The slow violence of bombing

When I spoke at the symposium on ‘The Intimacies of Remote Warfare’ in Utrecht before Christmas, one of my central arguments was about the slow violence of bombing.  The term is, of course, Rob Nixon‘s, but I borrowed it to emphasise that the violence of sudden death from the air – whether in the air raids of the First and Second World Wars or the drone strikes of the early twenty-first century – neither begins nor ends with the explosion of bombs and missiles.

Paul Saint-Amour speaks of ‘traumatic earliness’: that dreadful sense of deadly anticipation.  The sense of not only preparation – communal and individual – but also of an involuntary tensing.  I described this for the First and Second World Wars in ‘Modern Wars and Dead Cities’, which you can download from the TEACHING tab, but here is A.L. Kennedy who captures it as well as anyone:

Add to that the blackouts, the new landscape of civil defence with its sandbags and shelters, the new choreography of movement through the war-time city, the air-raid sirens and the probing arcs of the searchlights.

Perhaps this seems remote, but it shouldn’t.  Modern technology can radically heighten that sense of foreboding: calibrate it, give it even sharper definition.  Here is Salam Pax, counting down the hours to US air strikes on Baghdad:

Fast forward to drone strikes.  The sense of dread visited on innocents by multiple US drone programmes is readily overlooked in the emphasis on ‘targeted killing’, on what the US Air Force once called its ability to put ‘warheads on foreheads’, and on the individuation of this modality of later modern war.  ‘The body is the battlefield’, as Grégoire Chamayou argues.

I’ve written about all those things, but there is a powerful sense in which the battle space still exceeds the body: for in order to target the individual these programmes also target the social, as this set of slides from my Utrecht presentation tries to show:

Here too, surely, is traumatic earliness.  (I’ve discussed this in more detail in ‘Little Boys and Blue Skies’ [DOWNLOADS tab], and I’m indebted to Neal Curtis, ‘The explication of the social’, Journal of sociology 52 (3) (2016) 522-36) for helping me to think this through).

And then, after the explosion – the shocking bio-convergence that in an instant produces the horror of meatspace – the violence endures: stored in the broken buildings and in the broken bodies.  In the Second World War (again as I show in ‘Modern Wars and Dead Cities’) the landscape was made strange every morning: buildings newly demolished, people driven from their homes and their workplaces, roads blocked by hoses and ambulances, by craters and unexploded bombs, rescue workers still toiling in the rubble to remove the dead and the injured, hospitals still treating and caring for the casualties.

And the violence of a drone strike lingers too: not on the same scale, but still the destroyed houses, the burned-out cars, the graves of the dead and above all the traumatized survivors (and their rescuers), some of them forced into newly prosthetic lives (see here and here).  The explosion is instantaneous, a bolt from the blue, but the pain, the grief and the scars on the land and the body endure.

These effects have a horizon that is not contained by any carefully calculated blast radius.  The grief spirals out through extended families and communities; and – depending on the target – so too do the casualties.  As I’ve said before, power stations in Gaza or Iraq have been targeted not for any localised destructon but because without power water cannot be pumped, sewage cannot be treated, food (and medicines) stored in refrigerators deteriorates.  And hospitals have been systematically targeted in Syria to deny treatment to hundreds and thousands of sick and injured:

The work of enumerating and plotting air strikes, in the past or in the present, is immensely important.  But those columns on graphs and circles on maps should not be read as signs of an episodic or punctiform violence.

Eyes in the sky – bodies on the ground

Several months ago I was invited to contribute a short essay to Critical Studies on Security, for an ‘Interventions’ section edited by Linda Roland Danil.  Here’s the brief:

Visual representations of war and violence: considering embodiment

The recent release of a number of critically acclaimed films that involve wars of the 20th century – such as Mel Gibson’s Hacksaw Ridge (2016), and more recently, Christopher Nolan’s Dunkirk (2017) – both of them World War II films – raise questions anew about the representation of war and violence. However, an insufficiently investigated field is the specific embodied experiences of those represented. What is the embodied or “corpographic” (Gregory, 2015) experience of those represented in the films/artistic works/photographs/documentaries/etc. – and therefore what are the specific embodied dimensions of war (McSorley, 2014) that are represented? How do these representations of the embodied dimensions of war preclude the possibility of conceiving of war in a de-realized, surgical, or “virtuous” (Der Derian, 2000) manner? Such embodied experiences may also include the aftermath of war and conflict, such as through the embodied experiences of post-traumatic stress disorder (PTSD). How does an understanding of the embodied experiences of soldiers (as well as the enemy Other) feed into an understanding of the larger geopolitical dynamics at play (Basham, 2013), if at all? This call is seeking Interventions that explore specific visual representations of war and violence in relation to the above and related questions…’

I’ve written about Dunkirk earlier – and I wish I’d said more about the extraordinary, keening sound-track – so in this short essay I returned to the classic US air strike in Afghanistan in February 2010 – see here and here  – and elaborated on the visual rendering of its aftermath by the US military (see here) and in Sonia Kennebeck‘s marvellous National Bird.

You can find the result under the DOWNLOADS tab: the title is ‘Eyes in the sky – bodies on the ground’ but the pdf is simply ‘Bodies on the ground’.

Bombs, bunkers and borders

Here is the first of a series of updates on Syria, this one identifying recent work on attacks on hospitals and health care which I’ve been reading while I turn my previous posts into a long-form essay (see ‘Your turn, doctor‘ and ‘The Death of the Clinic‘).

First, some context.  Human Rights Watch has joined a chorus of NGOs documenting attacks on hospitals and health care around the world.  On 24 May HRW issued this bleak statement:

Deadly attacks on hospitals and medical workers in conflicts around the world remain uninvestigated and unpunished a year after the United Nations Security Council called for greater action, Human Rights Watch said today.

On May 25, 2017, UN Secretary-General Antonio Guterres is scheduled to brief the Security Council on the implementation of Resolution 2286, which condemned wartime attacks on health facilities and urged governments to act against those responsible. Guterres should commit to alerting the Security Council of all future attacks on healthcare facilities on an ongoing rather than annual basis.

“Attacks on hospitals challenge the very foundation of the laws of war, and are unlikely to stop as long as those responsible for the attacks can get away with them,” said Bruno Stagno-Ugarte, deputy executive director for advocacy at Human Rights Watch. “Attacks on hospitals are especially insidious, because when you destroy a hospital and kill its health workers, you’re also risking the lives of those who will need their care in the future.”

The statement continues:

International humanitarian law, also known as the laws of war, prohibits attacks on health facilities and medical workers. To assess accountability measures undertaken for such attacks, Human Rights Watch reviewed 25 major attacks on health facilities between 2013 and 2016 in 10 countries [see map above]. For 20 of the incidents, no publicly available information indicates that investigations took place. In many cases, authorities did not respond to requests for information about the status of investigations. Investigations into the remaining five were seriously flawed…

No one appears to have faced criminal charges for their role in any of these attacks, at least 16 of which may have constituted war crimes. The attacks involved military forces or armed groups from Afghanistan, Central African Republic, Iraq, Israel, Libya, Russia, Saudi Arabia, South Sudan, Sudan, Syria, Ukraine, and the United States.

More here.

The World Health Organisation reached similar conclusions in its report of 17 May 2017:

Alexandra Sifferlin‘s commentary for Time drew attention to the importance of attacks on medical facilities in Syria:

In a 48-hour period in November, warplanes bombed five hospitals in Syria, leaving Aleppo’s rebel-controlled section without a functioning hospital. The loss of the Aleppo facilities — which had been handling more than 1,500 major surgeries each month — was just one hit in a series of escalating attacks on health care workers in 2016, the World Health Organization (WHO) reported on Friday.

Violent attacks on hospitals and health workers “continue with alarming frequency,” the WHO said in its new report. In 2016, there were 302 violent attacks, which is about an 18% increase from the prior year, according to new data. The violence — 74% was in the form of bombings — occurred in 20 countries, but it was driven by relentless strikes on health facilities in Syria, which the WHO has previously condemned. Across the globe, the 302 attacks last year resulted in 372 deaths and 491 injuries…

After the spate of attacks on Syrian hospitals last November, the WHO reported that three of the bombed hospitals in Aleppo had been providing over 10,000 consultations every month. Two other bombed hospitals in the city of Idleb were providing similar levels of care, including 600 infant deliveries. One of the two hospitals in Idleb was a primary referral hospital for emergency childbirth care.

“The attack…is an outrage that puts many more lives in danger in Syria and deprives the most vulnerable – including children and pregnant women – of their right to health services, just at the time when they need them most,” the WHO said.

The WHO has also provided a series of reports on attacks on hospitals and health care in Syria; here is its summary for last month:

But the WHO’s role in the conflict in Syria has been sharply criticised by Annie Sparrow, who has accused it of becoming a de facto apologist for the Assad regime.  Writing in Middle East Eye earlier this year, she said:

For years now, the World Health Organisation (WHO) has been fiddling while Syria burns, bleeds and starves. Despite WHO Syria having spent hundreds of millions of dollars since the conflict began in March 2011, public health in Syria has gone from troubling in 2011 to catastrophic now…

Yet WHO Syria has been anything but an impartial agency serving the needy. As can be seen by a speech made by Elizabeth Hoff, WHO’s representative to Syria, to the UN Security Council (UNSC) on 19 November 2016, WHO has prioritised warm relations with the Syrian government over meeting the most acute needs of the Syrian people.

Annie singles out three particularly problematic issues.

  • She claims that the WHO parrots the Assad regime’s claim that before the conflict its vaccination programmes had covered 95 per cent of the population (or better), whereas she insists that vaccinations had been withheld from children ‘in areas considered politically unsympathetic, such as the provinces of Idlib, western Aleppo, and Deir Ezzor.’  On her reading, in consequence, the re-emergence of (for example) polio ‘is consistent with pre-existing low immunisation rates and the vulnerability of Syrian children living in government-shunned areas.’
  • It was not until 2016 that the WHO reported attacks on hospitals at all, and when its representative condemned ‘repeated attacks on healthcare facilities in Syria’ she failed to note that the vast majority of those attacks were carried out by the Syrian Arab Air Force and its Russian ally.  The geography of deprivation was erased: ‘It is only in opposition-held areas that healthcare is compromised because of the damage and destruction resulting from air strikes by pro-government forces.’
  • Those corpo-materialities – an elemental human geography, so to say – did emerge when the WHO accused the Assad regime of of ‘withholding approval for the delivery of surgical and medical supplies to “hard-to-reach” and “besieged” locations.’  But Annie objects to these ‘politically neutral terms’ because they are ‘euphemisms for opposition-controlled territory, and so [avoid] highlighting the political dimension of the aid blockages, or the responsibility of the government for 98 percent of the more than one million people forced to live in an area under siege.’

You can read WHO’s (I think highly selective) response here.

Earlier this month 13 Syrian medical organisations combined with the Syria Campaign to document how attacks on hospitals have driven hospitals and health facilities underground (I described this process – and the attacks on the Cave Hospital and the underground M10 hospital in Aleppo – in ‘Your turn, doctor‘).  In Saving Lives Underground, they write:

Health facilities in Syria are systematically targeted on a scale unprecedented in modern history.

There have been over 454 attacks on hospitals in the last six years, with 91% of the attacks perpetrated by the Assad government and Russia. During the last six months of 2016, the rate of attacks on healthcare increased dramatically. Most recently, in April 2017 alone, there were 25 attacks on medical facilities, or one attack every 29 hours.

While the international community fails to protect Syrian medics from systematic aerial attacks on their hospitals, Syrians have developed an entire underground system to help protect patients and medical colleagues as best they can. The fortification of medical facilities is now considered a standard practice in Syria. Field hospitals have been driven underground, into basements, fortified with sandbags and cement walls, and into caves. These facilities have saved the lives of countless health workers and patients, preserved critical donor-funded equipment, and helped prevent displacement by providing communities with emergency care.

But all this comes at a cost:

Donors often see the reinforcement and building of underground medical facilities exclusively as long-term aid, or development work. However, as the Syria crisis is classified as a protracted emergency conflict, medical organizations do not currently have access to such long-term funds.

Budget lines for the emergency funding they receive can include “protection” work, but infrastructure building, even for protective purposes, often falls outside of their mandate. The divide between emergency humanitarian and development funding is creating a gap for projects that bridge the two, like protective measures for hospitals in Syria.

For this reason, as Emma Beals reported in the Guardian, many projects have resorted to crowdfunding:

The latest underground medical project seeking crowdfunding to complete building works is the Avicenna women and children’s hospital in Idlib City, championed by Khaled al-Milaji, head of the Sustainable International Medical Relief Organisation.

Al-Milaji is working to raise money with colleagues from Brown University in the US, where he studied until extreme security vetting – the Trump administration’s “Muslim ban” – prevented him re-entering the country after a holiday in Turkey.

He has instead turned his attention to building reinforced underground levels of the hospital, sourcing private donations to meet the shortfall between donor funding and actual costs…

Crowdfunding was an essential part of building the children’s Hope hospital, near Jarabulus in northern Syria. The project is run by doctors from eastern Aleppo, who were evacuated from the city in December after it was besieged for nearly six months amid a heavy military campaign. Doctors worked with the People’s Convoy, which transported vital medical supplies from London to southern Turkey as well as raising funds to build the hospital, which opened in April. More than 4,800 single donations raised the building costs, with enough left over to run the hospital for six months.

Saving Lives Underground distinguishes basement hospitals (the most common response to aerial attack by aircraft or shelling: 66 per cent of fortified hospitals fall into this category; the average cost is usually around $80–175,000, though more elaborate rehabilitation and repurposing can run up to $1 million); cave hospitals (‘the more effective protection model’ – though there are no guarantees – which accounts for around 4 per cent of fortified hospitals and which typically cost around $200–800,000) and purpose-built underground hospitals (two per cent of the total; these can cost from $800,000 to $1,500,000).

It’s chilling to think that hospitals have to be fortified and concealed in these ways: but even more disturbing, the report finds that 47 per cent of hospitals in these vulnerable areas have no fortification at all.

Seriously ill or wounded patients trapped inside besieged areas have few choices: medical facilities are degraded and often makeshift; access to vital medical supplies continues to be capriciously controlled and often denied; and attempts to evacuate them depend on short-lived ceasefires and deals (or bribes).  In Aleppo control of the Castello Road determined whether ambulances could successfully run the gauntlet from eastern Aleppo either west to hospitals in Reyhanli in Turkey or out to the Bab-al Salama Hospital in northern Aleppo and then across the border to state-run hospitals in Kilis: but in the absence of a formal agreement this was often a journey of last resort.

A victim of a barrel bomb attack in Aleppo is helped into a Turkish ambulance on call at the Bab al Salama Hospital near the Turkish border.

In October 2016 there were repeated attempts to broker medical evacuations from eastern Aleppo; eventually an agreement was reached, but the planned evacuations were stalled and then abandoned.  In December a new ‘humanitarian pause’ agreed with Russia and the Syrian government allowed more than 100 ambulances to be deployed by the Red Cross and the Red Crescent from Turkey; 200 critical patients were ferried from eastern Aleppo to hospitals in rural Aleppo, Idlib or Turkey – but the mission was abruptly terminated 24 hours after it had started.

The sick and injured have continued to make precarious journeys to hospitals in Turkey (Bab al-Hawa, Kilis, Reyhanli and other towns along the  border: see here, here and here), and also Jordan (in Ramtha and Amman, and in the Zaatari refugee camp: see here and here), Lebanon (in Beirut, Tripoli and clinics in the Bekaa Valley), and even Israel (trekking across the Golan Heights into Northern Israel: see here, herehere and especially here).

But there are no guarantees; travelling within Syria is dangerous and debilitating for patients, and access to hospitals outside Syria is frequently disrupted by border closures (which in turn can thrust the desperate into the hands of smugglers).  In March 2016, for example, Amnesty International reported:

 Since 2012 Jordan has imposed increasing restrictions on access for Syrians attempting to enter the country through formal and informal border crossings. It has made an exception for Syrians with war-related injuries.  However, Amnesty International has gathered information from humanitarian workers and family members of Syrian refugees with critical injuries being denied entry to Jordan for medical care, suggesting the exceptional criteria for entry on emergency medical grounds is inconsistently applied. This has led to refugees with critical injuries being returned to field hospitals in Syria, which are under attack on a regular basis, and to some people dying at the border.

In June Jordan closed the border, after an IS car bomb killed seven of its soldiers, and by December MSF had been forced to close its clinic at the Zaatari camp, which had provided post-operative care for casualties brought in from Dara’a.

Tens of thousands of refugees are now trapped in a vast, informal encampment (see image above) between two desert berms in a sort of ‘no man’s land‘ between Syria and Jordan.  From there Jordanian troops transport selected patients to a UN clinic, located across the border in a sealed military zone – ‘and then take them back again to the checkpoint after they are treated.’

(For the image above, and a commentary by MSF’s Jason Cone, see here).

For patients who do manage to make it across any of these borders, it’s far from easy for doctors to recover their medical history – as the note below, pinned to an unconscious patient who was admitted to the Ziv Medical Center in Safed implies – and in the case of Syria (as in Iraq) everything is further complicated by a fraught politics of the wound.

Here, for example, is Professor Ghassan Abu-Sitta, head of plastic and reconstructive surgery at the medical centre in Beirut, talking earlier this month with Robert Fisk:

In Iraq, patients wounded in Saddam’s wars were initially treated as heroes – they had fought for their country against non-Arab Iran.  But after the US invasion of 2003, they became an embarrassment.  “The value of their wounds’ ‘capital’ changes from hero to zero,” Abu-Sitta says.  “And this means that their ability to access medical care also changes.  We are now reading the history of the region through the wounds.  War’s wounds carry with them the narrative of the wounding which becomes political capital.”

In the bleak wars that have scarred Syria, and which continue to open up divisions and divides there too, the same considerations come into play with equal force.

A heavy reckoning

Emily Mayhew‘s Wounded was one of the catalysts for my present research project on medical care and casualty evacuation in war zones.  The original idea was to complete four case studies – the Western Front in the First World War, the deserts of North Africa in the Second, Vietnam and Afghanistan – but since then it has expanded to include a detailed analysis of attacks on hospitals and healthcare in Syria and elsewhere.  But running throughout these investigations is an interest in what Emily called ‘precarious journeys‘ – and a determination to break away from the usual academic voice (see here) –  so an announcement of her new book is extremely welcome.

It’s due from Profile in May:

What happens when you reach the threshold of life and death – and come back? As long as humans have lived together on the planet, there have been wars, and injured soldiers and civilians. But today, as we engage in wars across the globe with increasingly sophisticated technology, we are able to bring people back from ever closer encounters with death. But how do we do it, and what happens next? Here, historian Emily Mayhew explores the modern reality of medicine and injury in wartime, from the trenches of World War One to the dusty plains of Afghanistan and the rehabilitation wards of Headley Court in Surrey. Mixing vivid and compelling stories of unexpected survival and giving astonishing insights into the frontline of medicine, A Heavy Reckoning is a book about how far we have come in saving, healing and restoring the human body. But what are the costs involved in this hardest of journeys back from the brink? From the plastic surgeon battling to restore function to a blasted hand to the double amputee learning to walk again on prosthetic legs, Mayhew gives us a new understanding of the limits of human life and the extraordinary costs paid both physically and mentally by casualties all over the world in the twenty-first century.

The book is published in conjunction with the Wellcome Collection, and I should note that Emily has also co-curated the current exhibition Wounded: Conflict, Casualties and Care at London’s Science Museum (more information here and here).  I spent a fascinated couple of hours there when I was in London last month – it is well worth a visit, though the parallels it draws between the Western Front and Afghanistan were too abbreviated for me.

Collateral damage

A gracious note from Antipode prompts me to add that today is also a day to remember the countless others who are victims of war and military/paramilitary violence.  And so to a new book due at the end of the month from Frederik RosénCollateral Damage: a candid history of a peculiar form of death (Hurst/Oxford University Press):

ROSEN Collateral damageThe dilemmas precipitated by the unintentional killing of civilians in war, or ‘collateral damage’, shape many aspects of military conduct, yet noticeable by its absence has been a methodical examination of the place and role of this phenomenon in modern warfare. This book offers a fresh perspective on a distressing consequence of conflict.

Rosén explains how collateral damage is linked to ideas of authority, thereby anchoring it to the existential riddles of our individual and collective lives, and that this peculiar form of death constitutes an image of what it means to be human.

His investigation of collateral damage is notable too for how the death of non-combatants sheds light on some of today’s critical challenges to war and global governance, such as the growing role of non-state actors, mercenary contractors and the impact of military privatization.

In the ethical realm those who successfully prove that collateral damage has occurred also enter the debate about which institutions may exert authority and thus how a truly decentralized world might be organized. This is why the in many ways underrepresented victims of collateral damage appear on closer inspection to have experienced a most significant form of death.

Contents:

Introduction
1. The Third Category of Death
2. Urban Warfare and Collateral Damage
3. Collateral Damage and the Question of Legal Responsibility
4. Collateral Damage and Compensation
5. Lifting the Fog of War and Collateral Damage
6. How Bad Can Be Good
7. A Death Without Sacrifice
8. Collateral Damage or Accident?
9. A Private Call for Collateral Damage?
10. A Place Between it All

This is a good moment to remember Patricia Owens’ classic and still vitally important essay, ‘Accidents don’t just happen: the liberal politics of high-technology “humanitarian” war’, Millennium 32 (3) (2003) 596-616, and to reflect on what is surely a classic-in-the-making: Emily Gilbert‘s brilliant new essay, ‘The gift of war: cash, counterinsurgency and “collateral damage”‘, Security dialogue (online early).

Then there is the intentional killing of civilians in war….

Asymmetric law

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Breaking the Silence has just published a major report into the Israeli military’s tactics during its most recent offensive against Gaza and its people, so-called ‘Operation Protective Edge’ (see my posts herehere, here and here).

Based on interviews with 65 IDF soldiers, the report includes Background, Testimonies (‘This is how we fought in Gaza‘), and a media gallery.

Writing in today’s Guardian, Peter Beaumont reports:

Describing the rules that meant life and death in Gaza during the 50-day war – a conflict in which 2,200 Palestinians were killed – the interviews shed light for the first time not only on what individual soldiers were told but on the doctrine informing the operation.

Despite the insistence of Israeli leaders that it took all necessary precautions to protect civilians, the interviews provide a very different picture. They suggest that an overarching priority was the minimisation of Israeli military casualties even at the risk of Palestinian civilians being harmed….

Post-conflict briefings to soldiers suggest that the high death toll and destruction were treated as “achievements” by officers who judged the attrition would keep Gaza “quiet for five years”.

The tone, according to one sergeant, was set before the ground offensive into Gaza that began on 17 July last year in pre-combat briefings that preceded the entry of six reinforced brigades into Gaza.

“[It] took place during training at Tze’elim, before entering Gaza, with the commander of the armoured battalion to which we were assigned,” recalled a sergeant, one of dozens of Israeli soldiers who have described how the war was fought last summer in the coastal strip.

“[The commander] said: ‘We don’t take risks. We do not spare ammo. We unload, we use as much as possible.’”

“The rules of engagement [were] pretty identical,” added another sergeant who served in a mechanised infantry unit in Deir al-Balah. “Anything inside [the Gaza Strip] is a threat.  The area has to be ‘sterilised,’ empty of people – and if we don’t see someone waving a white flag, screaming: “I give up” or something – then he’s a threat and there’s authorisation to open fire … The saying was: ‘There’s no such thing there as a person who is uninvolved.’ In that situation, anyone there is involved.”

“The rules of engagement for soldiers advancing on the ground were: open fire, open fire everywhere, first thing when you go in,” recalled another soldier who served during the ground operation in Gaza City. The assumption being that the moment we went in [to the Gaza Strip], anyone who dared poke his head out was a terrorist.”

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You can find an impassioned, detailed commentary on the report by Neve Gordon – who provides vital context, not least about the asymmetric ethics pursued by supposedly ‘the most ethical army in the world’ – over at the London Review of Books here, and a shorter commentary by Kevin Jon Heller at Opinio Juris here.  Kevin notes:

The soldiers’ descriptions are disturbingly reminiscent of the notorious “free fire” zones in Vietnam and the US government’s well-documented (and erroneous) belief that signature strikes directed against “military-age men in an area of known terrorist activity” comply with IHL’s principle of distinction. The testimonials are, in a word, stunning — and put the lie to oft-repeated shibboleths about the IDF being “the most moral army in the world.” As ever, the stories told by the IDF and the Israeli government are contradicted by the soldiers who actually have to do the killing and dying.

The legal and ethical framework pursued by the Israeli military – and ‘pursued’ is the mot (in)juste, since its approach to international law and ethics is one of aggressive intervention – is in full view at a conference to be held in Jerusalem this week: ‘Towards a New Law of War‘.

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‘The goal of the law of war conference,’ say the organisers, ‘is to influence the direction of legal discourse concerning issues critical to Israel and her ability to defend herself. The law of war is mainly unwritten and develops on the basis of state practice.’

You can find the full program here, dominated by speakers from Israel and the US, but notice in particular the session on ‘Proportionality: Crossing the line on civilian casualties‘:

CIvilian Casualties

As this makes clear, and as Ben White reports in the Middle East Monitor, law has become the target (see also my post here):

After ‘Operation Cast Lead’, Daniel Reisner, former head of the international law division (ILD) in the Military Advocate General’s Office, was frank about how he hoped things would progress.

If you do something for long enough, the world will accept it. The whole of international law is now based on the notion that an act that is forbidden today becomes permissible if executed by enough countries….International law progresses through violations.

Similarly, in a “moral evaluation” of the 2008/’09 Gaza massacre, Asa Kasher, author of the IDF’s ‘Code of Ethics’, expressed his hope that “our doctrine” will ultimately “be incorporated into customary international law.” How?

The more often Western states apply principles that originated in Israel to their own non-traditional conflicts in places like Afghanistan and Iraq, then the greater the chance these principles have of becoming a valuable part of international law.

Now Israel’s strategy becomes clearer… Israel’s assault on the laws of war takes aim at the core, guiding principles in IHL – precaution, distinction, and proportionality – in order to strip them of their intended purpose: the protection of civilians during armed conflict. If successful, the victims of this assault will be in the Occupied West Bank and Gaza Strip, Lebanon – and in occupations and war zones around the world.

Divisions of Life

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My main presentation at the AAG in Chicago was part of a session organised by Noam Leshem and Alasdair Pinkerton on Remnants of No Man’s Land: history, theory and excess (more on their larger project here).  Here is an extended summary of what I had to say, together with some of my slides, but bear in mind that this all had to be done in 20 minutes so there wasn’t much room for nuance.  Neither was there time to discuss civilian entanglements, both volunteers and victims, nor the sick: the presentation focuses on the wounded, even though the problems of trench foot, ‘trench flu’, and a host of other diseases were also extremely important.  They do all receive attention in the larger project from which this is extracted.  One last, geographical qualification: my discussion is limited to the evacuation of British and imperial troops from the Western Front.

My starting-point was the strange disappearance of the wounded from the field of battle.  As John Keegan wrote in The Face of Battle, in most histories the ‘wounded apparently dematerialize as soon as they are struck down’; he was writing specifically about General Sir William Napier’s account of the battle of Albuera in 1811, but the point is a sharp one that can be enlisted as part of a more general critique of military history.

In the case of the First World War, the emphasis on those who lost their lives – on the dead not the wounded – derives not only from the sheer scale of the slaughter but also from the enduring landscape of memorialisation and commemoration.  When John McCrae‘s elegaic poem ‘In Flanders Fields’ is recited every Remembrance Day – ‘In Flanders fields the poppies grow, between the crosses, row on row’ – it is all too easy to forget that he wrote those lines not only to commemorate the death of a close friend but that he did so at Essex Farm Advanced Dressing Station:

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What lies behind those haunting lines – and that medical outpost – is a vast canvas of wounded men, which Christopher Nevinson captured as ‘The Harvest of Battle’ (below).  The dead occupy the foreground, but behind them is the endless, moving panorama of the wounded whose precarious journeys took most of them far beyond ‘No Man’s Land’.

(c) IWM (Imperial War Museums); Supplied by The Public Catalogue Foundation

In fact, as Emily Mayhew reminds us, ‘being wounded was one of the most common experiences of the Great War’: on the Western Front, she writes, ‘almost every other British soldier could expect to become a casualty’.

But, perhaps not surprisingly, for the first six months of the war the British Expeditionary Force was unprepared for the scale of casualties, and even with the help of civilian volunteers and aid societies – Nevinson briefly served as a medical orderly with the Friends Ambulance Unit, for example – the remarkably long time it took to evacuate the wounded combined with the perilous nature of their improvised journeys to increase the mortality rate.

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And so what Mark Harrison called the military-medical machine had to be speeded up – and moved closer to the field of battle.

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Before every major offensive elaborate plans for medical support were prepared: casualties were ‘cleared’ down the line as far and as fast as possible to make room for the newly injured, casualty clearing hospitals moved closer to the line, ambulances and stretcher-bearers made ready, and ‘down’ trenches designated for the efficient removal of the wounded (below).

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Soldiers wounded in ‘No Man’s Land’ – a term never recognised by the British General Staff, who insisted that they controlled the field of battle right up to the enemy front lines – were often immobilised and disoriented; some crawled into shell holes, seeking refuge below the field of fire, but it could take hours, even days before they were discovered and rescued (I’ll devote a later post to a detailed discussion of some of those cases).

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Sometimes their mates came to their rescue, sometimes the regimental stretcher bearers.  But they too had to find their way through a dangerous and devastated terrain, often with no landmarks to guide them and on occasion made virtually impassable by the thick, cloying mud that was always –  disconcertingly – much more than mud.

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By now, they were in the care of the Royal Army Medical Corps’s Field Ambulance, and their first objective was an Advanced Dressing Station.  

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Treatment at ADS 1917

Those that needed anything beyond simple treatment or emergency surgery were sent on by horse or motor ambulance to a Casualty Clearing Station (a field hospital).

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It was usually here that their first surgeries took place.  The journalist Philip Gibb was shown around a CCS at Corbie and the experience haunted him for years:

After a visit there I had to wipe cold sweat from my forehead, and found myself trembling in a queer way. It was the medical officer—a colonel—who called it that name. “This is our Butcher’s Shop,” he said, cheerily. “Come and have a look at my cases. They’re the worst possible; stomach wounds, compound fractures, and all that. We lop off limbs here all day long, and all night. You’ve no idea!”

CCS Corbie

I had no idea, but I did not wish to see its reality. The M.O. could not understand my reluctance to see his show. He put it down to my desire to save his time—and explained that he was going the rounds and would take it as a favor if I would walk with him. I yielded weakly, and cursed myself for not taking to flight. Yet, I argued, what men are brave enough to suffer I ought to have the courage to see… I saw and sickened. These were the victims of “Victory” and the red fruit of war’s harvest-fields. A new batch of “cases” had just arrived. More were being brought in on stretchers. They were laid down in rows on the floor-boards. The colonel bent down to some of them and drew their blankets back, and now and then felt a man’s pulse. Most of them were unconscious, breathing with the hard snuffle of dying men. Their skin was already darkening to the death-tint, which is not white. They were all plastered with a gray clay and this mud on their faces was, in some cases, mixed with thick clots of blood, making a hard incrustation from scalp to chin. “That fellow won’t last long,” said the M. O., rising from a stretcher. “Hardly a heart-beat left in him. Sure to die on the operating-table if he gets as far as that… Step back against the wall a minute, will you?” We flattened ourselves against the passage wall while ambulance-men brought in a line of stretchers. No sound came from most of those bundles under the blankets, but from one came a long, agonizing wail, the cry of an animal in torture. “Come through the wards,” said the colonel. “They’re pretty bright, though we could do with more space and light.” In one long, narrow room there were about thirty beds, and in each bed lay a young British soldier, or part of a young British soldier. There was not much left of one of them. Both his legs had been amputated to the thigh, and both his arms to the shoulder-blades. “Remarkable man, that,” said the colonel. “Simply refuses to die. His vitality is so tremendous that it is putting up a terrific fight against mortality… There’s another case of the same kind; one leg gone and the other going, and one arm. Deliberate refusal to give in. ‘You’re not going to kill me, doctor,’ he said. ‘I’m going to stick it through.’ What spirit, eh?”…

“Bound to come off,” said the doctor as we passed to another bed. “Gas gangrene. That’s the thing that does us down.” In bed after bed I saw men of ours, very young men, who had been lopped of limbs a few hours ago or a few minutes, some of them unconscious, some of them strangely and terribly conscious, with a look in their eyes as though staring at the death which sat near to them, and edged nearer. “Yes,” said the M. O., “they look bad, some of ’em, but youth is on their side. I dare say seventy-five per cent. will get through. If it wasn’t for gas gangrene—“

He jerked his head to a boy sitting up in bed, smiling at the nurse who felt his pulse. “Looks fairly fit after the knife, doesn’t he? But we shall have to cut higher up. The gas again. I’m afraid he’ll be dead before to-morrow. Come into the operating-theater. It’s very well equipped.”

By now the bureaucratic machine had been activated: labels had been attached to the wounded and field medical cards (‘tickets’) completed; telegrams had been sent to advise families, and nurses had often written letters home on their patients’ behalf.

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The next stage for the most seriously wounded was evacuation by ambulance train to  a base hospital on the French coast.  There was a considerable bureaucracy involved in planning these movements, but for all the neatness and symmetry of the organisational diagrams – part of Clausewitz‘s ‘paper war’ – there were all sorts of delays.

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Priority was given to trains rushing reinforcements, supplies and ammunition to the front, and ambulance trains were frequently marooned in sidings waiting for them to pass so that journeys that might have taken hours could take days.  It was not uncommon for an ambulance train to arrive at a base hospital to find that there was little or no room for new patients and all but the most grievous cases had to travel on to the next.

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Many patients were treated at the base hospitals, but those with more serious wounds were evacuated by hospital ship to Britain.  This stage of the journey was no less dangerous than the previous one: as the war continued, there was an increasing danger of mines and submarines in the Channel.

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A distinctive  geography of the wounded emerged.  If they arrived at Southampton, the most critical cases were taken by train straight to the Royal Victoria Military Hospital at Netley, which treated as many as 50,000 patients during the war.  According to Lyn McDonald,

 ‘Those who could not be accommodated, and those who were seriously wounded but likely to survive a longer journey, were sent on by train to Birmingham, Bristol, Exeter, Leicester, Norwich and Plymouth.  But seven out of every ten hospital trains were directed to London, and during the first days of the Somme they rolled in almost every hour to Charing Cross and Paddington stations.’

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This is, of course, a highly abbreviated account of the casualty evacuation chain, and in the larger project from which this is derived I provide many more details.  But I think I’ve said enough to show that the chain was, in effect, a production line with an elaborate division of labour (again, in the larger study I show how class – or more accurately, rank – gender and race segmented the chain in various ways).  Indeed, in The Politics of Wounds Ana Carden-Coyne argues that what she calls ‘the Taylorist approach in modern war’ – and remember that this was industrial war on the grand (guignol) scale – ‘was particularly evident in the assembly-line style of evacuation and triage.’

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This prompts two concluding observations.

First, what was the instrumental logic that animated the evacuation chain?  After all, it was an expensive undertaking, as Arthur Empey (himself wounded on the Western Front) realised in this re-calculation of the chain:

It may sound heartless and inhuman, but it is a fact, nevertheless, that from a military stand-point it is better for a man to be killed than wounded.

EmpeyIf a man is killed he is buried, and the responsibility of the government ceases, excepting for the fact that his people receive a pension. But if a man is wounded it takes three men from the firing line, the wounded man and two men to carry him to the rear to the advanced first-aid post. Here he is attended by a doctor, perhaps assisted by two R.A.M.C. men. Then he is put into a motor ambulance, manned by a crew of two or three. At the field hospital, where he generally goes under an anaesthetic, either to have his wounds cleaned or to be operated on, he requires the services of about three to five persons. From this point another ambulance ride impresses more men in his service, and then at the ambulance train, another corps of doctors, R.A.M.C. men, Red Cross nurses, and the train’s crew. From the train he enters the base hospital or Casualty Clearing Station, where a good-sized corps of doctors, nurses, etc., are kept busy. Another ambulance journey is next in order — this time to the hospital ship. He crosses the Channel, arrives in Blighty — more ambulances and perhaps a ride for five hours on an English Red Cross train with its crew of Red Cross workers, and at last he reaches the hospital. Generally he stays from two to six months, or longer, in this hospital. From here he is sent to a convalescent home for six weeks.

If by wounds he is unfitted for further service, he is discharged, given a pension, or committed to a Soldiers’ Home for the rest of his life, — and still the expense piles up. When you realize that all the ambulances, trains, and ships, not to mention the man-power, used in transporting a wounded man, could be used for supplies, ammunition, and reinforcements for the troops at the front, it will not appear strange that from a strictly military standpoint, a dead man is sometimes better than a live one (if wounded).

Hence, for example, the orders recorded by A.M. Burrage:

The instructions given to stretcher-bearers are rather harsh. “ If you find two men wounded, and can take only one away, take away the one more likely to make a fit soldier again.” Therefore the one more urgently in need of attention must be left to die, because he would walk with a limp and would never again be able to carry a pack. Sound business, of course, but just a little hard.

Kate Luard captured another dimension of this when she wrote in January 1915:

‘The ambulance trains do so much bringing the British Army from the field that I hope some other  trains are busy bringing the British Army to the field, or there can’t be many left in the field…’

And Emily Mayhew provides this bleak vignette from a medical orderly that captures the seemingly insatiable drive of industrial war:

An ordinary train, similar to the one that had brought him to the front, was at one end unloading reinforcements, while at the other end it was filling up with wounded men.

The logic, then, was one of ‘salvage’; four out of every five men wounded on the Western Front were returned to the fighting, which was the over-riding objective of the military-medical machine.

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Second, the division of labour was also a division of life: the dead from the wounded, the dying from the ‘salvageable’, and the wounded from the unwounded or yet-to-be-wounded.  The last was not the least.  For breaching that separation could have the most unsettling consequences of all:

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 ***

What started me on this journey was Emily Mayhew‘s brilliantly conceived Wounded and an excellent series of articles by Martin Bricknell in the Journal of the Royal Army Medical Corps: see in particular here.

You can also find more on the casualty evacuation chain from the Western Front at Beyond the Trenches here and here, the Long, Long Trail here, the Medical Front here, and the Royal Army Medical Corps site here.

My larger project examines the evacuation of casualties, combatant and civilian, from four combat zones 1914-2014: the Western Front during the First World War, the deserts of North Africa during the Second World War, Vietnam, and Afghanistan.