Mass Murder in Slow Motion (II): Siege Economies

This is the second in a series of posts on East Ghouta (Damascus); the first, providing essential background, is here.

The logic of the siege warfare pursued by Syria and its allies has been to cordon off areas under rebel control; to restrict, disrupt and ultimately prevent movement across the siege lines (including food, fuel and medical supplies); to subject the besieged population to sustained and intensifying military violence from aircraft, ground ordnance (artillery, missiles and mortars) and sniper fire; and to outlaw the provision of medical aid to those inside the besieged areas and limit the evacuation of the sick and wounded.

You can find more on the reincarnation of siege warfare as a tactic of counterinsurgency in later modern war herehere, here and here.

Precarious lines and precarious lives

In this post I examine the siege economies that emerged in East Ghouta from 2012 and their transformation over the next six years (to March 2018).

The restrictions on movement imposed on the besieged population varied in time and space.  This map from the New York Times plots incidents between the Syrian Arab Army and various rebel groups from September to November 2012:

As the clashes intensified the Syrian Arab Army (SAA) and its allies established a series of checkpoints in November-December to regulate the movement of people and supplies between Damascus and East Ghouta, though Amnesty International reported that anyone crossing ‘ran the risk of being detained or shot by government snipers’ and there were also reports of goods being confiscated or pilfered.  Access to those crossing points was also controlled from within the besieged area by armed opposition groups whose actions affected both entrance and exit.

The restrictions increased, along with the dangers, until in August 2013 the two crossing points at al-Mleha and Douma were closed by the SAA.  One woman recalled how she ‘didn’t understand’ what was happening when the road out of Ghouta was first blocked::

What did it mean that we were trapped? Then stores’ shelves gradually went empty. Food, fuel, the most basic essentials … everything began to vanish.

But some trucks were still allowed through a third crossing point at al-Wafideen, and the ensuing geography of closure was intricate.

A series of semi-clandestine routes was established between East Ghouta and the suburban towns of al-Qaboun and Barzeh on the other side of the Damascus-Homs highway; an uneasy truce was concluded with rebels in those two towns in January and February 2014, and these routes became vital conduits for smuggling goods into East Ghouta.

People in al-Qaboun and Barzeh relied on conditional access to regime-controlled neighbourhoods beyond the checkpoints.  ‘The residents of al-Qaboun and Barzeh live as though they are trapped in a limbo,’ wrote Rafia Salameh, ‘at the mercy of checkpoints.’

The ʻmoodʼ of these checkpoints is measured in the distance between the guards’ pockets – as they are hungry and poor – and their strict application of the law within the presence of superior officers, punishing those who try to smuggle past them simple materials for survival…

Lighters, batteries, light bulbs and any other electrical devices are forbidden. Salt and citric acid, which may be used in the manufacture of explosives, are also forbidden. Gas, milk bottles, and diapers are allowed through if the family carries around the proper documentation in which checkpoint transits are recorded by date, to prove they are not smugglers. However, all these regulations frequently fell silent by paying a bribe at the Barzeh checkpoint.

Salim, a 13-year-old young merchant of sugar says: “They beat us and chase us when the main officer is present.” He went on to explain how his sales decisions are driven by what he can or cannot afford to pay at the checkpoint. His profit per kilogram of sugar is 100 Syrian pounds (SYP), or $0.20 on the black market. He can carry eight kilograms of sugar, and he dips into his profits to purchase a pack of cigarettes for the security officers to allow him through their inspection. The cigarette pack costs 300 SYP, or $0.60. That means he ends the day with less than 500 SYP of profit, which amounts to one US dollar.

Some of these goods ultimately found their way through the tunnels into East Ghouta, but the price differentials between Damascus (which was not without economic problems of its own) and the Ghouta were stark.  Aron Lund posted this chart for March 2015 (prices are all in Syrian Pounds):

On 17 February 2017 the Syrian Arab Army backed by the Russian Air Force opened a new offensive against al-Qaboun (below) and Barzeh and eventually sealed them off from the Ghouta.

The only route that remained open was the al-Wafideen crossing; it had been subjected to intermittent, temporary closures, but on 21 March 2017 it too was finally sealed.  The siege of East Ghouta immediately became absolute until the cordon was breached by the renewed SAA offensive in February 2018 and, the following month, by evacuation corridors for the besieged population.

The closure of al-Wafideen had a catastrophic effect.  Here is a second price comparison, this time for May 2017 (when the exchange rate was 500 SYP to $1):

Such price comparisons are inevitably difficult and shot through with all sorts of difficulties, but similar data on food security from the World Food Programme makes it clear that price inflation on this scale made life immensely precarious for those inside the besieged areas – lives then made even more precarious by the escalation of military and paramilitary violence (my next post) and the disruption of medical provision (my final post in this series).  According to the WFP in October 2017:

Since the Al-Wafideen crossing closed in September, all food supply routes to eastern Ghouta have been completely closed. Food prices have soared as a consequence, with particularly grave consequences for the poorest and most vulnerable people. During the WFP market assessment conducted in Kafr Batna (in eastern Ghouta) at the end of October, the remaining food stock was found to be very limited, with severe shortages of staple foods such as rice, pulses, sugar and oil.

Based on the market assessment data, the cost of the standard food basket in October 2017 reached SYP327,000, which is 204 percent higher than in September and more than five times higher than in August 2017 (before the crossing closed). The eastern Ghouta food basket currently is almost ten times more expensive than the national average.

According to key informants, the only available cooking fuel in eastern Ghouta is liquid melted plastic, which costs SYP 3,500/litre – ten times more than the national average price of diesel. Some households also reported burning animal remains and even used diapers to boil vegetables.

A bundle of bread in Kafr Batna is being sold at SYP2,000, which is more than 35 times the average price in accessible markets.

Food security is likely to deteriorate rapidly in the coming weeks if the siege continues. It is estimated that food stocks will be totally depleted by end November 2017.

Local resources and improvisations

Faced with the shortages and high prices imposed by the siege, the people of East Ghouta had limited resources to fall back on (see my previous post here), and these contracted sharply after the Syrian Arab Army finally seized control of the rich agricultural lands in the south of the Ghouta (the Marj) in May 2016, near the start of the harvest season.  People throughout the besieged area were forced to improvise and to devise ever more exacting economies.

The survival strategies listed by the WFP included reducing the number of meals, reducing portion size and limiting adult consumption, but once the siege became absolute – crossings closed, tunnels blown – many were reduced to far worse than those.  The designation of East Ghouta as one of four ‘de-escalation zones’ during the summer of 2017 only opened what Reuters called ‘the doors of starvation’:

‘When people in the Ghouta learned of the deal and thought it would bring relief, many began using up their food reserves at home, said Khalil Aybour, head of the local council in the town of Douma. “After they saw it was all rumors,” he said, “the misery grew immensely.”

Here is a report from November 2017:

The sight of a woman weeping as she drags her malnourished children into a clinic is not rare in eastern Ghouta…. But when one mother told Abdel Hamid, a doctor, that she had fed her four starving children newspaper cutouts softened with water to stop them from screaming into the night, even he was stunned.  “I could try to describe to you how terrible the conditions are in which we are living, but the reality would still be worse,” [he] said.

Another young widow described how she rationed food between her three young daughters:

My girls take turns eating now. We barely have any food so each one eats one meal every three days. It breaks my heart because they go to bed hungry and wake up with no energy.

Stories like these are what lie behind the distanced prose of an interagency assessment of food security conducted for the World Food Programme that same month, which reported:

Due to the lack of available food and the high food needs, a food basket meant to support a five member household for a month [supplied by the UN] is being shared among six different households (approximately 30 people).

Due to lack of staple food commodities and severe shortfall of cooking fuel (firewood, diesel and gas) in addition to their high prices, residents have been reduced to subsist on raw vegetables such as maize corn, cabbage and cauliflower with no more than one meal per day. In many households with multiple mouths to feed, priority is given to children with adults often skipping entire days without eating. Some households are even resorting to rotation strategies whereby the children who ate yesterday would not eat today and vice-versa.

Cases of severe acute malnutrition among children were identified by the UNICEF team…

Three months later, once the offensive started in deadly earnest, the situation deteriorated still further.  By March 2018, when thousands of people were huddled in basements and cellars sheltering from the incessant bombing and artillery fire, some of those that could find food were reluctant to eat in front of other people in the face of such widespread hunger.  Others shared what little they had.

In fact food was the central concern throughout the siege.  In the beginning some residents started to grow vegetables on their roofs to supplement local production and avoid the soaring prices in local markets:

“The blockade has forced us to find alternatives, especially in towns like al-Buwaidah, hijjera, and al-Sbeneh, where all the surrounding farming lands were destroyed, and many farmers were killed,” said Ahmad Abu Farouq, a 19-year-old who lives in Ghouta with his family of nine.

Ahmad said he and his family have turned their 1,600-square-foot (150 sq meter) rooftop into a year-round farm, planting zucchini and pumpkin in the winter, and lettuce and parsley in the summer [see the image below]. “I throw in a mix of eggplant, peppers and cucumbers when I can,” he added.

Eastern Ghouta is frequently and heavily hit by government airstrikes. To protect themselves and their crops, according to Ahmad, most people who have chosen to take up alternative farming find ways to hide their box planters so as not to make them entirely visible from up above.

This proved to be a short-term solution: when the Assad regime cut electricity supply to the Ghouta it had serious spill-over effects, and ‘on rooftops, as in the agricultural fields, the [consequent] lack of an irrigation system providing clean water caused the end of this semi-autonomous way of surviving the siege.’

So fuel was a second major concern, but there too there were improvisations. Mark Hanrahan and Bhassam Khabieh described an elaborate scheme in Douma to convert plastic waste into fuel.  Using methods he learned from YouTube videos, Abu Kassem and his family collected plastic bottles, rubble from damaged buildings, plastic cooking utensils, even plastic water and sewage pipes; they burned them all in a makeshift refinery, and sold the gas for domestic and commercial use or condensed the gas and refined the liquid into fuel for generators and vehicles.

At its height the workshop was running 15 hours a day six days a week; on an average day it burned 800 – 1,000 kg of plastic waste to produce around 850 litres of fuel. This was a dangerous, noxious business:

“Working here is very tiring, but we feel that we are providing a great service to people. I have been working here for a short time and have begun to adapt to the atmosphere here,” said Abu Ahmed, 28, [one] of the workers.

And the products were snapped up:

“When the siege began on eastern Ghouta at the end of 2013 fuel prices rose madly and we were no longer able to water crops as in the past,” Abu Firas, 33, an agricultural worker in the district told Reuters. “When we started producing local fuel, and water engines could be powered by this fuel, … life returned to agricultural land.”

Abu Talal had the same idea:

“We get plastic materials from areas and buildings that are deserted after being shelled by the regime forces. We collect all the plastic we find, such as water tanks and drainage pipes.”

After Talal and his team gather the plastic, they cut it into smaller pieces and put 50 kilograms in each barrel, along with 20 meters of piping to cool the water that runs in and out of the barrel. They contain narrower tubes, which contain the fumes that come from the burned plastic. Then they light a fire.

“It takes two to three hours to extract as much as possible from one batch of plastic,” he says. “In the last stage, we get the temperature to 100 to 115 degrees to extract a kind of diesel. The temperature must be accurate for the diesel to come out and for it to burn well, so it can be used in cars and motorcycles.”

Ammar al-Bushy described a similar operation at Erbin here.  ‘People are aware that the fuel extracted from burning plastic [is of a lower] quality than that extracted from oil,’ he reported, and it ’causes long-term problems for engines, but it meets the purpose for people living in a dire situation, in addition to the lower cost than fuel extracted from oil.’

The economics of the operation were explained by Abu Hassan:

“Gasoline reached the price of 4000-4200 Syrian Pounds ($20-$21), and the amounts available were minimal. However, we found a substitute by heating plastic and extracting methane, gasoline, and diesel.

“The price of diesel was 3200-3500 Syrian Pounds ($16-$18.50) per liter, which is considered very expensiv. So people were no longer able to purchase it, but after we started operating on plastic and started extracting diesel from it, the price decreased to 1200-1500 SP and it became more available.”

There were other manufactories too: there is a remarkably detailed analysis of the manufacture of weapons by Jaish al-Islam here, including improvised mortars, rockets, grenades and rifles.

But my focus here is on those resources basic to civilian survival in the besieged area. There were all sorts of other substitution strategies in East Ghouta  – I’ll deal with the improvisation of medical supplies and anaesthetics in the final post in this series – but the two examples I’ve provided show concerted attempts to devise solutions to the supply shortages and high prices that were the immediate products of the tightening siege.

Those economic conditions were also affected by cross-cordon transactions: by merchants who were allowed to bring goods in through the al-Wafideen checkpoint, and by smugglers who (until the offensives against Barzeh and al-Qaboun) operated a series of clandestine tunnels that gave access to markets on the suburban fringe.  I’ll consider each in turn, but in both cases there was an elaborate administration of precarity: an apparatus of permissions and permits, exactions and kick-backs, through which the local economy was manipulated and political and (para)military relations were managed.

There was another set of cross-border transactions: these were non-commercial flows of humanitarian aid.  The Syrian government put in place an intensely bureaucratic system  to regulate aid convoys which was also part of the administration of precarity.  It proved to be (and was intended to be) so restrictive that these flows had precious little sustained impact on economic conditions in Ghouta.  But, as I’ll show, these transactions were entangled in a wider and intrinsically partisan geography of precarity that magnified the marginality of Ghouta and effectively enlarged the power of the regime to dictate the terms of its ‘surrender or starve‘ strategy.

Merchants and the Million Checkpoint

One of Amnesty International‘s informants described how the importation of food into East Ghouta was slowly restricted:

By April  2013, you were not allowed to take any food into Eastern Ghouta. Security forces would beat women and men when they found bread or vegetables hidden in the boot of the car or under clothes. As I passed by a checkpoint, I remember seeing food piled up and people being beaten up or humiliated. The Syrian authorities did not allow any bread, vegetables, fruits, pasta, sugar or eggs to enter.

As individual transactions were banned, so selected merchants were allowed to organise much larger shipments. The al-Wafideen crossing became the most important external source of food and fuel for East Ghouta – often described as the ‘lung’ through which the Ghouta breathed – and the central figure in commercial transactions through the checkpoint was Mohyeddin al-Manfoush (‘Abu Ayman’), one of what the Economist called ‘Syria’s new war millionaires’: the ‘dairy godfather’.

Before the war Manfoush lived in Mesraba near Douma, where he owned a small herd of cows and a cheese factory, and traded as al-Marai al-Dimashqiya (Damascus Pastures).  Once the siege began he quickly struck a deal with the Syrian government.  The Economist again:

He began to bring cheap milk from rebel territory in Eastern Ghouta to regime-held Damascus, where he could sell it for double the price. The regime received a cut of the profit. Mr Manfoush reinvested his share. He snapped up the region’s best cows and dairy machinery from farmers and businessmen whose livelihoods had been hammered by the siege. As the business evolved, the trucks that left Ghouta with milk and cheese came back laden with the barley and wheat he needed to feed his growing dairy herd there and run the bakeries he bought.

It was immensely profitable; with a captive market of 400,000 people and runaway prices Manfoush not only expanded his business (under the umbrella Manfoush Trading Company) but also moved to a new house in Damascus and even established his own private militia.

Others profited too.  The security forces controlling the crossing (above, in February 2018) received ‘extra payments’ from Manfoush; there have been reports that they charged 200-300 Syrian pounds ($1 – $1.40) and sometimes as much as 750 Syrian pounds for each kilogram of goods passing through the checkpoint.  Local people came to refer to al-Wafideen as ‘the Million Crossing’ because it supposedly generated one million Syrian pounds per hour in bribes for its soldiers and security officers.  In March 2015 researchers were told a fee of one million Syrian pounds allowed a vehicle to pass through the checkpoint.  And Manfoush dispatched convoys not single trucks:

But the kickbacks almost certainly went much higher than those operating the checkpoint.  Roger Asfar has claimed that Manfoush’s web of companies is linked to the business empire of President Assad’s brother, Maher al-Assad (who also usefully heads the Republican Guard).  Be that as it may, the regime had more than a commercial interest in Manfoush’s transactions because it was able to leverage its control over al-Wafideen and ‘exploit its ability to turn trade on and off in order to sow enmity among [different] rebel [groups].’

The state’s ability to goad its enemies in this way depended not only on the rivalries between different rebel groups, however, but also on those groups’ own stakes in the siege economy.  These derived, in part, from the revenues generated through their ancillary checkpoints.  Many informants testified that another set of ‘fees’ were exacted there, though what eventually became the major rebel group in Douma, Jaish al-Islam [JAI], denied having any stake in Manfoush’s operations at al-Wafideen:

“Manfoush does not serve the Islam Army [JAI], he serves the Ghouta in its entirety,” said the Islam Army official Mohammed Bayraqdar. “Our interests are in harmony with the interests of the people and our relationship is merely that of facilitating his services. If there were another person [who performed the same function], we would provide the same services to him in return for his services to the people of the Ghouta.”

Those ‘facilitations’ and ‘services’ involved granting Manfoush’s convoys safe passage into East Ghouta, and it seems highly unlikely that this was a purely philanthropic gesture.  In June 2015 one of Amnesty International‘s informants explained:

Since the end of 2014, the Army of Islam [JAI] has controlled the supply route from al- Wafedine camp and Ajnad al-Sham, the underground tunnels in Harasta. The Army of Islam is responsible for regulating the prices. During the winter, the Army of Islam collects most of the food supplies from the market, increasing the prices threefold. You sleep one night and wake up the next day to find there is no food and prices are high.  The Army of Islam in collaboration with suppliers store food and non-food items in [its] warehouses. 

Siege Watch was even more blunt in its assessment for May-July 2017: ‘the corrupt trading monopoly run by al-Manfoush at the al-Wafideen checkpoint lined the pockets of the Syrian miilltary and JAI’.

There is no doubt that Jamash al-Islam’s provision of ‘services’, whether corrupt or not, was far from disinterested: facilitating the importation of food, fuel and other supplies gave it leverage over the besieged population. It was able to extend its control over the local labour market in Douma – determining which shops were allowed to open, for example – and gave those on its payroll privileged access to imported goods from its own warehouses. JAI was not the only group to take advantage of the siege economy.  In Harasta, Fajr al-Umma reportedly ‘gave away free food and a tank of propane … in [an] attempt to strengthen its popularity in the area.’  In short, food and fuel became vital currencies not only for the counterinsurgency but also for the insurgency.  ‘Joining one of the armed groups can provide a monthly salary of an average of USD 50,’ Rim Turkmani and her collaborators in the LSE’s ‘Security in Transition’ programme (including Mary Kaldor) found, ‘in addition to food parcels.’  And at times, they continued, ‘fighters are only paid in food.’

Putting all this together, Rim produced this diagram which traces the journey of a loaf of bread from Damascus into East Ghouta and shows how extensive was the system of exchange whose fulcrum was al-Wafideen:

Underground economies

In his detailed analysis of the tunnels excavated and operated by the armed opposition groups in the Ghouta, Aron Lund explains:

Apart from the Wafideen Crossing, the Eastern Ghouta has been supplied through a system of secret tunnels and semi-informal frontline crossings. While the crossings can bring in a far greater volume of trade, the tunnels serve to import goods that are restricted or banned by the government (including fuel, medical supplies, and arms), to move people in and out of the enclave, and to challenge and undercut food prices set by the Wafideen monopolists.

Digging the tunnels was difficult and dangerous work – but in a place where the economy was collapsing, where there were so few jobs to be had, and where some rebel groups resorted to more directly coercive methods of recruitment the work proceeded apace:

Men of Douma work in three shifts a day to finish their job, using primitive tools. “Each worker has one meal – either breakfast with an egg and a piece of bread, or lunch with rice and bread. The digging never stops. When we hit a large rock or anything like it, we turn on the generator and use a jackhammer,” said Abdullah, a tunnel digger. When asked about the reason that men take this job and whether it pays well, Abdullah said: “Many have lost their job because of the ongoing war, so we have no means to earn money to buy food. Prices are also very high because of the prolonged siege. They pay around 1,000 Syrian pounds per worker, which covers the price of a kilo of flour….”

“When we first started digging tunnels, we faced many difficulties; however, we found solutions and continued the operation. For example, we pumped oxygen at certain points inside the tunnels, which is very important for the workers. We also set up pillars inside the tunnel to prevent them from collapsing over the workers, which had happened often earlier, and killed and trapped many workers for many hours before we could rescue them,” said Abu Mahmoud.

There were five main tunnels (I’ve taken most of these details and the maps from a report by Enab Baladi‘s Investigative Unit on ‘The economic map of Ghouta‘).  

The first (the Zahteh or Central Tunnel) ran 800 metres from Harasta under the Damascus–Homs highway to Qaboun; construction was started by Fajr al-Umma towards the end of 2013, and the tunnel opened the following summer.  It soon emerged as ‘the primary [clandestine] artery for the Eastern Ghouta’s siege economy’.

In January 2015 Jaish al-Umma opened a second, parallel tunnel, but Fajr al-Umma soon controlled this route too:

In May 2015 two other rebel groups, Failaq al-Rahman and al-Liwan al-Awwal, dug the so-called ‘Mercy Tunnel’ from Arbin to Qaboun; this was much longer than the previous two (2,800 metres) and wide enough to allow the passage of cars and even Kia 2400 trucks.

In June 2015 Jaish al-Islam constructed a 3km tunnel from Arbin and Zamalka to Qaboun; it too was wide enough to accommodate small trucks.

In September 2015 Falaq al-Rahman joined with Jabhat al-Nusra in Qaboun to establish a third tunnel under its control, the ‘Nour [Light] Tunnel’, from Arbin to Qaboun for foot traffic only.

These were the main tunnels, but several smaller tunnels were dug between the Ghouta and Jobar, and others were dug primarily for (para)military purposes to move personnel, ammunition and armaments.  Other tunnels were dug within the Ghouta as defences against air strikes; they served multiple purposes, not least connecting the dispersed facilities of underground field hospitals (more on this in a later post).  One SAA informant described to Robert Fisk what he saw when he entered Douma in March 2018:

I have never seen so many tunnels. They had built tunnels everywhere. They were deep and they ran beneath shops and mosques and hospitals and homes and apartment blocks and roads and fields. I went into one with full electric lighting, the lamps strung out for hundreds of yards. I walked half a mile through it. They were safe there. So were the civilians who hid in the same tunnels.

The main cross-line tunnels were used for multiple purposes too: but commercial traffic was always an important consideration.

I describe this as commercial not only because the goods were sold at stores inside Ghouta but also because the tunnels provided the groups that controlled them (often through nominally civilian front organisations or ‘foundations’) with income and resources.  This caused considerable jockeying between them;  Aron Lund provides a superbly detailed analysis of the rivalries, deals and counter-deals that ensued.

The tunnels were considerable undertakings.  The director of the organisation set up to operate the Mercy Tunnel told Enab Baladi that it cost 30,000,000 Syrian Pounds each month to cover ‘the expenses of nine Kia 2400 trucks that work between 3 p.m. and 6 a.m. and the salaries of 450 employees, including drivers, workers, administrators, officials and custodians, in addition to security officials.’

There were three streams of commercial transactions.  The first involved the passage of civilians and, like all movement through the tunnels, was closely controlled by the rebel groups.  One of Enab Baladi‘s informants outlined the rules:

Those passing through the tunnels must be born before 1970, since the factions are in need of young fighters.

The person passing must provide clearance from the Unified Judiciary, to prove that there are no cases outstanding against him or her, and a clearance from the Housing Bureau.

Fighters must provide an official permit  (below) from their faction.

All documents must be submitted to the Crossing Office, which will assign the person a date to pass.

Medical emergencies are exempted from the waiting period, but must provide a report from the Unified Medical Bureau.

Under no circumstances are weapons allowed to leave Ghouta.

No goods other than clothes and basic supplies are allowed (not to exceed two bags).

Abu Ali described how he and his family made their escape:

The process of applying to use the tunnel, he said, was strangely bureaucratic for such a risky method of escape: He submitted an official request at a Jaish al-Islam office and was informed two weeks later that it had been granted… [He] and three other families granted access to the tunnel started their journey on a bus from the city of Hamouriyya.

“The bus took us to the city of Arbin. In Arbin, the bus took side streets, so that we wouldn’t be noticed. We finally arrived at a house where our identification cards were checked, and our luggage was searched. We were told that we had to be very careful, so no one would discover where the tunnel was,” he said.

The tunnel “was very tight – there was barely enough room for two people to walk side by side and it was about two meters in height. In addition to lights, the tunnel had turbines for ventilation purposes.”

These rules were never set in stone, still less once the co-operation implied by the ‘Unified Medical Bureau’ and the ‘Unified Judiciary’ [established in the summer of 2014] broke down and in-fighting between the groups controlling the tunnels became commonplace.  Despite the age restrictions, some of them were willing to allow young people to pay for a permit: the cost varied between 100,000 and 200,000 Syrian pounds.  If they wished to escape Qaboun or Barzeh, they would then pay further bribes to the soldiers and security officers controlling the regime’s checkpoints into Damascus.

There was one constant: the rules allowed for the evacuation of medical emergencies but no medical staff – doctors, nurses, pharmacists – were permitted to leave.  In fact it seems unlikely that many serious medical cases were evacuated through the tunnels either. They would not have found better treatment in Barzeh or Qaboun, but during the early stages of the truce some patients were allowed to cross from those besieged districts into Damascus.   Dr Immad al-Kabbani testified that ‘for a period beginning in September 2014 we were able to evacuate a minimum of 20 patients and their families each week’ through the tunnels (and even ‘to send biopsies from cancer patients to cooperative labs in Damascus for diagnosis’) but by March 2016 the clandestine system was already failing. One cancer patient was allowed to leave for radiation therapy which was unavailable at the Dar al-Rahma Center for Cancer in Ghouta, but her journey turned out to be fruitless:

 I received no care at hospitals [in Damascus] so I relapsed and the tumour returned to its previous status. I decided to go back to Eastern Ghouta through the same tunnels to have the chemical doses.

That same month patients were travelling in the opposite direction.  A doctor from the Syrian-American Medical Society testified:

Now, as access to Damascus has been cut off, the 35,000 civilians inside Barzeh have extremely limited access to healthcare, and must travel to East Ghouta to obtain treatment. Even the dialysis patients in Barzeh are traveling to East Ghouta [via the tunnels] to obtain treatment with the extremely limited supplies.

For a time the tunnels were a two-way street of sorts for cancer patients: those who needed chemotherapy were treated at the Dar al-Rahma Center in Ghouta, using medical supplies smuggled through the tunnels [below], while those needing radiotherapy were taken through the tunnels to al-Nawawi hospital in Damascus.  According to the director of the Dar al-Rahma, ‘after the closure of the tunnels, there is no possibility of providing either of the treatments.’

By the time the tunnels were closed in February 2017 the UN estimated that around 80 patients out of 700 estimated to be in need of urgent treatment had been evacuated from East Ghouta through the tunnels.  Some were transferred because there were no specialists available inside the besieged area, others because clinics there had been denied the medicines and equipment needed to treat them.  But the numbers were small when set against the extensive record of seriously injured or ill patients being placed on evacuation lists from the Ghouta only to have their doctors’ requests refused or ignored by the Syrian government.  Once the tunnels were closed ‘all movement of patients was halted.’

The second stream of traffic involved everyday supplies of all kinds, including food and fuel.  Some rebel groups limited their dealings to particular merchants but in every case a tunnel ‘tax’ was levied.  The usual fee seems to have been 10 per cent but there were times when 25 per cent and even 45 per cent of the value of the goods was levied.  The ‘tax’ was paid in cash or in kind: the different factions maintained their own warehouses and usually gave their own fighters and supporters privileged access to the supplies they skimmed from the shipments.  During the first two months that the Mercy Tunnel was in operation, for example, Falaq al-Rahman allegedly ‘filled its warehouses with more than 12 tons of goods, claiming that it had to secure its fighters first.’  As this implies, the totals involved were small – they paled into insignificance alongside the commercial shipments through al-Wafideen – but they provided the armed opposition groups with significant financial gains.  Enab Baladi again, citing one of the directors of the Mercy Foundation:

“Everyone finds in the tunnel the perfect opportunity to make money. Since the very first tunnel was completed, Fajr al-Umma, the faction that had dug the tunnel, took control of all incoming goods and sold them for extremely high prices. In 2014, for example, 1kg of sugar was sold for 60-70 Syrian pounds [around 30 cents] in Damascus, but Fajr al-Umma sold it for 3, 500 Syrian pounds [more than $16] within Ghouta.”

These exactions – and the subterranean monopolies that underwrote them – prompted endless negotiations (and worse) between the groups over shared access.  Kholoud al-Shami suggested that Jabhat al-Nusra planned the Nour Tunnel explicitly to undercut its rivals, bring prices down, and so boost its support among the besieged population.  One local resident told her:

It appears that Nusra’s goal is to reduce the suffering of the besieged residents, who had begun cursing the revolution and the rebels because of Falaq al-Rahman and Fajar al-Umma keeping prices high. All factions want to build up their popular support, which is what Nusra is doing… Local residents have viewed the drastic drop in prices positively and stood in solidarity with Jabhat a-Nusra when Falaq al-Rahman prevented them from selling gasoline at reduced prices when they were still sharing a tunnel.

Similarly, Jaish al-Islam apparently pressured Fajar al-Ummah to lower its prices. It was an intricate and constantly changing story, but running through all these deals was the imbrication of the political with the economic.  The attempts to lower prices were all about more than the high-minded desire to ‘reduce suffering’: they were also aimed at boosting support for one faction over another.

The third stream of traffic consisted of medical supplies.  I have separated these from other supplies because they were categorically barred from the al-Wafidden crossing; even UN convoys with the appropriate authorisations had them removed at the checkpoint.  Yet they were vital.  Inside Ghouta doctors were struggling with often catastrophic injuries from shelling and bombing, and doing their best to treat seriously ill patients with chronic conditions (how often we forget that people still get sick in war zones).  With no provision possible through the overland crossings, doctors had to use the tunnels.  A team from the Union of Free Syrian Doctors worked around the clock in Barzeh to obtain vital medical supplies for hospitals and clinics in Ghouta, but by the time they had paid Syrian Arab Army soldiers controlling checkpoints on the highway and then the tunnel tax – medicines were not exempt but were charged ‘only’ 5 per cent – the costs of even routine medications had soared.  Students from the Columbia School of Journalism reported:

By the time all the fees are paid, the price of medical supplies in Eastern Ghouta “is three times higher, sometimes as much as five times, than what’s in the north or south of Syria,” said [Mahmoud] al-Sheikh [director of the Unified Revolutionary Medical Bureau in Eastern Ghouta]. A liter of serum, which is used to help the body replenish lost blood, goes for about $1 in regime-controlled areas (one liter is about one fluid quart). But health workers say they’ve paid anywhere from $3.50 to $10 for one liter of serum brought in from Barzeh.

[Osama] Abu Zayd [a medical equipment engineer with the Union of Free Syrian Doctors] estimates that Ghouta, with its many neighborhoods, needs about 10,000 liters (more than 2,600 gallons) of serum per month.

Whatever came through the tunnels, it was never enough, and all three traffic streams came to a juddering halt as the offensive against Barzeh and Qaboun was renewed.  During the winter of 2016-17 the regime sought to amend the terms of the truce, stipulating that the smuggling trade had to stop; then in February 2017 it peremptorily closed the checkpoints so that supplies from Damascus dried up, and within days nothing was moving through the tunnels to Ghouta.

The fighting that followed was protracted and bloody, and thousands fled through the tunnels to find refuge in East Ghouta.  But by the end of February the Syrian Arab Army occupied the warehouse concealing the portal to the Zahteh Tunnel, and by the middle of May, when the remaining opposition fighters in Barzeh and Qaboun had surrendered and the population was forcibly evacuated, all the major tunnels had been breached.  

State media published videos showing the army cutting the tunnels and carrying out controlled explosions.  The ultimate objective was not only to take down Barzeh and Qaboun but ‘to strangle the Ghouta … by closing off the crossings and tunnels,’ a spokesman for Jaish al-Islam explained.  ‘Trade through the tunnels has completely stopped.’

The loss of the tunnels triggered panic buying in Ghouta, driving prices still higher, and triggered a new round of fighting between the two major blocs of rebel fighters (Jaish al-Islam based in Douma and Falaq al-Rahman in fractious and as it turned out temporary alliance with Hay’at Tahrir a-Sham, which later became Jabhat al-Nusra, which were based in the so-called ‘Central Section’ to the south and the west).

Residents of the Ghouta demonstrated against the infighting – and, in a displaced and horrifying repetition of the tactics employed by regime’s security forces, Jaish al-Islam opened fire on the crowd – and the deepening tension served only to aggravate the economic crisis.  In July 2017 Alaa Nassar reported:

Dozens of recently erected checkpoints and berms split the suburbs [of East Ghouta] in half. For residents trapped inside the Central Section, this means a lack of access to the Wafideen crossing and, therefore, to outside resources.

By September 2017 the Syrian-American Medical Society‘s report on the siege of East Ghouta described a truly dreadful predicament:

In a report for the Middle East Institute, ‘Sieges in Syria: Profiteering from misery‘ (2016) Will Todman summarises the two sets of cross-cordon transactions I’ve described so far – overt commercial transactions through al-Wafideen and clandestine transactions through the tunnels – like this:

It’s an effective summary but, as I now need to show, the bottom line (sic), in which UN convoys are described as ‘an effective means to get goods to civilians at a lower price,’ is problematic.

Aid convoys

Like the commercial convoys of merchandise that were allowed in to East Ghouta, humanitarian aid came in through al-Wafideen (above).  Unlike the commercial flows, however, humanitarian aid was rigorously policed, strictly limited and utterly spasmodic. In Douma, for example, which had been under siege since 2013, the first UN interagency aid convoy did not arrive until 10 June 2016 (below). Its 36 trucks provided emergency food, wheat flour, and nutrition supplies for only 17 per cent of the population.  Those stocks were supposed to last for one month, but the next convoy did not arrive until 19 October 2016, with 44 trucks carrying food supplies for 24 per cent of the population (baby milk had been removed at the checkpoint).  Those supplies were also intended to last for one month, and a third convoy duly arrived at al-Wafideen with supplies for 49 per cent of the population on 17 November 2016.  But the mission was aborted because ‘it lacked specific approval needed to proceed without dog searches and unsealing of the trucks.’  The next UN convoy arrived on 30 October 2017.

I have extracted most of these details from a report prepared by Elise Baker for Physicians for Human Rights with the dismally appropriate title Access Denied.  The report describes a system of deliberate obstruction of humanitarian aid by the Assad regime that imposed – by design, remember – ‘slow, painful death by starvation’ on populations in areas besieged by its forces: what the report also calls ‘murder by siege’.

There have been two main modalities of obstruction.  The first has involved a byzantine process through which UN agencies have been required to obtain formal permission from the government to deliver humanitarian aid.  Following the establishment of a joint working group to facilitate (sic) the process in 2014, it was agreed that each convoy would need approval from the Ministry of Foreign Affairs and ‘facilitation letters’ from the Ministry of Social Affairs, the Syrian Arab Crescent and (in the case of medical supplies) the Ministry of Health.  The process was described by the UN Humanitarian Coordinator as ‘extremely complex and time-consuming’, and matters were not improved by the introduction of additional clearance requirements from the High Relief Committee and the National Security Office.

After repeated protests from the UN the Syrian government finally agreed to ‘simplified procedures for the approval of interagency convoys across conflict lines‘ in March 2016, that should have reduced an eight-step process to a two-step process, with all approvals (or refusals) being issued within seven working days.  In practice, the two-step became a ten– or even eleven-step process.  In January 2017 the UN Security Council was advised of ‘subsequent administrative delays on the part of the government, including in the approval of facilitation letters, approval by local governors and security committees, as well as broader restrictions by all parties [that] continue to hamper our efforts’ to deliver humanitarian aid to besieged populations.  Even with approvals from the authorities in Damascus, protocols were routinely violated at checkpoints.   Stephen O’Brien elaborated:

We continue to be blocked at every turn, by lack of approvals at central and local levels, disagreements on access routes, and by the violation of agreed procedures at checkpoints by parties to the conflict. Are these important? Yes. We can’t – and if I may quote – “just plough on” or “just get on with it” as I’ve heard one member sitting around this say table to me. Because if one brave aid worker drives through the checkpoint without the facilitation letter and the command transmitted down the line, the check-point guard or their sniper takes the shot.

In a statement two months later he bluntly declared: ‘The current bureaucratic architecture is at best excessive and at its worst, deliberately intended to prevent convoys from proceeding.’

The second modality of obstruction was to withhold permission altogether.  The chart below was compiled for PHR’s Access denied; notice the substantial differences between the populations for whom the UN requested access and the populations for whom access was approved, a difference that was the product of both outright rejection and a calculated failure to respond.

Notice too the still smaller population eventually reached by the aid convoys:

From May through December 2016, on average, Syrian authorities authorized UN interagency convoys to deliver aid to approximately two thirds of the besieged and hard-to-reach populations that UN authorities requested access to each month – a figure which, in itself, represents a fraction of the entire besieged and hard-to-reach population. However, UN convoys only reached 38 percent of that smaller approved population, due to additional approval procedures and other delays imposed overwhelmingly by government officials…  At worst, this pattern reflects an effort by Syrian authorities to appear cooperative while still ensuring that access to besieged areas remained blocked.

The approval process allowed the authorities not only to veto the populations permitted to receive humanitarian aid but also to restrict the amount and composition of that aid.  In November 2017, for example, a UN convoy of 24 trucks was allowed in to Douma – the first since August – with food for an estimated 21,500 people (the original request had been for supplies for 107,500); medical supplies had been removed from the convoy.  In March 2018 another, much delayed convoy reached Douma with food for 27,500 people (below); deliveries were interrupted by renewed shelling and 10 of the 46 trucks were forced to return with their loads.  Marwa Awad, who accompanied the convoy with the World Food Programme, described what she found:

Volunteers gathered to help offload the aid from the trucks, including WFP’s wheat flour which the men were offloading into underground cellars. Speaking with the local council, we learned that there were more than 200,000 people in Douma, many of them displaced from nearby villages and other areas within Eastern Ghouta, and all of them needing food and medicine….

Leaving the devastation above, we took a long and narrow staircase deep into Douma’s underworld: a network of basements that has become fertile ground for disease and infection.  Many residents are forced to live underground, crammed together in packed spaces to avoid airstrikes…

There we met Mustafa, a man in his twenties.

“The food aid trickles in very slowly, drop by drop. Many families here are struggling. I hope whoever is hungry gets help,” he said. Because of the increasing demand for food and limited quantities allowed inside, residents of Douma have had to split the food assistance WFP delivered during an earlier convoy in order to reach as many people as possible.

The convoy took place at the height of the final military offensive against the Ghouta: yet the World Health Organisation said that Syrian government officials had ordered the removal of 70 percent of the medical supplies it had prepared for the convoy, including all trauma kits, surgical supplies, dialysis equipment and insulin.

The control exercised by the Assad regime over humanitarian aid derived not only from formal procedures, or the subsequent ‘deletions’ and on occasion, even contamination of supplies at checkpoints; it also depended on the system of clandestine intelligence built in to the architecture of the authoritarian state. The head of one UN agency working out of Damascus told one US/UK investigation team:

We were spied on, followed, our computer traffic was monitored, our notebooks stolen, they knew what we were doing. I’m not sure anyone appreciates how hard all of this was . . . the daily grind of getting a tiny concession of access or movements of goods. The SARC [Syrian Arab Red Crescent] were used as a proxy to control and spy on us and contain us.

So many controls.  And yet UN Security Council resolutions 2139 (2014), 2165 (2014), 2191 (2014) and 2258 (2015) authorized the unconditional delivery of humanitarian assistance, including medical assistance, to besieged and hard-to-reach communities countrywide.  The emphasis is mine; the wording is the UN’s.  But the Assad regime clearly called the shots and imposed the most exacting conditions on the delivery of humanitarian aid to besieged areas like the Ghouta.  The UN even deferred to the Syrian government over the identification of what constituted a siege; its mappings of besieged and ‘hard-to-reach’ areas were far more restrictive than those conducted by Siege Watch or the Syrian-American Medical Society.  Its in-country contracts had to be approved by the government, and not surprisingly many of them – individually worth tens of millions of dollars for accommodation, trucks, fuel, and cellphone service – were with businesses closely tied to the Assad regime.   As Reinoud Leenders put it, ‘the Syrian regime’s aggressive assertions of state sovereignty have locked UN aid agencies into a disturbingly submissive role.’

A report from the Syria CampaignTaking Sides – found that humanitarian aid delivered under the auspices of the UN was disproportionately directed towards areas under the direct control of the Assad regime.  Here is the distribution of aid through the World Food Programme – the largest UN agency handling food aid – shortly after the passage of UNSC 2139, revealing what John Hudson described as ‘Assad’s starvation campaign’:

The following month (April 2014) 75 per cent of food aid delivered from inside Syria went into government-controlled areas.  Two years later (April 2016) 88 per cent of food aid delivered from inside Syria went into government-controlled territory; once cross-border deliveries from Iraq, Jordan, Lebanon and Turkey were taken into account – now authorised by further UN Security Council resolutions – the (dis)proportion going into government-controlled territories fell to 72 per cent.  But by April 2017 it had increased to 82 per cent.  

Still, these raw figures conceal as much as they reveal; humanitarian aid for government-controlled areas has not been subject to the same restrictions, deletions and delays as aid for areas outside the regime’s direct control.  Convoys were far more frequent, loads were larger, and medical supplies were not removed.  The Assad regime frequently represented aid to areas under its control as both a gift from the government (through granting access to international agencies) and a gift of the government: at its highest levels, the Syrian Arab Red Crescent (a central and compulsory actor in these deliveries) is a de facto arm of the state.  There was and continues to be an undoubted need for aid throughout Syria, but according to the UN’s own figures 54 per cent of the population in need lived in government-controlled areas in 2016.  Accordingly, Taking Sides argues that 

The effective subsidy of government areas releases resources that are likely used by the government in its war effort. The UN has enabled one side in the conflict to shift more of its resources away from providing for the needs of its people and into its military campaign.

The official position was always that the UN had to comply with the Assad regime’s predilections and stipulations as a necessary price for access to the besieged areas, but David Miliband (President of the International Rescue Committee) countered that ‘the Assad regime can’t afford to kick the UN out of Damascus [because] the UN is feeding so many of [Assad’s] own people.’  

Conversely, the carefully calibrated restrictions placed by the regime on flows of goods through al-Wafideen into the Ghouta amounted to an assertion of continued control over the besieged population.  Esther Meinghaus [‘Humanitarianism in intra-state conflict: aid inequality and local governance in government and opposition-controlled areas in the Syrian war’, Third World Quarterly 37 (8) (2016) 1454-82] argues that in those areas where the regime was not able to maintain military control it exercised effective ‘humanitarian control’ by continuing to dictate the parameters within which the population lived (and died).  In consequence, like Esther, José Ciro Martinez and Brett Eng [‘The unintended consequences of emergency food aid: neutrality, sovereignty and politics in the Syrian civil war, 2012-15’, International Affairs 92 (1) (2016) 153-73; also available here] describe besieged areas like the Ghouta as spaces of exception.  They reveal a persistent attempt by the Assad regime to separate those ‘included in a juridical order and those stripped of juridical-political protections – a separation between life that is politically qualified and one that is “bare” or naked.’  But as José and Brett emphasise, actors inside the Ghouta (and outside) have repeatedly called into question the actions of the Syrian government and its allies and sought to confound them.   The political salience of those counter-strategies is itself compromised, they insist, by treating humanitarian aid as a ‘neutral’ and essentially technical matter of alleviating physical distress and deprivation – the register within which UN agencies conceive their interventions – because that is to become complicit in the reduction of besieged populations to ‘bare life’: ‘Those receiving assistance are valued strictly in terms of their biological life not their political voice’ (p. 165).

The administration of precarity

Throughout this essay I’ve written about ‘the administration of precarity’ because – following David Nally‘s wonderful example – the siege economy was administered by multiple actors whose regulations and restrictions made them responsible for delivering precarity to the besieged population.  That the Assad regime and its allies had a direct interest in doing so followed directly from their strategy of ‘surrender or starve’, and there was an elaborate web of exactions and extortions reaching from the highest levels of the state down to the foot soldiers who controlled the checkpoints and crossings.  The rebel groups were involved too, but they had a more direct interest in the subterranean smuggling economy, levying fees in cash or in kind on flows through the tunnels to boost their coffers and secure their own supporters.  But the United Nations and its agencies were also culpable in acceding to the demands of the Assad regime, allowing it to funnel most humanitarian aid to areas under its control and condemning the civilian populations in besieged areas to half-chance lives of ever increasing precarity.

Yet precarity does not mean passivity, and a ‘siege economy’ is always more than a political economy: it is also and always what E.P. Thompson would have called a moral economy.  The rebel groups in the Ghouta were chronically incapable (or uninterested) in finding common ground, and their support amongst the besieged population was uneven and variable.  As the siege wore on, protests against their exactions and impositions – and the infighting amongst them – multiplied.  For all that, many (and probably most) civilians remained opposed to the Assad regime, and we should remember too that the war emerged out of the violent response of the state to peaceful protests by ordinary people in the Ghouta and elsewhere calling for democratic reforms.  This matters because as I worked on this essay – watching the videos, reading the reports, unearthing the testimonies – I became aware of an extraordinary resilience and communal solidarity forged within the population.  I think of the ingenuity of the rooftop farmers, the fuel distillers, and the makers of gauze and medicines; the dedication of the doctors, nurses, ambulance drivers and rescue workers faced with so many grievously wounded and seriously ill people; the courage of mothers sharing blankets and what little food they had and singing songs and sharing stories as they huddled with their children in the crowded basements sheltering from the bombs and missiles (see here).

I wrote those words last night; this morning I read this moving letter from the Syria Campaign on ‘Leaving Ghouta‘:

Over the past five years, Ghouta has faced terrible violence including the sarin gas chemical attack that took the lives of hundreds in their sleep. And despite it all they have taught the world a lesson in courage and resilience. When the regime lost control of Ghouta its people built new forms of local governance and held free elections for the first time in Syria’s history. When the bombs started falling on neighbourhoods its teachers and doctors took schools and hospitals underground and ordinary residents put on white helmets and rushed to rescue their friends and neighbours. The people of Ghouta launched inspiring civil society projects, often women-led. They created new media platforms and produced award-winning photojournalism. They created alternative energy resources and introduced new farming techniques.

But after this latest, relentless onslaught, people were truly left with no choice. If they remained in Ghouta they risked being detained and tortured as the Syrian regime closed in, particularly the ones who decided to teach, treat the wounded, or post updates to Facebook. So now many are leaving behind everything they’ve ever known to go to a place that isn’t that much safer. The province of Idlib, home to more than two million, is also being struck from the air by the Syrian regime and its Russian ally.

If only the ‘international community’ had been even half the community created by these brave men and women.

To be continued

The Death of the Clinic

This is the fifth in a new series of posts on military violence against hospitals and medical personnel in conflict zones. It follows directly from my analysis of the situation in Syria here.

President Bashar al-Assad has consistently denied that his forces have attacked hospitals or doctors.  In an interview with SBS Australia on 1 July 2016 he asked his interviewer:

‘… the very simple question is: why do we attack hospitals and civilians?… No government in this situation has any interest in killing civilians or attacking hospitals. Anyway, if you attack hospitals, you can use any building to be a hospital. No, these are anecdotal claims, mendacious statements …’

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There are at least four answers to Assad’s disingenuous question (if you falter at the adjective, see here).

(1) Silencing the witnesses

When Widney Brown from Physicians for Human Rights testified at the Tom Lantos Human Rights Commission on 31 March 2016 she provided one clear and compelling rationale for Assad’s attacks on doctors:

‘… attacks on doctors silence particularly powerful witnesses. When the Syrian government denies its use of chemical weapons, cluster munitions, starvation, or torture, doctors can bear witnesses to these violations because they have seen and treated the victims.’

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To be sure, there are other witnesses and even paper trails and photographic records.  Ben Taub, who has done so much to bring ‘Syria’s war on doctors‘ to the attention of a wider public, has also provided a detailed account of the work done by Bill Wiley and the Commission for International Justice and Accountability whose volunteers have smuggled over 600,000 documents out of Syria detailing mass torture and killings by the regime.

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The war crimes have not been confined to attacks on hospitals in opposition-held areas.  A photographer known only as ‘Caesar’, who had been attached to the Defence Ministry’s Criminal Forensic Division, smuggled out thousands of high-resolution digital images exposing the horrors of the regime’s own military hospitals:

The pictures, most of them taken in Syrian military hospitals, show corpses photographed at close range – one at a time as well as in small groupings. Virtually all of the bodies – thousands of them – betray signs of torture: gouged eyes; mangled genitals; bruises and dried blood from beatings; acid and electric burns; emaciation; and marks from strangulation…

These unfortunates may have lived and died in different ways, but they were bound in death by coded numerals scribbled on their skin with markers, or on scraps of paper affixed to their bodies. The first set of numbers (for example, 2935 in the photographs at bottom) would denote a prisoner’s I.D. The second (for example, 215) would refer to the intelligence branch responsible for his or her death. Underneath these figures, in many cases, would appear the hospital case-file number (for example, 2487/B)…

[T]he system of organizing and recording the dead served three ends: to satisfy Syrian authorities that executions were carried out; to ensure that no one was improperly discharged; and to allow military judges to represent to families—by producing official-seeming death certificates—that their loved ones had died of natural causes. In many ways, these facilities were ideal for hiding “unwanted” individuals, alive or dead. As part of the Ministry of Defense, the hospitals were already fortified, which made it easy to shield their inner workings and keep away families who might come looking for missing relatives. “These hospitals provide cover for the crimes of the regime,” said Nawaf Fares, a top Syrian diplomat and tribal leader who defected in 2012. “People are brought into the hospitals, and killed, and their deaths are papered over with documentation.” When I asked him, during a recent interview in Dubai, Why involve the hospitals at all?, he leaned forward and said, “Because mass graves have a bad reputation.”

(2) Multiplying the casualties

This is a radicalisation of an old strategy.  As Sam Weber pointed out in Targets of opportunity (2005), ‘every target is inscribed in a network or chain of events that inevitably exceeds the opportunity that can be seized or the horizon that can be seen.’  So, for example, when the United States or Israel bombs a power plant it often as not explains that it has been careful to bomb in the small hours when only a skeleton staff was in the building in order to minimise collateral damage.  But this begs the question: why bomb the power plant at all?  In most instances the degradation of the electricity supply means that it becomes impossible to pump water or treat sewage; refrigerators fail and food perishes; hospitals are forced to use unreliable generators. The result – the intended, carefully calculated result – is that casualties rise at considerable distances from the target and over an extended period of time.

Similarly, Dr Abdulaziz Adel notes:  ‘Kill a doctor and you kill thousands.’  Simply put, patients who are sick or injured then go without treatment and in many cases their lives are put at risk.  (The images below are from Collateral Damage: more here).

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Dr Rami Kalazi, a neurosurgeon from East Aleppo, agrees:

‘They are the artery of life in the city. Can you imagine a life in city without hospitals? Who will treat your kids? Who will make the surgeries for the injured people? So, they are targeting these hospitals because they know, if these hospitals were completely destroyed, the life will be completely destroyed.’

(3) ‘Moral[e] bombing’

This too is an old strategy.  The architects of ‘area bombing’ during the combined bomber offensive against Germany during the Second World War described it as ‘moral [sic] bombing’: a sustained and systematic attempt to undermine the morale of the enemy population so that they would demand their leaders sue for peace.  If this was a tried and tested strategy, however, the test showed that it was a complete failure (see my ‘Doors into nowhere’: DOWNLOADS tab).

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But the lesson was lost in Syria, where attacks on hospitals have had a central place.  As Samir Puri argues, the strategy behind the joint Syrian and Russian air campaign seems to be:

“If there is a total collapse of any kind of trauma care, those are the sort of things that can contribute to collapsing morale very suddenly. The morale of a besieged force can look robust until it collapses.”

And Syria is not unique in contemporary wars: Israel has deployed the same strategy in its repeated assaults on Gaza (see here, here and here for ‘Operation Protective Edge’ in 2014), and the Saudi-led coalition has attacked more than 70 hospitals and health facilities in Yemen since March 2015 (in this latter case Russian media have reported MSF’s objections to the ‘utter disregard for civilian life’ without dissent: see for example here).

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‘Preventing medicine’, as Annie Sparrow puts it, has become ‘a new weapon of mass destruction’.

(4) ‘Violence legislates’

Following the attack on the UN aid convoy delivering supplies to a Syrian Red Crescent warehouse outside East Aleppo on 19 September 2016, 101 humanitarian organisations issued a joint appeal to the United Nations on 22 September; in part it read:

‘Deliberate attacks on humanitarian workers and civilians are war crimes. This must mark a turning point: the UN Security Council cannot allow increasingly brazen violations of international humanitarian law to continue with impunity.

‘Heads of state are gathered in New York this week for the United Nations General Assembly. Each one that accepts a lack of accountability for perpetrators and facilitators of war crimes colludes in the ongoing dissolution of international humanitarian law’ (my emphases).

The first paragraph is damning enough.  Ben Taub in the New Yorker again:

Nowhere has the supposed deterrent of eventual justice proved so visibly ineffective as in Syria. Like most countries, Syria signed the Rome Statute, which, according to U.N. rules, means that it is bound by the “obligation not to defeat the object and purpose of the treaty.” But, because Syria never actually ratified the document, the International Criminal Court has no independent authority to investigate or prosecute crimes that take place within Syrian territory. The U.N. Security Council does have the power to refer jurisdiction to the court, but international criminal justice is a relatively new and fragile endeavor, and, to a disturbing extent, its application is contingent on geopolitics.

But the sting comes in the second paragraph.  As I’ve noted before, international humanitarian law is not a neutral court of appeal, a deus ex machina above the fray, but has always been closely entangled with military violence.  In many respects it travels in the baggage train, constantly pulled by the trajectory of the very violence it supposedly seeks to regulate (or facilitate, depending on your point of view).  In short, as Eyal Weizman has it, ‘violence legislates‘.

There is good reason to fear that the systematic violation of medical neutrality is intended to force its dissolution.  Thomas Arcaro writes: ‘Humanitarian principles like neutrality and impartiality that once seemed so self-evident have been drawn into question, especially on the politically and ethnically complex battlefields of Iraq and Syria.’

And not only there.  In the case of the US airstrike on the MSF Trauma Centre in Kunduz in 2015, I’ve suggested that some key Afghan officers and politicians chafed at the protections afforded to wounded Taliban combatants by international humanitarian law.  They also alleged that the Trauma Centre had breached its conditional immunity because the Taliban had overrun the hospital and were firing at US and Afghan forces from its precincts.  There is no evidence to support that assertion, but it is an increasingly familiar claim.  On 7 December 2016 US Central Command justified a ‘precision strike’ requested by Iraqi forces on a building within the al-Salem hospital complex in Mosul by claiming that IS fighters had used it as a base to launch heavy and sustained machine-gun and rocket-propelled grenade attacks.  That would certainly have compromised the hospital’s immunity, but international humanitarian law still requires a warning to be issued before any attack and a proportionality analysis to be conducted; Colonel John Dorrian said that the US Air Force did not ‘have any reason to believe civilians were harmed’ but conceded that it was ‘very difficult to ascertain with full and total fidelity’ whether any medical staff or patients were in the building at the time of the air strike.

But what the Syrian case suggests is a new impatience with medical neutrality tout court: not only a hostility towards the treatment of wounded and sick combatants but also an unwillingness to extend sanctuary to wounded and sick civilians.

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And that reluctance is not confined to the Assad regime and its allies.    A survey carried out for the International Committee of the Red Cross between June and September makes for alarming reading – even once you’ve overcome your scepticism about public opinion polls.  As Spencer Ackerman reports:

Areas in active conflict record greater urgency over questions of civilian protection in wartime than do the great powers that often conduct or participate in those conflicts. In Ukraine, 83% believe everyone wounded and sick during a conflict has a right to health care, compared with 62% of Russians. A full 100% of Yemenis endorse the proposition, as do 81% of Afghans, 66% of Syrians and 42% of Iraqis – compared with 49% of Americans, 53% of Britons, 37% of the Chinese and 67% of the French.

It’s that last clause that is so disturbing: for the last four states listed are all permanent members of the UN Security Council…

So what, then, are we to make of what I’ve been calling ‘the exception to the exception’?

The exception to the exception

homo-sacerI think it’s a mistake to treat ‘the camp’, following Giorgio Agamben‘s vital work, as the exemplary, diagnostic site of the modern space of exception; the killing fields of today’s wars (themselves spaces of indistinction, where it is never clear where war stops and peace begins, where the geometry of the battlefield or, better, ‘battlespace’ becomes ever more fractured and blurred, and where the partitions between international and internal conflicts have been reduced to rubble) are also spaces within which groups of people are deliberately and knowingly exposed to death through the removal of legal protections that would ordinarily be afforded to them.  In short, killing and injuring become legally permissible.

Those exposed groups include both combatants and civilians, but their fate is not determined solely by the suspension of national laws (the case that concerns Agamben) because international humanitarian law continues to afford them some minimal protections.  One of its central provisions has been medical neutrality: yet if, through its serial violations in Syria and elsewhere, we are witnessing the slow ‘death of the clinic’ – which I treat as a topological figure which extends from the body of the sick or wounded through the evacuation chain to the hospital itself – and the extinction of ‘the exception to the exception’, the clinic as a (conditionally) sacrosanct space – then I think it’s necessary to add further twists to Agamben’s original conception.

As Adia Benton and Sa’ed Ashtan have argued, medical neutrality – the exception to the exception – represents a fraught attempt to restrict the state’s recourse to military violence: it is a limitation on and has now perhaps become even an affront to sovereign power and the state’s insistence that it is ‘the sole arbiter of who can live and who can die’.

Agamben describes the inhabitants of the space of exception as so many homines sacri – where sacer has the double meaning of both ‘sacred’ and ‘accursed’ – and it may be that in today’s killing fields doctors, nurses and healthcare workers are being transformed into new versions of homo sacer: once ‘sacred’ for their selfless devotion to saving lives, they are now ‘accursed’ for their principled dedication to medical neutrality.

 

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Yet the precarity of their existence under conditions of detention and torture, siege and airstrike, has not reduced them to what Agamben calls ‘bare life’.  They care – desperately – whether they live or die; they have improvised a series of survival strategies; they have not been silent in the face of almost unspeakable horror; and they have developed new forms of solidarity, support and sociality.

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‘Your turn, doctor’

This is the fourth in a new series of posts on military violence against hospitals and medical personnel in conflict zones.  It follows from my analysis of air strikes on base hospitals on the coast of France in 1918 here, and of the US air strike on the MSF Trauma Centre in Kunduz, Afghanistan in 2015 here and here.  This post, together with the next in the series, is about Syria.  They all derive from a new presentation – still in active development – called ‘The Death of the Clinic: surgical strikes and spaces of exception’ that will eventually become an essay in my next book, so I would appreciate any comments or suggestions.

The eye of the storm 

Syria’s civil war has multiple origins, but one of the most incendiary incidents took place on 16 February 2011 in the city of Dara’a 80 km south of Damascus near the Jordanian border.  Inspired by the spread of the Arab uprisings east across the Maghreb from Tunisia, and the threat they posed to a succession of autocratic regimes, a group of local teenagers decided to daub slogans on the wall of their high school.  One of them, a brave 15-year old (who now lives with his family in Jordan), painted this:

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‘Ejak el door ya Doctor’ – ‘Your turn, doctor’.

The doctor in question was Bashar al-Assad, Syria’s president, who had trained as an opthalmologist in Damacus and London.  In the months to come, Assad would give that slogan a viciously ironic twist.

The immediate response of the security forces to the graffiti was swift and draconian; the boys were rounded up, imprisoned and tortured (see herehere and here).  When their relatives protested to the officer in charge he told them:

‘Forget your children.  Just make more children. And if you don’t know how to make more, I’ll send someone to show you.’

hrw-weve-never-seen-such-horrorLocal people took to the streets, and as the demonstrations spread on 22 March security forces entered the National Hospital in Dara’a, cleared it of all non-essential medical staff and stationed snipers on the roof who were under orders to fire on protesters.  The hospital remained until military control until May 2013; admissions were restricted and snipers continued to fire on the sick and wounded who tried to approach the hospital.  On 8 April security forces opened fire on thousands of demonstrators approaching a roadblock; ambulances were prevented from reaching the wounded, and a doctor, a nurse and an ambulance driver were killed when they tried to get through (UN Human Rights Council: ‘Assault on Medical Care in Syria’, 13 September 2013: download here; see also the Human Rights Watch report, ”We’ve never seen such horror’ here).

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Others took up the cry, taking to the streets and chanting ‘Dara’a is Syria‘.  In many other areas the government stationed snipers, armoured personnel carriers, tanks and heavy artillery at hospitals; doctors suspected of treating protesters were arrested and tortured; security forces forcibly removed patients from hospitals, ‘claiming bullet or shrapnel wounds as evidence of participation in opposition activities’; and ambulances transporting casualties were attacked and pharmacies looted.

The UN Human Rights Council concluded:

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This was, sadly, hardly novel.  In 2006, at the height of sectarian violence in occupied Baghdad, for example, Muqtada al-Sadr‘s Shi’a militia controlled the Health Ministry and manipulated the delivery of healthcare in order to marginalise and even exclude the Sunni population.  As Amit Paley reported:

‘In a city with few real refuges from sectarian violence – not government offices, not military bases, not even mosques – one place always emerged as a safe haven: hospitals…

‘In Baghdad these days, not even the hospitals are safe. In growing numbers, sick and wounded Sunnis have been abducted from public hospitals operated by Iraq’s Shiite-run Health Ministry and later killed, according to patients, families of victims, doctors and government officials.

‘As a result, more and more Iraqis are avoiding hospitals, making it even harder to preserve life in a city where death is seemingly everywhere. Gunshot victims are now being treated by nurses in makeshift emergency rooms set up in homes. Women giving birth are smuggled out of Baghdad and into clinics in safer provinces.’

He described hospitals as ‘Iraq’s new killing fields’, but in Syria the weaponisation of health care has been radicalised and explicitly authorized by the state.

Counterterrorism and the criminalisation of health care

Doctors were systematically targeted for treating anyone who opposed the government.  In April 2012 one surgeon from Idlib told Annie Sparrow:

‘We were detained in the hospital for several days. Tanks parked out front, artillery in the wards, snipers on the roofs shooting patients who tried to come. They took our names, and summoned three of the five security branches – state, political and military. I was interrogated and forced to sign several commitments not to treat anyone not pro-regime. Of course, as soon as I was released I violated it immediately…the city was full of wounded and sick people. Soon after that a friend who worked in military security let me know I was now “wanted” [for my work], the charge being that I was the leader of a terrorist group. So I went into hiding, and moved my family to Turkey. In retaliation my brother was executed.’

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The State of Emergency that had been in force in Syria since 1962 was abruptly ended on 21 April 2012.  But on 2 July a new Counter-terrorism Law came into force that criminalised all medical aid to the opposition.  Here is Annie Sparrow again:

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The parallels with the objections voiced by some members of Afghanistan’s security services against MSF’s work in Kunduz are only too clear: but in Syria they have been given explicit state sanction enforced through the law.

As Neil Macfarquhar and Hala Droubi reported for the New York Times in March 2013, doctors repeatedly found themselves in the cross-hairs.  Here, for example, is the case of Dr Mohamad Nour Maktabi:

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The Counter-terrorism Law also declared that all medical facilities operating in opposition-held areas without government permission were illegal – and thereby transformed them (under Syrian law, at least) into legitimate targets of military violence.

Air wars and ‘surgical strikes’

The nature of military and paramilitary violence has changed during the course of the war; shooting and mortar-fire have increasingly been supplemented by air strikes.

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Even in the early stages of the war doctors were confronting what one trauma specialist called ‘unimaginable injuries’.  Dr Rami Kalazi, a neurosurgeon in east Aleppo, explained:

‘In the beginning, we saw new injuries that we did not know how to treat. Fortunately, at the beginning of the revolution and when we began working in field hospitals, there was more freedom of movement. In 2012 and 2013, there was no such thing as “barrel bombs” and there was no violent shelling from airplanes, so many visiting foreign doctors came…

‘But even so, they told us that they were seeing injuries that they had never seen before in books or textbooks or in the hospitals where they worked in their home countries. Unfortunately, reality forces you to learn.’

But air strikes transformed the calculus of injury.  Many more casualties resulted from each attack, and the wounds of those who survived were often far more serious.

The US-led coalition has carried out multiple airstrikes primarily in areas controlled by IS, and the campaign has caused (minimally) hundreds and probably several thousand civilian casualties – see my analysis of specific US air strikes here and here, for example –  but the Syrian Arab Air Force has concentrated its fire on areas controlled by other rebel groups (see Jeffrey White‘s analysis here).

A favourite tactic has been the deployment of ‘barrel bombs‘ – in effect, aerial IEDs: oil drums filled with high explosive and cut rebar to act as shrapnel – dropped from helicopters (see Human Rights Watch here).  Basel al-Junaidi described witnessing their impact:

I saw the aftermath of a barrel bomb. I saw human remains scattered in the street; I heard the screaming. I’m trained as a doctor, but I was unable to act. I just stood there, petrified. The West thinks we’re used to this, but we aren’t of course. We’re like anyone else – we use computers and cars, not camels and tents…

Another doctor who worked in Syria said he kept ‘a drawing from a second grader in Aleppo, showing helicopters bombing the city, blood and destruction below.’  Chillingly, ‘the dead children are smiling while the living ones are crying.’

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From September 2015) the Russian Air Force, often acting in concert with the Syrian Arab Air Force, has also concentrated on targets in areas controlled by other opposition groups:

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Russia has routinely denied these charges, but from 30 September to 12 October 2015 its Ministry of Defence published videos of 43 airstrikes. Bellingcat, aided by crowdsourcing, identified the exact location of 36 of them and overlaid them on the ministry’s own map identifying which groups controlled what parts of the country (see the full report, ‘Distract, Deceive, Destroy’, here):

‘The result revealed inaccuracy on a grand scale: Russian officials described 30 of these videos as airstrikes on Isis positions but in only one example was the area struck in fact under the control of Isis, even according to the Russian MoD’s own map.’

The effect of these air strikes has been devastating on the population at large.  To make matters even worse, air strikes cannot target individual doctors and have instead frequently been directed against hospitals and other medical facilities.   This compromises not only trauma care for the wounded but also the treatment of chronic and infectious diseases:

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(You can find a discussion of the problem of infectious diseases in Sima L. Sharara and Souha S. Kanj, ‘War and infectious diseases: challenges of the Syrian Civil War’, PLOS Pathogens 10 (11) (2014) here).

Hospitals and bomb sights

Doctors and other medical staff had to adjust to a new, sickening vulnerability.  Here is one OB/GYN who was still working in a hospital in East Aleppo when she was interviewed on Public Radio International in August 2016:

Carol Hills, PRI: Doctor Farida, did I just hear a noise there? Was that some sort of attack that I just heard?
Dr Farida Almouslem: It’s attack. [Laughs]. It’s normal. It’s away from me. Not next to me. These noises are all the time.
Hills: Do you and the doctors and patients you work with feel safe inside the place where you’re working?
Dr Farida: No. It’s not safe. I work at the third floor in my hospital. And many times the wall was perforated. So every woman came to the hospital, she knows that there is a danger on her life. So they just give the delivery, or give the birth, and then go home. She escapes to home because she knows our hospital is always targeted.

Other doctors in opposition-held areas said the same.  Here is Dr Mohamed Tennari, director of an above-the-ground field hospital in Idlib:

‘When I am in the hospital, I feel like I am sitting on a bomb. It is only a matter of time until it explodes. It is wrong − a hospital should not be the most dangerous place.  I wish I could say that targeting a hospital in Syria is unique, but is not.’

In fact, it’s far from unique: Physicians for Human Rights has issued a report detailing Attacks on Doctors, Patients and Hospitals hospitals and provided a interactive map of attacks on healthcare in Syria.

In the face of these escalating attacks, hospitals in opposition-held areas have tried to conceal their locations from the Syrian government.  In contrast to the protocol adopted by the MSF Trauma Centre in Kunduz, they have been markedly reluctant to provide their GPS coordinates (and see MSF’s explicit comparison between what happened in Kunduz and the situation in Syria here):

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But this has trapped them in a grim Catch-22.  Michiel Hofman of Médecins sans Frontières – which is not permitted to operate in government-controlled areas in Syria – explains:

‘Hospitals that MSF supports in Syria are bereft of the possible protection of being clearly marked as a hospital or sharing of GPS coordinates, as the Syrian government passed an anti-terrorist law in 2012 that made illegal the provision of  humanitarian assistance – including medical care – to the opposition, forcing most health structures to go underground and operate without governmental medical registration. The bombing parties can then conveniently claim they were unaware it was a hospital they hit.’

More often, the Syrian government and its allies routinely describe the bombed building as a ‘so-called hospital’.  After an air strike on an MSF-supported hospital near Maarat al-Numan in Idlib on 15 February 2016 Bashar Jaafari, Syria’s ambassador to the United Nations, made this statement:

‘The so-called hospital was installed without any prior consultation with the Syrian government by the so-called French network called MSF which is a branch of the French intelligence operating in Syria… They assume the full consequences of the act because they did not consult with the Syrian government. They did not operate with the Syrian government permission.’

The allies of the Syria government are not confined to Russia and Iran.  On 27 April 2016 the Al Quds hospital in Aleppo was hit by two air strikes that killed 55 people  – among them two specialists, including Dr Muhammad Waseem Maaz, Al Quds’s pediatrician – and severely damaged the hospital. When it partially reopened 20 days later its capacity was reduced from 34 to 12 beds.  MSF conducted a detailed review of the operations of the hospital and the circumstances of the attack:

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Here is Professor Tim Anderson on what he calls ‘The “Aleppo Hospital” Smokescreen‘ (and for reasons that will become obvious I am so tempted to put scare-quotes around the title that adorns his post; the Department of Political Economy at the University of Sydney lists him as a Senior Lecturer not a Professor, but perhaps anxiety over the appellation ‘Doctor’ is contagious):

‘…the story of Russian or Syrian air attacks on the ‘al Quds hospital’ gained prominence in the western media… CCTV showed people leaving this ‘hospital’ before an explosion.

‘The building is in the southern al-Sukkari district, which has been a stronghold of Jabhat al Nusra for some years. Many Aleppans had never heard of ‘al Quds hospital’. Dr Antaki [Aleppo Medical Association in Western Aleppo] says: “This hospital did not exist before the war. It must have been installed in a building after the war began”…. This facility was not a state-run or registered facility.’

Anderson is joined in his disinformation effort by Eva Bartlett writing in the ‘OffGuardian’:

Dr. Zahar Buttal, Chairman of the Aleppo Medical Association … said: “The media says the only pediatrician in Aleppo was killed in a hospital called Quds. In reality, it was a field hospital, not registered.”

As for the pediatrician, “We checked the name of the doctor and didn’t find him registered in Aleppo Medical Association records.”…

… central to the lies were the bias and propaganda of the very partial, corporate-financed Médecins Sans Frontières (MSF), which supports areas in Syria controlled by terrorists, specifically Jabhat al-Nusra…’

To repeat: the Syrian government has refused to register or recognise any hospitals operating in areas outside its control – hence the snide reference to ‘so-called hospitals’ and Anderson’s meretricious scare-quotes – and it does not permit MSF to operate in areas under its control (despite repeated requests).  As for the disappearance of Dr Muhammad Waseem Maaz from the Syrian government’s registry (though I have no doubt he was on other lists maintained by the regime) the director of the Children’s Hospital in Aleppo provides a graceful tribute to him here.  And here is the doctor whose death these commentators dismiss so lightly (if you have the stomach for it, you can see his last moments caught on CCTV here):

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What, apart from the grotesque stipulations of the Syrian state, makes them think it proper to withdraw medical care from those living – surviving – in rebel-held areas?  International humanitarian law is unequivocal: they are entitled to medical treatment and to be protected whilst it is provided to them.

In rebel-held areas medical care has increasingly moved outside what were once established hospitals into the clandestine ‘field hospitals’ referred to above, which have been given numbered code-names to conceal their locations.  Some, like those established by MSF, follow strict medical protocols and, according to a study of one operating in Jabal al-Akrad by Miguel Trelles and his colleagues, they have (for a time) been able to provide high-quality medical care with remarkable survival rates (‘Providing surgery in a war-torn context: the Médecins Sans Frontières experience in Syria’, Conflict and Health (December 2015)).  As the attacks on them have increased and qualified personnel and medical supplies have become scarce, however, many have become exercises in improvisation:

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Some of these hospitals have literally gone underground.  ‘‘In our worst dreams – in our worst nightmares – we never thought we would have to fortify hospitals,’ declared Dr Zaidoun al-Zoabi of the Union of Medical Care and Relief Organizations. ‘It’s not humane. It’s impossible to comprehend.’

Subterranean locations have been used not only to protect the hospitals but also to protect local populations.  Charles Davis reported that

‘whether it’s a vehicle or a building, anything that’s identifiable as providing medical care is ripe for an airstrike, so that staff have now taken to covering up any distinguishing characteristics. Even so, [Dr Abdulaziz Adel, a surgeon in East Aleppo, admits that] local residents are “always begging us to go away, take your hospital away from us or otherwise we’ll be a target.”‘

When the Syrian-American Medical Society proposed to build a hospital in Hama in 2014, local people begged them to locate it outside the city and so SAMS excavated what became the Dr Hasan al Araj Hospital, better known as ‘The Cave’:

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Supply chains and kill-chains

As the civil war ground on, even the most basic medical supplies became scarce and obtaining them ever more dangerous.  In March 2015 MSF reported that:

‘Even if it is available, many suppliers do not want to risk selling material like gauze or surgical threads when they know it is going to be sent into North Homs. Gauze is considered synonymous with war surgery, and often a supplier is not willing to take the risk of being arrested or shut down for supplying a besieged area.’

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You can read more here and here.  One doctor told MSF:

‘It is precious, dangerous, incriminating. There are secret outlets supplying us with gauze.’

At the end of last year the Guardian provided this image of one of the secret factories:

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In East Ghouta, hospitals have been forced to use tunnels to bring in medical supplies (more from Ellen Francis and her colleagues here):

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The risks are formidable and the costs have been almost prohibitive.  Ellen Francis and her colleagues at Columbia’s Graduate School of Journalism report that in January 2014 the Free Syrian Army and the Syrian Arab Army agreed an uneasy and ragged cease-fire in Barzeh, a small town on the northern edge of Damascus. There a team from the Union of Free Syrian Doctors was able to buy medical supplies from merchants who travelled out from the capital.

The merchants paid a 20 per cent ‘customs fee’ to Syrian Army soldiers; the agents for the doctors then paid a ‘tax’ to get the supplies through the Harasta checkpoint on the Army-controlled highway, and then a ‘toll’ to the rebels (‘tunnel lords’) who controlled the tunnels into Ghouta.

The combined fees inflated the price of medical supplies.  A litre of serum used to help the body replenish lost blood cost $1 in government-controlled areas and $3.50 to $10 via the tunnel route. Ghouta was using about 10,000 litres of serum per month.  The supply chain was subsequently severed once Barzeh itself came under siege and was cut off from Damascus.

Some humanitarian aid has crossed the lines by more conventional routes – conventional for a war zone at any rate – but medical supplies have routinely been removed from aid convoys.  On 19 May 2016 the UN Secretary-General reported to the Security Council:

‘[By May] 2016, WHO [had] submitted 21 individual requests to the Government of the Syrian Arab Republic to deliver medical supplies to 82 locations in 10 governorates. The Government approved five requests [while] 16 requests remained unanswered.

‘The removal of life-saving medicines and medical supplies continued, with nearly 47,459 treatments removed from convoys in April intended for locations in Homs, Aleppo and Rif Dimashq governorates. Removed items included surgical supplies, emergency kits, trauma kits, mental health medicines, burn kits and multivitamins. Removals extended to basic items, such as antibacterial soap, which was removed from midwifery kits. Items were also removed from other kits, notably surgical tools…’

Even then, aid convoys are not safe.  Four months later to the day a UNICEF aid convoy delivering supplies to a Syrian Red Crescent warehouse at Urum al-Kubra in Aleppo was attacked from the air, killing at least 18 people and destroying 18 of the 31 trucks.  Most analysts have concluded that the Russian Air Force was responsible, perhaps acting in concert with the Syrian Arab Air Force – see for example here and here– but the Russian Ministry of Defence and the usual suspects have variously blamed spontaneous combustion, a ground attack by rebels and a US drone attack.

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These shortages are threaded into dispersed and precarious siege economies that gravely affect the health of local populations.  In December 2015 an estimated 400,000 people were surviving without access to life-saving aid in 15 besieged locations across Syria; the figures gathered by Siege Watch are even higher.

Surrounded by 6,000 land-mines and 65 sniper-controlled checkpoints, Madaya’s 40,000 inhabitants have been under siege since July 2015; 32 people died of starvation and malnutrition in December 2015 alone.  One resident interviewed by Amnesty International in January 2016 described the catastrophic situation:

‘Every day I wake up and start searching for food. I lost a lot of weight, I look like a skeleton covered only in skin. Every day, I feel that I will faint and not wake up again… I have a wife and three children. We eat once every two days to make sure that whatever we buy doesn’t run out. On other days, we have water and salt and sometimes the leaves from trees. Sometimes organizations distribute food they have bought from suppliers, but they cannot cover the needs of all the people.

‘In Madaya, you see walking skeletons. The children are always crying. We have many people with chronic diseases. Some told me that they go every day to the checkpoints, asking to leave, but the government won’t allow them out. We have only one field hospital, just one room, but they don’t have any medical equipment or supplies.’

An aid convoy was allowed in four days after this interview.

There are also grave shortages of skilled medical personnel.  The doctors who remain in opposition-held areas have all had to learn new skills sometimes far beyond their original training.  In March 2015 one young surgeon working in an MSF-supported hospital east of Damascus recalled:

‘There was a pregnant woman who was trapped during the time we were under full siege. She was due to deliver soon. All negotiation attempts to get her out failed. She needed a cesarean operation, but there was no maternity hospital we could get her to, and I had never done this operation before.

A few days before the expected delivery date, I was trying to get a working internet connection to read up information on doing a C-section. The clock was ticking and my fear and stress started to peak. I wished I could stop time, but the woman’s labour started…’

In 2015 OCHA estimated that more than 40 per cent of pregnant women in these areas now scheduled C-sections to reduce the risk of an attack preventing them from obtaining care.

In some cases doctors can call on skilled overseas help via Skype from consultants on call 24/7 in the United States, Canada and the United Kingdom.  Ben Taub has written movingly of the extraordinary efforts of what he calls ‘the shadow doctors’ enlisted in ‘the underground race to spread medical knowledge as the Syrian regime erases it.’  One of the most active is Britain’s Dr David Nott:

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But not all those seeking specialist help are qualified surgeons.  In the field hospital serving the besieged town of Madaya medical care has been provided by a dentist, a dental student and a veterinarian.  Avi Asher-Schapiro reports:

‘The five-year civil war has plunged the Madaya clinicians into the deep end, forcing them to perform medical procedures that push them far beyond their training. They have treated countless gunshot victims, performed seven amputations, over a dozen C-sections, and diagnosed everything from meningitis to cancer.’

As he explains, this remarkable trio has also relied on remote medicine:

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These are all extraordinary responses to near-impossible, life-threatening situations.  But their successes have been short-lived.

The Madaya clinic was forced to close in November 2016:

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And the M10 hospital where Nott helped direct surgery – the largest trauma and ICU centre in East Aleppo – was hit by successive, catastrophic air strikes.  First, an attack on 28 September 2016 left only half the hospital operational.  On 1 October Xisco Villalonga, MSF’s Director of Operations, reported that

‘Bombs are raining from Syria-led coalition planes and the whole of east Aleppo has become a giant kill box.’

That night multiple strikes on M10 killed two people and injured ten others; the hospital had to be evacuated because one crater was so deep there were fears that the rest of the building would collapse.

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But the ordeal was not over: there were further, devastating strikes on 3 October:

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The underground hospitals have fared no better.  ‘The Cave’ – 15 metres inside a mountain, remember – was hit by two ‘bunker-buster’ bombs at 1500 on 2 October 2016. After 35 staff and patients had been evacuated a second strike occurred in the early evening involving missiles and cluster bombs. The E.R. was wrecked, ceilings collapsed, cement walls crumbled and generators, water tanks and medical equipment were destroyed (see image below).  Nobody was seriously injured but the hospital sustained critical damage and has been closed indefinitely. It used to treat 300 patients and perform 150 surgeries a month.

Cave Hospital hit by bunker-buster bombs

The exception to the exception

Once safe places under the protection of international humanitarian law – the exception to the space of exception that is the conflict zone – hospitals have become the targets of a new and extraordinarily vicious modality of modern war.  The systematic attacks on hospitals have not only threatened the lives of patients and healthcare workers; they have also made many patients reluctant to seek medical treatment at all.  In February 2015 a report from the Centre for Public Health and Human Rights at Johns Hopkins University was already warning of the consequences:

‘Unless they feel their life is in danger, many people won’t go to hospital because it is targeted for bombardment’ [Physician, Aleppo]. Two physicians reported that fear of travel and an understanding that the hospital is a target has led to a 50% decrease in clinic visits and surgery cases, even though the level of violence has not decreased.

Dr Farida, the OB/GYN in East Aleppo interviewed earlier, no longer has a hospital to work in – the last remaining hospital was reduced to rubble and closed on 18 November – and she now provides what medical care she can from a basement:

‘People know it’s a basement, but they are afraid to come here because they know any health facility is deliberately targeted by the regime. For women, they are afraid to come — but they don’t have any other option. When they don’t have a car or fuel to come here, they have to give birth at home. Women are bleeding at home and babies are born dehydrated without oxygen.’

Those that do make the precarious journey to a field hospital or other medical facility almost always now find that their care is compromised by the shortage or even the absence of doctors, nurses, medical supplies and even the most basic medical equipment.  So doctors use ordinary sewing cotton instead of surgical thread; local anaesthetic where they would normally use a general, or even home-made, improvised variants.  Dr Zaher Sahloul, who still tries to provide help to colleagues in Syria from his home in Chicago via WhatsApp, explains:

‘We operate on the mindset that they have basic things we take for granted… The reality is, they don’t have 90 percent of the things we think they have. They know better what they have and what they can do with it. These people are facing decisions we will never face in our lives. If you have 10 patients dying, who will you see first? Do you use spoiled gauze and dirty tubes at the risk of infection? It’s Hell for them.’

As I write, the Syrian Arab Army and its supporting militias are advancing into East Aleppo, where air strikes and artillery bombardments have left more than 250,000 people without access to any form of advanced medical care.  The World Health Organisation announced that ‘although some health services are still available through small clinics, residents no longer have access to trauma care, major surgeries, and other consultations for serious health conditions.’

The final irony – although in this catalogue of horrors it probably isn’t the last at all – is that the Kremlin has announced that it will send two mobile hospitals to treat patients from East Aleppo.  The Defence Ministry will operate ‘a special 100-bed clinic with trauma equipment for treating children’ and the Emergencies Ministry will provide a 50-bed clinic capable of treating 200 outpatients a day.

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While the Kremlin congratulates itself on its ‘humanity’, we need to remember that this minimalist contribution would not have been necessary at all had medical neutrality been respected and doctors and nurses, hospitals and clinics not been so ruthlessly, systematically and deliberately targeted in the first place.

UPDATE:  On 5 December the Defence Ministry’s mobile hospital (set up in West Aleppo to treat patients from East Aleppo) came under mortar fire from the crumbling opposition-held area to the east; one Russian doctor and two paramedics were killed.  It’s not clear whether the hospital was deliberately targeted – there have been accusations that the co-ordinates of the hospital must have been given to the militants for it to have been hit ‘right at the moment when it started working‘ – or whether it was caught in the indiscriminate shelling and mortar-fire that has hit other hospitals in West Aleppo.

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But I should make two things clear.  First, attacks on hospitals in West Aleppo – even though I don’t think they have exhibited anything like the scale or the systematicity of those directed against medical facilities and healthcare workers in opposition-held areas – are as reprehensible as those on hospitals in the East.  Second, the muted response from the US-led coalition to the shelling of the Russian field hospital is deeply disturbing.  The International Committee of the Red Cross announced after the attack that ‘all sides to the conflict in Syria are failing in their duties to respect and protect healthcare workers, patients, and hospitals, and to distinguish between them and military objectives.’  The Russian Ministry of Defence dismissed this as a ‘cynical’ display of indifference to the deaths of its doctors, but I don’t read it like that at all – what is cynical is the partisan appeal to medical neutrality when it suits, and its systematic violation when it doesn’t.

To be continued

Fighting over Kunduz

This is the third in a new series of posts on military violence against hospitals and medical personnel in conflict zones. It examines some of the key issues arising from the US attack on the Trauma Centre run by Médecins Sans Frontières (MSF) in Kunduz on 3 October 2015; it follows directly from my detailed analysis of the attack here and prepares the ground for a still more detailed analysis of attacks on hospitals, doctors and casualties in Syria to follow.

There are at least four main issues arising from the US attack on the MSF Trauma Centre in Kunduz that spiral out into a wider argument about what I will later call ‘The Death of the Clinic’.  I’m treating ‘the clinic’ here as a topological figure that extends from the body of the wounded through the evacuation chain to the hospital itself.  The clinic has been accorded a privileged status within the space of exception that is the modern conflict zone – a complicated, fractured space in which killing is made permissible subject to the protocols of international humanitarian law –  so that the clinic becomes an exception to the exception and its inhabitants granted a conditional immunity from attack.

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It’s important to understand that this legal armature is not immutable, and that changes (and challenges) to it arise through both (geo)political and military actions; international humanitarian law is not a deus ex machina, somehow above the fray, but is thoroughly entangled with the prosecution of military violence.  More on this to come, but for now it will be enough to list some of the major protections accorded to the clinic in war-time.

The first Geneva Convention (1864) (‘the Red Cross Convention’):

Ambulances and military hospitals shall be acknowledged to be neuter, and, as such, shall be protected and respected by belligerents so long as any sick or wounded may be therein.  Such neutrality shall cease if the ambulances or hospitals should be held by a military force … A distinctive and uniform flag shall be adopted for hospitals, ambulances and evacuations.

Under the Hague Regulations (1899/1907) that were in force during the hospital raids in France at the end of the First World War:

… all necessary steps must be taken to spare, as far as possible, … hospitals, and places where the sick and wounded are collected, provided they are not being used at the time for military purposes. It is the duty of the besieged to indicate the presence of such buildings or places by distinctive and visible signs, which shall be notified to the enemy beforehand.

Geneva Conventions 1949 care of woundedUnder the Geneva Conventions (1949) – whose provisions applied to the attack on the MSF Trauma Centre a hundred years later – there is a similar immunity granted to the military-medical machine:

The protection to which fixed establishments and mobile medical units of the Medical Service are entitled shall not cease unless they are used to commit, outside their humanitarian duties, acts harmful to the enemy. Protection may, however, cease only after a due warning has been given, naming, in all appropriate cases, a reasonable time limit and after such warning has remained unheeded.

And this is explicitly extended beyond the military-medical machine to institutions like the MSF Trauma Centre:

Civilian hospitals organized to give care to the wounded and sick, the infirm and maternity cases, may in no circumstances be the object of attack but shall at all times be respected and protected by the Parties to the conflict.

The protection to which civilian hospitals are entitled shall not cease unless they are used to commit, outside their humanitarian duties, acts harmful to the enemy. Protection may, however, cease only after due warning has been given, naming, in all appropriate cases, a reasonable time limit and after such warning has remained unheeded.

In so doing the treatment of hostile combatants is also explicitly provided for and protected:

The fact that sick or wounded members of the armed forces are nursed in these hospitals, or the presence of small arms and ammunition taken from such combatants and not yet been handed to the proper service, shall not be considered to be acts harmful to the enemy.

The language and specifications change, but there is nevertheless a consistent thread running through these provisions.  It has been stretched – and perhaps broken – by the attack on the MSF Trauma Centre, and here I’ll focus on four issues that have proved contentious.  First, the visual identification of the Trauma Centre; second, the alleged breach of its conditional immunity; third, the construal of the attack as a war crime; and fourth, the putative rejection of medical neutrality altogether.

(1) Visual identification

International humanitarian law (IHL) requires those responsible for hospitals ‘to indicate their presence’ – the language varies – in order to ensure their protection, and here the US military investigation made this finding (all page numbers in brackets refer to the redacted report):

The center roof of the MSF Trauma Center was marked with two rectangular MSF flags… The front and sides of the MSF hospital were marked from the street view and a MSF flag flew in the courtyard.  The MSF Trauma Center was not marked with any internationally recognized symbols such as a red cross, red crescent or a red “H”.  If it had been marked with these symbols, it is possible the Trauma Center would not have been engaged. (082)

This counterfactual does not loom large in the report or its recommendations, but Charles Dunlap (at Lawfire) has seized upon it to berate MSF:

Ask yourself: wasn’t it a mistake for [MSF] – and a serious one – not to have marked its facility in accordance with Protocol III to the Geneva Conventions which designates “the only emblems recognized by nations signifying the protected status of individuals or objects bearing them during armed conflict”?  Had, for example, the hospital been marked with large Red Crosses/Red Crescents or one of the other internationally-recognized symbols (as the U.S. does) or something that would make its protected use clear from the air, isn’t it entirely plausible that the aircrew (or someone) might have recognized the error and stopped the attack before it began?

Put another way, isn’t it foreseeable that in an exceptionally chaotic combat situation (where a belligerent is making use of civilian buildings to conduct combat operations) that mistakes could occur in identifying a protected structure absent Protocol III markings or at least something to make it identifiable at a distance, especially when it’s known that attacking aircraft are being used?  Wouldn’t reasonably prudent persons have marked their medical facility with an internationally-recognized symbol or something of similar clarity to the warring parties?  Wouldn’t due care demand it in that situation?

In accusing MSF of ‘imprudence’ and even recklessness Dunlap applies a double standard.  He repeatedly insists that the US and the Afghan militaries confronted ‘an extraordinarily intense situation’ in Kunduz, that they faced ‘terrible urgency’ and ‘enormous pressure’ as they operated ‘in the turmoil of a war zone’ – all of which is undoubtedly true – but he uses this to excuse their mistakes while refusing to extend the same privilege to MSF.

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Let me remind you of Dr Kathleen Thomas‘s account of working in the ER (above) once the city had fallen to the Taliban:

The first day was chaos – more than 130 patients poured through our doors in only a few hours. Despite the heroic efforts of all the staff, we were completely overwhelmed. Most patients were civilians, but some were wounded combatants from both sides of the conflict. When I reflect on that day now, what I remember is the smell of blood that permeated through the emergency room, the touch of desperate people pulling at my clothes to get my attention begging me to help their injured loved ones, the wailing, despair and anguish of parents of yet another child lethally injured by a stray bullet whom we could not save, my own sense of panic as another and another and another patient was carried in and laid on the floor of the already packed emergency department, and all the while in the background the tut-tut-tut-tut of machine guns and the occasional large boom from explosions that sounded way too close for comfort.

In any case, MSF had clearly ‘indicated their presence’ to both the US and Afghan authorities by providing them with the GPS co-ordinates of the Trauma Centre (see my previous discussion here). Dunlap finds this ‘commendable’ but ‘legally problematic’.

Instead, he is fixated on the absence of a Red Cross flag from the roof, in which case he might reflect on another passage from the report.  On 2 October, the day before the air strike, MSF phoned the Special Operations Task Force in Bagram to develop a contingency plan: while the Taliban were respecting the neutrality of the Trauma Centre and ‘treating the government casualties well’, they wanted to know the feasibility of extracting their patients should conditions deteriorate.  During that conversation they were advised to ‘take the signs normally affixed to the sides of the trucks and to install them on the top of the vehicles for easy identification by aircraft during this or any future MSF resupply operations‘ (503; my emphasis).  This surely makes it clear that the US military anticipated no difficulty in recognising MSF’s flag and logo as symbols of medical neutrality.

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(2)  Conditional immunity

IHL makes it clear that treating wounded combatants does not compromise the protections afforded to a medical facility; that occurs only if it is used as a base from which ‘to commit, outside their humanitarian duties, acts harmful to [one of the belligerents]’.  I’ll address the intervening clause – ‘outside their humanitarian duties’ – under (4) and confine my discussion here to the alleged militarisation of the clinic.

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MSF’s internal review found that its unambiguous ‘no weapons‘ policy was adhered to:

All of the MSF staff reported that the no weapons policy was respected in the Trauma Centre. [Since the KTC opened, there were some rare exceptions when a patient was brought to the hospital in a critical condition and the gate was opened to allow the patient to be delivered to the emergency room without those transporting the patient being first searched. In each of these instances, the breach of the no weapon policy was rapidly rectified.]  In the week prior to the airstrikes, the ban of weapons inside the MSF hospital in Kunduz was strictly implemented and controlled at all times and all MSF staff positively reported in their debriefing on the Taliban and Afghan army compliance with the no-weapon policy.

The US military investigation accepted this was indeed the case:

Evidence provided to the investigation team supports the MSF internal initial report’s characterization that their no-weapons policy was adhered to with rare exceptions (038, note 15).

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Mathieu Aikins‘s interviewees also confirmed the absence of weapons from the Trauma Centre:

Though the MSF hospital was crowded with fighters, whether patients or caretakers (each patient was allowed one), staff members and civilians who were present said the insurgents respected the rules. They left their weapons outside or handed them over at the gun lockers at the entrance. One employee recalled seeing a fighter give up his weapon but forget his ammunition vest; when the employee nervously approached the fighter about it, the man apologized profusely and handed it over. “We had respect for the hospital, as they were serving the people,” said Shahid, the Taliban commander. “I myself went there once when one of our men was wounded, and before entering we submitted our weapons outside.”

Aikins goes on to report that patients were allowed to retain their cellphones, and some of their caretakers retained hand-held radios whose transmissions were intercepted by Afghan special forces.  They in turn concluded that not only were the Taliban inside the hospital but were using it as a base: ‘They had raised their flag and established their headquarters there.’  On 1 October, presumably in response to these reports, the Pentagon contacted MSF in New York to ask whether ‘they had a large number of Taliban “holed up”’ in the Trauma Centre, and were assured that the only Taliban inside the hospital were wounded patients.

But the suspicions clearly remained, and festered to such a degree that some of those on the ground were convinced that the hospital had been overrun by Taliban fighters.  Associated Press reported that the radio intercepts prompted US analysts to request ‘specific intelligence-gathering flights over the hospital’ – their outcome has never been disclosed – and on 1 October a senior Special Forces commander (whether in Kabul or in Kunduz is unclear) wrote in his daily log that the Trauma Centre was under Taliban control and that he planned to clear it in the coming days.   At least some of the Green Berets in Kunduz agreed with his assessment: ‘They were using it as a C2 node … They had already removed and ransomed the foreign doctors, and they had fired on partnered personnel from there.’  Indeed, after the attack a senior US officer in Kabul was told – by whom has been redacted – that ‘there were three dead Military-Aged Males near the hospital, identified as Taliban by the local population.  They were using the hospital as a command post (using its protected status)’ (275).

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But all of this was fantasy, and the investigation discounted it.  Although US intelligence reported that insurgents were present at the hospital at the time of the strike, the investigation accepted that this was for medical treatment and they could trace ‘no specific intelligence reports that confirm[ed] insurgents were using the MSF Trauma Center as an operational  C2 [command and control] node, weapons cache or base of operations’ (085).  In addition, they determined that observations made from the AC-130 revealed neither substantive hostile acts nor demonstrations of hostile intent –  only ‘unarmed individuals walking around [or] sitting in chairs’ (085).  The report describes these as ‘ordinary and innocuous acts’ (055), but to at least one member of the aircrew that was in itself grounds for suspicion: ‘In his experience, when AC-130 aircraft fly over insurgents, they act normally or try to stay normal… [whereas] civilians will not try to be nonchalant when the aircraft is overhead’ (093, note 304).  Damned if you do, and damned if you don’t: when everything is construed as hostile, even the most innocent acts are transformed into somcething sinister.

The claims made by Afghan forces were even wilder.  Here is May Jeong in The Intercept:

On the night of the hospital strike, a unit commander with the Ministry of Defense special forces was at the police headquarters taking fire from the direction of the hospital. “Vehicles were coming out of there, engaging, then retreating,” he told me. When I pointed out that he couldn’t have seen the gate of the hospital from where he was, several hundred meters away, he said that he was sure because he had personally interrogated a cleaner who told him that the hospital was full of “armed men using it as a cover.” The cleaner told the commander that there were Pakistani generals using the hospital as a recollection point and that they had set up a war room there. When I challenged his line of vision again, he responded, “Anyone can claim anything. The truth is different.”

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[Amrullah] Saleh, [former head of the National Security Directorate and] the author of the 200-page Afghan commission report on the fall of Kunduz … believed that the “hospital sanctity had been violated” and held out as evidence 130 hours of recorded conversations with more than 600 interlocutors. “I spoke with the MSF country director,” Saleh told me recently. “They don’t deny that the hospital was infiltrated by the Taliban.”

But of course they did deny it: repeatedly, emphatically and convincingly.

(3) War crimes?

The US military investigation was unequivocal: it found multiple violations of the military’s own Rules of Engagement and of international humanitarian law.

The first rule of customary international humanitarian law, now codified in the Additional Protocols to the Geneva Conventions, is distinction:

The parties to the conflict must at all times distinguish between civilians and combatants. Attacks may only be directed against combatants. Attacks must not be directed against civilians.

The investigation found that both the Ground Force Commander (GFC) and the aircraft commander failed to exercise this core principle:

Neither commander distinguished between combatants and civilians nor a military objective and protected property. Each commander had a duty to know, and available resources to know that the targeted compound was protected property’ (075-6).

A second core principle is proportionality:

Launching an attack which may be expected to cause incidental loss of civilian life, injury to civilians, damage to civilian objects, or a combination thereof, which would be excessive in relation to the concrete and direct military advantage anticipated, is prohibited.

The investigation found this to have been disregarded too:

The GFC and the aircraft commander failed to exercise the principle of proportionality in relation to the direct military advantage (076).

Both principles are deceptively simple, and in ‘The Passions of Protection: Sovereign Authority and Humanitarian War’ Anne Orford reminds us that IHL ‘immerses its addressees in a world of military calculations.’  In practical terms the distinction between civilians and combatants in today’s conflicts is rarely straightforward, but in this case the No-Strike List plainly recognised the protected status of the Trauma Centre and there is no convincing evidence that its immunity had been compromised.  In addition, the balance between loss of civilian life and military advantage is weighed on the military’s own scales – ‘expected’; ‘excessive’; ‘anticipated’: these are not self-evident calculations – but even if the GFC or the aircraft commander had grounds to believe the Taliban were firing from the hospital the Pentagon’s own Law of War Manual (which is not without its own controversies: see here and, specifically on proportionality, here and here) advises under §7.10.3.2 that

The obligation to refrain from use of force against a medical unit acting in violation of its mission and protected status without due warning does not prohibit the exercise of the right of self-defense. There may be cases in which, in the exercise of the right of self-defense, a warning is not “due” or a reasonable time limit is not appropriate. For example, forces receiving heavy fire from a hospital may exercise their right of self-defense and return fire.  Such use of force in self-defense against medical units or facilities must be proportionate.

Not only was there was no evidence of hostile let alone ‘heavy fire’ from the Trauma Centre but the AC-130 was also monitoring the progress of the Afghan Special Forces convoy that it was tasked with protecting and knew perfectly well that it was still within the perimeter of the airfield.  This was not a time-sensitive target (the report makes that crystal clear) and neither the GFC nor the aircraft commander had reason to believe that any putative threat to Afghan or US forces was so grave and so sustained that it called for an air strike involving multiple passes by the AC-130 – over 30 minutes according to the US military, an hour according to MSF – delivering such intense fires that the building was virtually destroyed.

For these reasons many commentators – and MSF (‘Under the clear presumption that a war crime has been committed, MSF demands that a full and transparent investigation into the event be conducted by an independent international body’) – have insisted that the attack was a war crime.

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But others (including the US military) have concluded that it was not.  US Central Command’s initial summary – produced before the redacted report was released – accepted that there had been breaches of both the Rules of Engagement and of IHL (‘the law of armed conflict’) but noted that

the investigation did not conclude that these failures amounted to a war crime.  The label “war crimes” is typically reserved for intentional acts – intentionally targeting of civilians or intentionally targeting protected objects.  The investigation found that the tragic incident resulted from a combination of unintentional human errors, process errors and equipment failures, and that none of the personnel knew that they were striking a medical facility.

The report has been so heavily redacted so that this legal discussion is unavailable (see also the commentary by Sarah Knuckey and two of her students here).  We do know that the investigation team included an unnamed legal advisor from US Central Command (CENTCOM) and that its report was subject to legal review by the Staff Judge Advocate, who accepted its findings as ‘legally sufficient’ with several, redacted exceptions  – though there is no way of knowing what they were (007-009).  We know too that General John Campbell, who ordered the investigation as commander of US Forces in Afghanistan, subsequently disapproved a number of findings and recommendations ‘not related to the proximate cause of the strike’ (002) but, again, the details have been excised.

General Votel at Pentagon press briefing on MSF attack

General Joseph Votel, commander of CENTCOM, repeated the summary statement’s disavowal of war crimes at a Pentagon Press Briefing on 29 April 2016, and in responding to a storm of questions from plainly incredulous reporters (above) he elaborated:

… an unintentional action takes it out of the realm of actually being a deliberate war crime against persons or protected locations…. They were absolutely trying to do the right thing; they were trying to support our Afghan partners; there was no intention on any of their parts to take a short cut, or to violate any rules that were laid out for them. And they were attempting to do the right thing.  Unfortunately, they made a wrong judgment in this particular case…

Jens David Ohlin explains the disputation (which Faye Donnelly helpfully re-casts as one between two contending narratives whose speech-acts struggle to realize their performative force):

The problem is that the killing of the innocent civilians was not intentional, it was accidental. As a matter of criminal law, it was either reckless or negligent … but the civilian killings were not performed with purpose.

The Rome Statute of the International Criminal Court provides for war crimes prosecutions for ‘intentionally directing’ or ‘intentionally launching’ attacks that contravene international humanitarian law (in effect, criminalizing the rules of IHL).  Jens discusses this in relation to attacks on civilians, but the Statute also proscribes ‘intentionally directing attacks against buildings, material, medical units and personnel’ or against ‘personnel, installations, material, units or vehicles involved in a humanitarian assistance or peacekeeping mission’.

In every case the emphasis is on intentionality, and yet intentionality – as philosophers have demonstrated time and time again – is not the simple, settled matter some legal scholars assume it to be.  Jens’s central point is that common-law cultures identify intentionality with purpose or knowledge whereas civil-law cultures widen its sphere to include a conscious disregard of risk or ‘recklessness’.  The full argument is here – including an intricate disection of the (geo)politics involved in drafting the Geneva Conventions and the Additional Protocols – but the sharp conclusion is that (for Jens, at least) the strike on the Trauma Centre would not constitute a war crime under the first count (he accepts that neither the GFC nor the aircraft commander possessed the knowledge or the purpose) but could under the second (their actions, and those of others, were reckless).  I should add that he recommends the recognition of a new war crime to explicitly address the second count and thereby signal ‘the moral difference between intentionally killing civilians and recklessly killing them.’

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The investigation report provides endless, explicit examples of a thoroughly compromised ‘risk management process’ by multiple actors at multiple sites, and this dispersal of responsibility in Kunduz (see map above) and Bagram further complicates the legal situation.  Peter Margulies – who does not accept that ‘the lack of intent among US personnel is determinative’ – concedes that ‘the cascading systemic errors in the hospital attack impede the attribution of culpable awareness to one or more specific individuals.’ In his view,

CENTCOM would have been better served by acknowledging that intent was not required [for the commitment of a war crime], but that awareness of risk was distributed among many organizational components, without full awareness concentrated in one or more individuals who could be charged criminally.

Adil Ahmad Haque notes that Additional Protocol I to the Geneva Conventions requires attackers to do ‘everything feasible’ to verify that their target is a military objective and instructs them in cases of doubt to presume that it is civilian – the Law of War Manual doesn’t follow this standard, but the investigation report does –  and here there is such clear evidence of recklessness on the part of many of the US forces involved (whose evidence is shot through with technical failures and radical uncertainty) that, in his view, their decision to press on with the attack ‘was unlawful, irrespective of their good faith.’

(4) Medical neutrality at risk

I noted above that hospitals only lose their protected status if they are used ‘to commit, outside their humanitarian duties, acts harmful to [one of the belligerents]’.  It’s a telling provision because its intermediate clause can be read as a tacit acknowledgement that those humanitarian duties – treating the sick and wounded – could otherwise be construed as acts harmful to their enemies.

And there is evidence that this is exactly how both the Afghan government and its military viewed MSF’s activities.  When Mathieu Aikins visited Kunduz after the air strike he reported:

Some members of the Afghan government and security forces there had little respect for MSF’s neutrality and resented its treatment of wounded Taliban. When I visited Kunduz in November, their anger was still surprisingly raw, despite the recent destruction of the hospital. “They give them medicine; they transport and treat their injured,” [Colonel Abdullah] Gard, the commander of the [Ministry of Interior’s] quick-reaction force, told me. “Their existence is a big problem for us…. The people that work there are traitors, all of them.”

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Gard (seen above) and one of his colleagues told May Jeong exactly the same:

Gard spoke of MSF with the personal hatred reserved for the truly perfidious. He accused the group of “patching up fighters and sending them back out,” a line I heard repeatedly. Cmdr. Abdul Wahab, head of the unit that guarded the provincial chief of police compound, told me he could not understand why in battle an insurgent could be killed, but the minute he was injured, he would be taken to a hospital and given protective status. Wouldn’t it be easier, he asked, wouldn’t the war be less protracted or bloody if they were allowed to march in and take men when they were most compromised? He had visited the MSF hospital three times to complain. Each time a foreign doctor explained the hospital’s neutral status and its no-weapons policy, which mystified him.

In short, it seems that some (perhaps many) in the Afghan security forces – particularly after the humiliation of being forced out of Kunduz – believed that the Taliban were legitimate targets wherever they were and that the fight against them was being hamstrung by what one officer described to Jeong as a ‘silly rule’.

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This becomes material because, as I showed previously, the intended target for the air strike was a National Directorate of Security compound whose co-ordinates had been passed to Major Michael Hutchinson, the Ground Force Commander, by Afghan Special Security Forces (who, like him, were unfamiliar with the city): they had identified the NDS compound as a Taliban command and control node, and planned to clear it on their return from the airfield following a casualty evacuation.  The AC-130 was supposed to provide Close Air Support, but a series of technical difficulties compromised the accuracy of its sensors and several hours after the Afghan Special Security Forces had left in an armoured convoy with their three casualties the aircrew were still unsure of the location of the target and so requested a verbal description of the NDS compound.  This was provided by Afghan forces still inside the Provincial Chief of Police compound: their description matched the MSF Trauma Centre much more closely than the NDS compound, and the aircrew fixed on this as their target.

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It’s impossible to know whether this was a mistake or misdirection, and the report fails to identify who provided the description.  Hutchinson was shown various photographs but explained that ‘it was dark when everything happened’; he couldn’t remember the name of the Afghan liaison officer and – the redactions make his responses difficult to follow at this point – he wasn’t always sure who he was talking to since he had to rely on interpreters (387-8).  But the description obviously had to come from someone who knew the city (which would include Gard and Wahab), and both Aikins and Jeong clearly believe that misdirection is not only possible but also extremely likely.  ‘That hospital is in the service of the Taliban,’ Gard told Aikins. ‘I swear to God, if they make it a hundred times, we’ll destroy it a hundred times.’  Hence the headline for Aikins’s searching New York Times report (above): ‘Doctors with enemies: did Afghan forces target the MSF hospital?‘ I should note that David Glazier dismisses all this as ‘highly speculative’ and insists that ‘it simply defies logic’.  While the claim is speculative it surely doesn’t defy logic, and Aikins and Jeong make at least a plausible if not definitive case).  They are clearly not alone in their suspicions: MSF’s very first question in response to the investigation report was this:

‘What was the physical description of the intended target provided by the Afghan forces and how did it match the description of the MSF hospital?’

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The studied refusal to recognise medical neutrality – if that is what this was – emerges from a long history of friction between MSF and the government in Kabul, and it threads its way out into a wider history and geography of deliberate attacks against medical facilities elsewhere in Afghanistan, and – among other recent places – in Gaza (by the Israeli military), in Syria (primarily by the Russian and Syrian Arab Air Forces) and in Yemen (primarily by the Saudi-led coalition which is advised by the United Kingdom on targeting).  In February 2014 Thanassis Cambanis was already writing that ‘medical care is now a tool of war’, and in a report issued in May 2016 the World Health Organisation counted almost 600 attacks against medical facilities, doctors and nurses in 19 countries since then.  These shocking statistics, which are inevitably imperfect, include attacks by non-state actors, among them the Taliban and Islamic State, but I have emphasised the complicity of state actors – including leading members of the UN Security Council – because it is their actions that determine the course of international humanitarian law and because they are ultimately responsible for what MSF’s president Joanne Liu saw in the wake of the attack on its Trauma Centre in Kunduz as  ‘not just an attack on our hospital’ but ‘an attack on the Geneva Conventions.’

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In a letter to the UN Security Council issued on 22 September 2016, after a direct and deliberate attack on a humanitarian convoy delivering aid to eastern Aleppo, more than 100 humanitarian organisations noted that:

‘Each [head of state] that accepts a lack of accountability for perpetrators and facilitators of war crimes colludes in the ongoing dissolution of international humanitarian law.’

That dissolution can be seen as a defiant reassertion of the absolutism of sovereign power, because ‘medical neutrality’ is not a neutral claim.  Adia Benton and Sa’ed Ashtan persuasively argue that:

The health worker’s claim to impartiality may itself be a stance against the state’s insistence that it is the sole arbiter of who can live and who can die. The local health worker’s claim to an international norm … may be understood as a direct challenge to the state’s claim to sovereignty…. Can ‘‘medical neutrality’’ accurately describe a situation where there is no neutral ground upon which to stand? (‘‘‘Even War has Rules’’: On Medical Neutrality and Legitimate Non-violence’ , Cult. Med. Psychiatry 40 (2016) 151-158).

As the spectral presence of Giorgio Agamben in my slide below implies, this has the liveliest implications for how we are to understand the space of exception and the refusal of its victims to be reduced to the passivity of ‘bare life’.

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As I will show in the next post in this series, Syria is the most egregious contemporary case.  If some members of the Afghan security forces wilfully misled the Americans into targeting the MSF Trauma Centre in Kunduz, then it seems clear that they objected to the protection extended by IHL to wounded Taliban combatants and those who treat them (though many of those killed in the attack were civilians, despite Alan Dershowitz‘s tawdry attempt to suggest that MSF ‘favoured Taliban fighters over civilian patients’: see Kevin Jon Heller’s magisterial response here).  But in Syria not only has the provision of medical aid to those in rebel-held areas been explicitly criminalised by the state’s new Counterterrorism Law which came into effect in July 2012 – the space of exception is far from being a ‘legal “black hole” – but the ban extends to those providing medical aid to sick or wounded civilians.  And make no mistake: there have been no mistakes.  The murder of doctors and nurses and the bombing of hospitals and clinics in Syria has been deliberate and systematic.  The exception to the exception contracts to its vanishing point.

To be continued.

 

Spaces of exception and enemies

Human Geography 25

I’m just back from a wonderful time at a conference in Galway organised by John Morrissey as part of The Haven Project on the refugee crisis in the Mediterranean.  The latest issue of Human Geography (Vol 9, No 2) is devoted to Geographical Perspectives on the European ‘Migration and Refugee Crisis‘ – those scare-quotes are vital – and if your library doesn’t subscribe you can contact the Institute of Human Geography at insthugeog@gmail.com (most of the articles can be downloaded here).

At Galway I gave a new presentation on ‘Surgical strikes and modern war’, describing and analyzing the ways in which hospitals and ambulances, doctors and nurses have become targets of military violence; it drew on my new series of posts (see here and here), and there will be more to come on both Kunduz and on Syria (which was my main focus), but you can find a preliminary account of the whole event from Alex Jeffrey here.

My starting point was the modern space of exception seen not as ‘the camp‘, as Giorgio Agamben would have it, but as the killing fields of contemporary military and paramilitary violence (what would once have been called ‘the battlefield‘).  For these are spaces in which groups of people are knowingly and deliberately exposed to death through the removal of legal protections that would ordinarily be afforded them; and yet these are not spaces in which the law is suspended tout court, spaces from which the law withdraws and abandons the victims of violence to their fatebut rather spaces in which law – and specifically international humanitarian law – seeks to regulate and, crucially, to sanction violence.  This is a form of martial law that Agamben never considers (I know I am taking liberties with that term, but that is precisely my point): here as elsewhere violence exists not only beyond the law but is inscribed within it.  My purpose was to show how what was once a sacred space within this zone of exception – ‘the hospital’,  a topological figure that extends from the body of the wounded through the sites of the evacuation chain to the hospital itself – has become corroded; no longer a space of immunity – of safety – an exception to the exception, it has often become a central target of contemporary violence.

The need to pull all this together largely explains my silence these last weeks, and a lot has happened in the interim.  Where to start?  A good place is the latest issue of Radical Philosophy, the last in its present form, which includes two essays of direct relevance to the theme of the Galway conference.

First, an important essay by Achille Mbembe on ‘The Society of Enmity’ which you can download here:

Desire (master or otherwise) is also that movement through which the subject – enveloped on all sides by a specific phantasy [fantasme] (whether of omnipotence, ablation, destruction or persecution, it matters little) – seeks to turn back on itself in the hope of protecting itself from external danger, while other times it reaches outside of itself in order to face the windmills of the imagination that besiege it. Once uprooted from its structure, desire then sets out to capture the disturbing object. But since in reality this object has never existed – does not and will never exist – desire must continually invent it. An invented object, however, is still not a real object. It marks an empty yet bewitching space, a hallucinatory zone, at once enchanted and evil, an empty abode haunted by the object as if by a spell.

The desire for an enemy, the desire for apartheid, for separation and enclosure, the phantasy of extermination, today all haunt the space of this enchanted zone. In a number of cases, a wall is enough to express it.  There exist several kinds of wall, but they do not fulfil the same functions. [6] A separation wall is said to resolve a problem of excess numbers, a surplus of presence that some see as the primary reason for conditions of unbearable suffering. Restoring the experience of one’s existence, in this sense, requires a rupture with the existence of those whose absence (or complete disappearance) is barely experienced as a loss at all – or so one would like to believe. It also involves recognizing that between them and us there can be nothing that is shared in common. The anxiety of annihilation is thus at the heart of contemporary projects of separation.

Everywhere, the building of concrete walls and fences and other ‘security barriers’ is in full swing. Alongside the walls, other security structures are appearing: checkpoints, enclosures, watchtowers, trenches, all manner of demarcations that in many cases have no other function than to intensify the zoning off of entire communities, without ever fully succeeding in keeping away those considered a threat.

You can already surely hear the deadly echoes of Carl Schmitt – whose spectral presence lurked in the margins of my own presentation in Galway (for geographical elaborations of Schmitt, see Steve Legg‘s Spatiality, sovereignty and Carl Schmitt and Claudio Minca and Rory Rowan‘s On Schmitt and space) – and Achille makes the link explicit:

dangerousmindThis is an eminently political epoch, since ‘the specific political distinction’ from which ‘the political’ as such is defined – as Carl Schmitt argued, at least – is that ‘between friend and enemy’.  If our world today is an effectuation of Schmitt’s, then the concept of enemy is to be understood for its concrete and existential meaning, and not at all as a metaphor or an empty lifeless abstraction. The enemy Schmitt describes is neither a simple competitor, nor an adversary, nor a private rival whom one might hate or feel antipathy for. He is rather the object of a supreme antagonism. In both body and flesh, the enemy is that individual whose physical death is warranted by their existential denial of our own being.

However, to distinguish between friends and enemies is one thing; to identify the enemy with certainty is quite another. Indeed, as a ubiquitous yet obscure figure, today the enemy is even more dangerous by being everywhere: without face, name or place. If they have a face, it is only a veiled face, the simulacrum of a face. And if they have a name, this might only be a borrowed name, a false name whose primary function is dissimulation. Sometimes masked, other times in the open, such an enemy advances among us, around us, and even within us, ready to emerge in the middle of the day or in the heart of night, every time his apparition threatening the annihilation of our way of life, our very existence.

Yesterday, as today, the political as conceived by Schmitt owes its volcanic charge to the fact that it is closely connected to an existential will to power. As such, it necessarily and by definition opens up the extreme possibility of an infinite deployment of pure means without ends, as embodied in the execution of murder.

The essay is taken from Achille’s latest book, Politiques de l’inimitié published by Découverte in 2016:

Introduction – L’épreuve du monde
1. La sortie de la démocratie
Retournement, inversion et accélération
Le corps nocturne de la démocratie
Mythologiques
La consumation du divin
Nécropolitique et relation sans désir
97827071881822. La société d’inimitié
L’objet affolant
L’ennemi, cet Autre que je suis
Les damnés de la foi
État d’insécurité
Nanoracisme et narcothérapie
3. La pharmacie de Fanon
Le principe de destruction
Société d’objets et métaphysique de la destruction
Peurs racistes
Décolonisation radicale et fête de l’imagination
La relation de soin
Le double ahurissant
La vie qui s’en va
4. Ce midi assommant
Impasses de l’humanisme
L’Autre de l’humain et généalogies de l’objet
Le monde zéro
Anti-musée
Autophagie
Capitalisme et animisme
Émancipation du vivant
Conclusion. L’éthique du passant

Asylum seekers being registered at Passau

Second, an essay by Mark Neocleous and Maria Kastrinou, ‘The EU hotspot: Police war against the migrant’, which you can download here.  They start by asking a series of provocative questions about the EU strategy of ‘managing’ (read: policing) migration through the designation of ‘hotspots’ in which all refugees are to be identified, registered and fingerprinted:

There is no doubt that in some ways the term ‘hotspot’ is meant to play on the ubiquity of this word as a contemporary cultural trope, but this obviousness may obscure something far more telling, something not touched on by the criticisms of the hotspots, which tend to focus on either their squalid conditions or their legality (for example, with routes out of Greece being closed off migrants are in many ways being detained rather than registered; likewise, although ‘inadmissibility’ is being used as the reason to ship migrants back to Turkey, in reality ‘inadmissibility’ often means nothing other than that the political and bureaucratic machine is working too slowly to adequately process asylum claims).  Neither the legality nor the sanitary state of the hotspot is our concern here. Nor is the fact that the hotspots use identification measures largely as instruments of exclusion. Rather, we are interested in what the label ‘hotspot’ might tell us about the way the EU wants to manage the crisis. What might the hotspot tell us about how the EU imagines the refugee? But also, given that the EU’s management of the refugee crisis is a means for it to manage migration flows across Europe as a whole, what might the hotspot tell us about how the EU imagines the figure of the migrant in general?

You can find an official gloss (sic) on hotspots here (and more detail here), critical readings by Frances Webber here and Glenda Garelli and Martina Taziolli here, and NGO responses from Oxfam here and Caritas here.  The Bureau of Investigative Journalism also has a useful report on Frontex, the EU’s border agency, here.

registration-at-hotspots-frontex

Here is the kernel of Mark’s and Maria’s answer to their questions – and you will see see the link with Achille’s essay immediately:

For every police war, an enemy is needed. Defining the zones as hotspots suggests that migrants have arrived as somehow already ‘illegal’ in some way, enabling them to be situated within the much wider and never-ending ‘war on crime’. Yet this process needs to be understood within the wider practice of criminalizing breaches of immigration law in western capitalist polities over the last twenty years, as individual states and the state system as a whole have increasingly sought to make the criminal law work much more closely with immigration law: ‘crimmigration’, as it has become known, means that criminal offences can now very easily result in deportation, while immigration violations are now frequently treated as criminal offences. Concerning the UK, for example, Ana Aliverti has noted that ‘the period between 1997 and 2009 witnessed the fastest and largest expansion of the catalogue of immigration crimes since 1905’.  This expansion serves to further reinforce the conception of the migrant as already tainted by crime, as the figure of the criminal and the figure of the migrant slowly merge. The term ‘illegal immigrant’ plays on this connection in all sorts of ambiguous ways. Indeed, it is significant that the very term ‘illegal immigrant’ has over the same period replaced the term ‘undocumented migrant’, so that a figure once seen as lacking papers is seen now as lacking law.

However, the fact that migrants arriving in the EU hotspots do so as propertyless (or at least apparently so) subjects adds a further significance. Why? Because by arriving propertyless the historical figure to which the migrant is most closely aligned is as much the vagrant as the criminal. Aliverti’s reference to 1905 is a reference to the Aliens Act of that year, in which any ‘alien’ landing in the UK in contravention of the Act was deemed to be a rogue and vagabond. The Act was underpinned by making such ‘aliens’ liable to prosecution under section 4 of the Vagrancy Act of 1824, usually punishable in the form of hard labour in a house of correction. As Aliverti puts it, ‘in view of the similarities between the poor laws and early immigration norms, it is no coincidence that the first comprehensive immigration legislation in 1905 penalized the unauthorized landing of immigrants with the penalties imposed on “rogues and vagabonds” and vagrancy was one of the grounds for expulsion of foreigners.’  In the mind of the state, the vagrant is the classic migrant, just as migrants arriving in the hotspots are increasingly coming to look like and be treated as the newest type of vagrant. In the mind of the state, the propertyless migrant is a kind of vagrant-migrant (which is of course one reason why welfare and migration are so frequently connected).

Vagrancy legislation has always been the ultimate form of police legislation: it criminalizes a status rather than an act (the offence of vagrancy consists of being a vagrant); it gives utmost authority to the police power (the accusation of vagrancy lies at the discretion of the police officer); and it seeks not to punish a crime as such but to instead eliminate what are regarded as threats to social order (as in section 4 of the UK’s Vagrancy Act of 1824, which enables people to be arrested and punished for being ‘idle and disorderly’, for ‘being a rogue’, for ‘wandering abroad’ or for simply ‘not giving a good account of himself or herself’; note the present tense used – section 4 of the Act of 1824 is still in operation in the UK).

And in case the links with ‘The society of enmity’ are still opaque, I leave the last word to Achille:

Hate movements, groups invested in an economy of hostility, enmity, various forms of struggle against an enemy – all these have contributed, at the turn of the twenty-first century, to a significant increase in the acceptable levels and types of violence that one can (or should) inflict on the weak, on enemies, intruders, or anyone considered as not being one of us. They have also contributed to a widespread instrumentalization of social relations, as well as to profound mutations within contemporary regimes of collective desire and affect. Further, they have served to foster the emergence and consolidation of a state-form often referred to as the surveillance or security state.

From this standpoint, the security state can be seen to feed on a state of insecurity, which it participates in fomenting and to which it claims to be the solution. If the security state is a structure, the state of insecurity is instead a kind of passion, or rather an affect, a condition, or a force of desire. In other words, the state of insecurity is the condition upon which the functioning of the security state relies in so far as the latter is ultimately a structure charged with the task of investing, organizing and diverting the constitutive drives of contemporary human life. As for the war, which is supposedly charged with conquering fear, it is neither local, national nor regional. Its extent is global and its privileged domain of action is everyday life itself. Moreover, since the security state presupposes that a ‘cessation of hostilities’ between ourselves and those who threaten our way of life is impossible – and that the existence of an enemy which endlessly transforms itself is irreducible – it is clear that this war must be permanent. Responding to threats – whether internal, or coming from the outside and then relayed into the domestic sphere – today requires that a set of extra-military operations as well as enormous psychic resources be mobilized. The security state – being explicitly animated by a mythology of freedom, in turn derived from a metaphysics of force – is, in short, less concerned with the allocation of jobs and salaries than with a deeper project of control over human life in general, whether it is a case of its subjects or of those designated as enemies.

The Last Dance

Mansour strike photo

I have – at long last – finished the longform version of “Dirty dancing: drones and death in the borderlands“, which analyses drone strikes in Pakistan’s Federally Administered Tribal Areas and situates them within a wider context of military violence in the region.  You can find it under the DOWNLOADS tab, but I’ve pasted the conclusion below; there’s also a video of the last presentation I gave under that title here.

To make sense of the conclusion, I should explain that the essay opens by juxtaposing the killing of two people, Baitullah Mehsud (leader of the Pakistan Taliban) and Mamana Bibi (a village midwife), to pose the question: what kinds of spaces are the FATA made to be for incidents like these – incidents as unlike as these – to be possible?

My answer works with two framing devices.

The first is the space of exception – a space in which people are knowingly and deliberately exposed to death through the political-juridical removal of legal protections and affordances that would otherwise be available to them.  My version of this is different from that proposed by Giorgio Agamben, and far from invoking a suspension of the law I explore three legal geographies that have been used to prepare the ground for aerial violence in the borderlands.

The second is the space of execution; here I riff off Owen Sheers‘ perceptive remark about ‘the territory of the screen’ (as I note, ‘Killing somebody with a Hellfire missile controlled from thousands of miles away depends upon a screen – or more accurately a series of screens – on which the image of a human body will eventually be touched by the cross-hairs of a targeting pod’).  Owen’s phrase is much more than metaphor, so I treat ‘territory’ as a (bio)political technology whose calibrations enable states to assert, enact and enforce a claim over bodies-in-space (you can no doubt hear the echoes of Stuart Elden) and then explore the technicity involved in three of its screen elements that jointly transform the FATA into a space of execution: kill lists, signals intercepts and visual feeds.

***

Mamana Bibi's surviving family

Here, then, is the conclusion:

The production of the borderlands as spaces of exception and spaces of execution are attempts to force those who live there into particular subject-positions as a means of subjugation. These positions are partial and precarious but the project to establish them as legitimate and rational has consequences that are material and affective. They clearly affect those targeted – people like Baitullah Mehsud – whose political agency exceeds in terrifying ways the normative space allowed them by the state of Pakistan and the United States and in so doing brings their actions to the attention of both. But they also impact the rest of the population in the FATA, constricting their mobilities and stoking their fears to such a degree that ‘normal life’ for many of them threatens to become a memory or a fantasy. Their existence is rendered more precarious because the subject-positions to which they are so brutally assigned are racialized. These are ‘tribal peoples’, different from those who inhabit ‘mainland Pakistan’, while the United States writes off their incidental deaths as ‘collateral damage’ whose anonymity confers on them no individuality only a collective ascription. When a CIA-directed drone strike on a compound in the Shawal Valley of South Waziristan on 15 January 2015 was found to have killed not only a deputy leader of al-Qaeda in the Indian subcontinent and a local Taliban commander but also two hostages, an American development contractor and an Italian aid worker, a ‘grim-faced’ and ‘visibly moved’ Obama made a personal and public apology. [i] The rarity of the gesture is revealing. For the value of their lives was acknowledged and their deaths were made grievable in ways that others – which is to say Others – were not. Nobody has ever accepted responsibility or apologised for the death of Mamana Bibi or any of the other innocent victims of aerial violence.

For this reason it is important to resist those versions of the space of exception that are complicit in the denial of agency to those who live within its confines. The state of Pakistan administers the inhabitants of the FATA through Political Agents: but this does not remove (though it does diminish) their own political agency. Pakistan’s armed forces conduct clearing operations that ruthlessly drive people from their homes and into camps for displaced persons: but this does not turn the FATA into one vast ‘camp’. The presence of US drones strips those who live under them of their well-being and dignity: but this does not reduce them to ‘bare life’. Similarly, the emergent subject that is produced within the space of execution, apprehended as a network trace, a sensor signature and a screen image, is a cipher that stands in for – and in the way of – a corporeal actor whose existence is not measured by the calculative alone.

***

This version, or something very much like it, will appear in a collection edited by Caren Kaplan and Lisa Parks, Life in the Age of Drones.  But an (even longer!) version will eventually appear in my own book, with images and maps (you can find many of them scattered through my previous posts: for example here, here and here), so I really would welcome any comments or suggestions if you have time to read the full thing: derek.gregory@ubc.ca.

 

Dirty Dancing online

I had a wonderful time at the Balsillie School at Waterloo last week – good company, constructive conversations and endless hospitality – and I’m truly grateful to Simon Dalby, Jasmin Habib and all the graduate students who made my visit so enjoyable.  I finished by giving one of the Centre for Global Governance Innovation (CIGI)’s Signature Lectures.

This was the latest (and near-final) version of “Dirty dancing: drones and death in the borderlands”.   The argument has developed considerably since my first presentations; I’ll upload the written version once it’s finished, but CIGI has posted the lecture and Q&A online here.  I’ve also embedded the YouTube version below, but if that doesn’t work try here.

My thanks to the AV technicians who made this possible: their help with the production followed by their assured and rapid-fire editing beats anything I’ve encountered anywhere.

In this version, I begin with two CIA-directed drone strikes in Pakistan’s Federally Administered Tribal Areas, one on Baitullah Mehsud (the leader of Tehrik-i-Taliban) and the other on ‘Mamana’ Bibi, an innocent grandmother and midwife, and ask what it is that makes strikes like these – which is to say strikes as unlike these – possible.  My answer turns on the kinds of space the FATA been made out to be: in particular, a space of exception in which people are knowingly and deliberately exposed to death, and a territory conceived as a political technology through which power lays claim to bodies-in-space.

Unlike Giorgio Agamben‘s original formulation, though, my discussion of the space of exception focuses not on violence authorised through the suspension of the law but rather violence that operates inside the law: so I look at the legal regimes, both international and national, that affect military and paramilitary violence in the FATA.  A further difference is that this exceptional state of affairs is provoked not by an event but by a margin: by the construction of the FATA as a liminal zone, borderlands that are outside ‘Pakistan proper’ or ‘mainland Pakistan’.  Many commentators (including me) trace the origin of aerial violence to the British Raj, its Frontier Crimes Regulations and its ‘policing’ of the North-West Frontier.  This is important, but the line of descent to today’s air strikes is not direct.  In particular, it is important to bring into view the cross-border incursions made by Soviet and Afghan aircraft during the occupation of Afghanistan.  Thousands of people were killed and injured during these attacks, and this constitutes an important horizon of memory, but no less important is the response of the Pakistan Air Force: their US-supplied jets intercepted incoming aircraft and either escorted them out of Pakistani air space or, towards the end of the 1980s, engaged them in combat.  This begs an obvious question: if Pakistan objects to the US strikes – carried out by drones that are slow, noisy and sluggish – why does its Air Force not shoot them down?  Since today’s drones cannot be used in contested air space – bluntly, they can only be used against defenceless people – why does Pakistan elect to render the people of FATA defenceless?  This immediately brings into view the other source of aerial violence in the borderlands: the ongoing offensives in the FATA launched by the Pakistan Air Force (in concert with large-scale ground operations).  Even though the Pakistan Air Force has its own reconnaissance drones, some of which are now armed, these are not attempts to put ‘warheads on foreheads’, as the US Air Force would have it, but wide-area assaults conducted by conventional strike aircraft and attack helicopters – as I show in the case of Mir Ali and Miran Shah during Operation Zarb-i-Azb (see here and here and here).

To complete the sequence and add the US drone strikes, I trace the intimate collaboration between both the CIA and the US Air Force and between Washington and Islamabad.  The diplomatic cables released by Wikileaks show time and time again that many of the negotiations about access to ‘flight boxes’ over North and South Waziristan were conducted by the Chairman of the Joint Chiefs of Staff and the commander of US Central Command.  I show, too, how the collaboration between Washington and Islamabad continued until at least 2013.

Hacking.001

In order for the CIA-directed strikes to be possible, however, the FATA must also be turned into a territory in something like the sense proposed by Stuart Elden.  So I describe the multiple ways in which data is harvested by the NSA and other agencies to produce what Rob Kitchin and Martin Dodge call code/space: the algorithmic combination of sensors, traces and intercepts to summon into being a body-as-target (for more, see here: scroll down), and to produce the space of the target where fleshy bodies disappear and are replaced by codes, co-ordinates and cross-hairs.  This is another version of what Ian Hacking calls ‘making up people’: there is an important sense, then, in which the supposed ‘individuation’ of later modern war depends on the selective and active production (and destruction) of an ‘individual’.

The questions and comments after the lecture were immensely helpful, and as I turn this into its final, written version I’d be grateful for any further comments if you watch the video.