue of returns, the Commission makes a series of pragmatic recommendations for the sustainable return of all displaced Syrian women, men and children.

A report from Elizabeth Tsurkov in Ha’aretz confirms many of these findings.  Describing Assad’s Syria as a police state with rampant poverty’ and a ‘playground for superpowers’, she writes:

Eight years into the crisis, Syria’s economy is in tatters, half of its population displaced, hundreds of thousands of Syrians are dead, many of Syria’s cities and towns lie in ruins. Yet on top of this pile of ashes Assad sits comfortably, quite secure in his grip on power.
In areas reconquered by the regime — or as the regime euphemistically describes it, areas that “reconciled” and whose residents “returned to the bosom of the nation” — the Syrian police state is back, more aggressive than ever…

In 2011, Syrians took pride in “breaking the barrier of fear.” But fear now prevails, as the various branches of the regime’s secret police launch raids and arrest suspected disloyal elements. Many of those arrested are former activists, rebels, health and rescue workers, and civil society leaders. Syrians who wish to prove their loyalty to the regime, obtain power through it or simply settle personal scores inform on others to the regime. Suhail al-Ghazi, a Syrian analyst based in Istanbul, told Haaretz that Syrians are informing on each other “because they have been doing it for years or because they need money or favors from the regime.” In areas recently recaptured by the regime, “some locals were always pro-regime and stayed there to work as informants or just could not leave. Now they have the chance to take revenge on the majority of civilians who apparently held a more favorable view of the opposition,” Ghazi explained.

Most of Syria’s population now lives below the poverty line. Across all parts of Syria unemployment rates are high, as the normal economy has been disrupted by years of war and the mass flight of businesspeople and capital out of the country. Syria’s middle class has largely disappeared — many of them fled to neighboring countries or Europe, while others are now living in abject poverty, along with most Syrians.
A small group of war profiteers linked to the various armed groups have been able to enrich themselves by trading in oil, weapons, antiquities, stealing aid, and smuggling people and goods in and out of the country and into besieged areas, while most Syrians struggle to survive. Nearly two-thirds of Syrians are dependent on aid for their subsistence. Basic services like electricity, cooking gas, clean water and health services are lacking in many parts of the country.

Speaking on the condition of anonymity, a resident of Latakia — an area where many of the regime’s leadership and their relatives reside — told Haaretz: “You have corruption everywhere. Bribing was common before the war, but now it is endemic.”
He described the ostentatious displays of ill-gotten wealth: “High-ranking officials, they and their families, have more rights. They roam the city in fancy cars and do whatever they want. Half of the country is dying from hunger, while the sons of officials are arrogantly showing off their wealth. With money you can do everything. This is not new, but it has become more obvious because of the lawlessness prevailing in Syria.”

At the sub-regional scale Enab Baladi filed a revealing report last month on conditions in the Ghouta (which it describes as ‘military-ruled ruins’):

Today, Ghouta is living in a state of siege similar to that it witnessed between 2013 and 2018 at the service, relief and security levels, but the difference is that food is available.

With dozens of announcements about the restoration of electricity to areas east of the capital, as well as the restoration of water and communication services, the needs of civilians are still not covered by those services repeatedly announced by the regime.

Enab Baladi spoke to five people from the eastern Ghouta who returned to it, all of whom refused to be identified for fear of the regime prosecution. They described the service situation as “miserable”, especially with regard to the water and electricity services.

According to the five sources, the electricity is continuously cut for five hours, operates for only one hour, and then it is cut again, while water reaches homes one hour a day, and people rely on submersibles and artesian wells which they dug during siege in the previous years to get water.

Some areas of Ghouta also lacked many of the services that were the top priorities of organizations before the regime forces controlled the region, while food today enters without manipulated prices, unlike in the past….

The report describes Eastern Ghouta as riven by checkpoints; an emphasis on demolition rather than reconstruction; and continuing arrests and detentions.

In early August [2018], al-Assad forces launched a campaign of arrests, which has been considered as one of the largest security operations since the regime took over Ghouta, for it has targeted the regime dissidents and activists in the Syrian revolution. The campaign was carried out in the cities and towns of Saqba, Hamuriyah, Duma, Mesraba, and Ein Tarma.

The regime also subjected local activists, civil society workers, and former media professionals, as well as members of local councils and relief agencies, to investigations into the aids they received when the area was held by the opposition.

Security branches launched arrest campaigns targeting members of the former “local council” and other members of Rif-Dimashq Provincial Council in the city of Kafr Batna in central Ghouta, according to Enab Baladi referring to local sources.

Sources affiliated to the council told Enab Baladi that Syrian security forces raided the houses and workplaces of the detainees before taking them to an unknown destination. Other local council members, who preferred to stay in Ghouta rather than go to northern Syria, are detained for the same reasons.

In the face of all that, it’s not easy to find grounds for optimism, but there is a glimmer of hope in a report from Maryam Saleh at The Intercept:

Syrian activists and lawyers are testing the bounds of international law, making two new attempts to bring the government of Bashar al-Assad before the International Criminal Court.

Syrian refugees in Jordan, through London-based lawyers, sent communications to the office of the ICC prosecutor, asking her to exercise jurisdiction over Syria based on a precedent set last year in a case involving Myanmar’s persecution of Rohingya Muslims. The communications are the latest push by Syrian civilians to hold accountable the government whose brutality upended their lives. In recent years, Syrian lawyers and human rights activists have experimented with rarely utilized aspects of international law, succeeding in getting European and American courts to weigh in on atrocities committed in Syria.

“Because of how politicized the war in Syria became, lawyers and those fighting for accountability really had to be creative,” said Mai El-Sadany, the legal and judicial director at the Washington-based Tahrir Institute for Middle East Policy. “The most recent ICC Article 15 submissions” — a reference to communications with the ICC on information about alleged international crimes — “are evidence of this, that there is space for creativity in the accountability space.”

She continues:

Even when the evidence of potential crimes exists, investigations into crimes committed in states that have not ratified the Rome Statute are near impossible because of jurisdictional issues, and U.N. Security Council members are quick to use their veto power to block investigations into crimes potentially committed by their allies.

That’s what makes the various avenues Syrians are pursuing so significant. As of last March, more than two dozen cases had been filed in European courts regarding atrocities committed by the Syrian regime, rebel fighters, and the Islamic State and other fundamentalist militant groups. The family of Marie Colvin, an American journalist killed in 2012 while reporting from the city of Homs, sued the Syrian government in a U.S. district court; in January, the court found Syria responsible for killing Colvin.

Many of the cases in Europe were brought under a legal doctrine known as universal jurisdiction; application of the doctrine varies from country to country, but it essentially allows for courts to prosecute cases regardless of where the crime was committed or whether the accused party has any links to the prosecuting state.

The biggest success so far has been in Germany, where authorities last month arrested a former high-ranking Syrian intelligence officer and two others who are accused of crimes against humanity for torturing detainees in Syrian prisons. Other cases remain pending in France, Sweden, and Spain….

These attempts are possible in part due to an unprecedented level of documentation of crimes in Syria. The victims in some of the cases were identified from a trove of 28,000 photos of people killed in Syrian detention centers, smuggled out of the country by a military defector codenamed Caesar. The U.N. General Assembly, in December 2016, took the step of creating the International, Impartial, and Independent Mechanism to investigate crimes in Syria since 2011. The IIIM, as the body is known, does not have independent prosecutorial authority, but it exists to collect information that could later be provided to courts or tribunals with jurisdiction over the crimes. Last year, 28 Syrian nongovernmental organizations committed to collaborating with the IIIM on its work.

This is heartening in its way, but whenever I’ve been asked about attempts to enforce accountability in relation to the systematic attacks on hospitals, I’ve had to say that the hideous intimacy between torturer and tortured allows for an identification and assignment of culpability that is much more difficult in the case of the extended ‘kill-chain’ involved in bombing.

But that doesn’t mean it’s impossible: we know, from the courageous work of activists cited in Maryam’s report, that Assad’s security apparatus fetishized record-keeping, and that many of those records have been smuggled out of Syria so that they can now serve as testimony and evidence  (For other testimonies, see the work of Forensic Architecture on Saydnaya Prison that I described here: scroll down).  To sharpen the point, hare some of the slides from a presentation I once gave around precisely these questions:

If my work on bombing in other theatres of war is anything to go by, there will also be extensive trails (paper or digital) that animated the air strikes: though how they can ever be exposed is another question.

War Doctor

I’m still converting my ‘Trauma Geographies‘ lecture into an essay – which has involved writing a prequel of sorts, ‘Woundscapes of the Western Front‘ – so, with my head buzzing with first-person accounts of trauma surgery on the front-lines, I was thrilled to see that David Nott has just published an account of his marvellous work in Syria (and many other conflict zones), War Doctor: Surgery on the Front Line (Pan Macmillan):

For more than twenty-five years, David Nott has taken unpaid leave from his job as a general and vascular surgeon with the NHS to volunteer in some of the world’s most dangerous war zones. From Sarajevo under siege in 1993, to clandestine hospitals in rebel-held eastern Aleppo, he has carried out life-saving operations and field surgery in the most challenging conditions, and with none of the resources of a major London teaching hospital.

The conflicts he has worked in form a chronology of twenty-first-century combat: Afghanistan, Sierra Leone, Liberia, Darfur, Congo, Iraq, Yemen, Libya, Gaza and Syria. But he has also volunteered in areas blighted by natural disasters, such as the earthquakes in Haiti and Nepal.

Driven both by compassion and passion, the desire to help others and the thrill of extreme personal danger, he is now widely acknowledged to be the most experienced trauma surgeon in the world. But as time went on, David Nott began to realize that flying into a catastrophe – whether war or natural disaster – was not enough. Doctors on the ground needed to learn how to treat the appalling injuries that war inflicts upon its victims. Since 2015, the foundation he set up with his wife, Elly, has disseminated the knowledge he has gained, training other doctors in the art of saving lives threatened by bombs and bullets.

War Doctor is his extraordinary story.

There’s a good review in The Guardian here,

If you’re unfamiliar with David’s extraordinary efforts in Syria, I touch on them – all too briefly – in ‘Death of the Clinic’ here.  And the David Nott Foundation Facebook page is here.