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.

Gender, war and technology

Christiane Wilke writes with news of a fascinating special issue of the Australian Feminist Law Journal (441, 1) on Gender, War, and Technology: Peace and Armed Conflict in the Twenty-First Century.

Gender, War, and Technology: Peace and Armed Conflict in the Twenty-First Century:  Emily Jones, Sara Kendall & Yoriko Otomo

Targeting, Gender, and International Posthumanitarian Law and Practice: Framing The Question of the Human in International Humanitarian Law: Matilda Arvidsson

How International Law Learned to Love the Bomb: Civilians and the Regulation of Aerial Warfare in the 1920s: Christiane Wilke

Technology, Dead Male Bodies, and Feminist Recognition: Gendering ICT Harm Theo:  Kristin Bergtora Sandvik

War’s Perpetuity: Disabled Bodies of War and the Exoskeleton of Equality: Gina Heathcote

A Posthuman-Xenofeminist Analysis of the Discourse on Autonomous Weapons Systems and Other Killing Machines: Emily Jones

The Architecture of Slow, Structural, and Spectacular Violence and the Poetic Testimony of War: Helene Kazan

The editors explain in their Introduction:

As the following articles illustrate, triangulating gender, war, and technology as a field of inquiry produces a wide domain of analysis, with topics ranging from human enhancement technologies to autonomous weapons systems, surveillance and aerial bombardment, artificial intelligence, and big data. The three terms themselves invite interpretation and debate.

The first term, ‘gender’, has been used in the context of international humanitarian law to signify vulnerability; women are treated as a group that may require further protection, where gender operates as a qualified identity that supplements the category of civilian (or indeed, comes to define the category of civilian). Yet some of the articles considered here adopt a more reflexive approach informed by feminist scholarship, considering issues of agency, difference, and intersectionality, and contesting gendered constructions that presuppose femininity, ethnicity, and passivity. The gendered subjects of law and war are at the same time subjects embedded within political economies of race, class, ability, age, and other factors. While gender serves as the primary focus of many articles within this special issue, gender theory’s commitment to intersectionality can be seen throughout, with articles considering issues of race, colonialism, ability, masculi- nity, and capitalism (and thus, implicitly, class). Beyond this special issue, the field would benefit from analysis of the broader range of intersectional concerns that emerge from recent technological developments in warfare.

The second term, ‘war’, is understood through drawing on existing feminist and gender critiques of war and armed conflict. Our point of departure is Cockburn’s well-known ‘continuum of violence’, whereby war and peace are noted to be part of a shared continuum as opposed to distinct (legal) categories. Such an outlook dis- rupts legal categorisations of conflicts by acknowledging that when a conflict ends as a matter of law, it has not necessarily ended for people living through it.  Not only do the place and time of ‘armed’ conflict then become questions, but presumptions about who produces, participates in, and is affected by conflict are also revisited and critiqued.

The final term, ‘technology’, has been defined within the context of conflict in the twenty-first century, following the post-war ideological movement described above. We are aware of the vast amount of literature which seeks to define technology broadly, with Heidegger defining technology to include things such as art and law, roughly defining technology as a tool and theorising how it is technology which helps humans become human. This special issue focuses on technology specifically within the context of twenty-first-century armed conflict, such as military technologies and/or algorithmic decision-making and data collection. In light of the multiple ways in which technology is changing conflict, we argue that the focus on these technologies reflects the ways in which technology is impacting on and changing the global order and conflict. This special issue seeks to draw attention to the urgent need for gendered perspectives on the interrelationships between war and technology.