The intersection of medicine and war

Had another blog published on Physicians Practice:
http://www.physicianspractice.com/blog/when-war-and-medicine-combine-physician-reflects

Things continue to heat up

Reading the news about Ukraine continues to scare me. The countries of the victims of MH17 send more police and even troops to help with the investigation. It was revealed that the man who likely fired the rocket that downed the passenger plane (http://www.ibtimes.co.uk/igor-strelkov-key-mh17-crash-suspect-linked-massacre-3000-bosnian-muslims-1992-1458304) is a veteran of both the Soviet and Russian armies, and is thought to be a covert agent of Russian military intelligence (GRU).

Russia is moving more powerful weapons close to the border. It may also be delivering more powerful weapons to the separatists. US intelligence is reporting that rockets are being fired from within Russia across the border into Ukraine.

NATO is placing more troops in Poland (http://rt.com/news/175292-nato-poland-supply-base/). Poland is buying more weapons, as it and the Baltic countries are increasingly concerned that, despite being members of NATO, the alliance will be reluctant to engage Russia in their defence. Those in Brussels have acknowledged that defence of the eastern countries now in NATO would be difficult. Perhaps that is the reason for the new base being proposed in Poland.

Even as I watch from the comparative safety of the US, I remember that a Russian AWACS plane flying along the coast interfered with air traffic control at LAX. The world is now not that big. Regional conflicts can spread quite quickly.

The Russian bear seems to be wanting to reclaim the territory it lost in "the worst disaster of the twentieth century," as Putin described the breakup of the Soviet Union. It is nearly the 75th anniversary of the start of World War II, as the Germans and the Soviets invaded and divided Poland under the Molotov-Ribbentrop Pact. I hope that we are not seeing the lead up to World War III.

IPPNW weighs in

Since my last two blogs have dealt with Ukraine, here is IPPNW's opinion:
http://peaceandhealthblog.com/2014/07/22/crisis-in-ukraine/

Medicine and War

War and medicine have always been linked. Surgical instruments are often developed by military surgeons--Army/Navy retractors, Russian forceps, Jackson-Pratt drains, external fixators, to name just a few of the instruments developed by military surgeons. Sometimes this is obvious by the name, sometimes not. But war has helped with the development of medicine, as medicine has struggled to cope with the devastation of war. And physicians have at times been involved in development of "better ways to kill."

I have never been in a war. The closest I have come was working in inner city hospitals while drug cartels were fighting for "turf." But, I could return home to the safety of a middle class community where shootings were rare. Nevertheless, I have worked with Physicians for Social Responsibility and EMERGENCY to try to help prevent war and care for the civilian victims of war.

Tonight, as I learned more about the Malaysian Airlines jet shot down in Ukraine, I learned that there were 41 war zones around the world. Forty-one. The number surprises me and yet it does not. I know that we have always been a violent species. Perhaps, this is a typical number.

Tonight, I learned of another way war has affected medicine. One hundred AIDS researchers were killed in Malaysian Airlines jet shot down over Ukraine.(http://www.medscape.com/viewarticle/828523 and http://thinkprogress.org/health/2014/07/18/3461625/aids-experts-malaysian-plane/) Usually, medical researchers spend much of their time in academic settings, being exposed only to the violence and drug use of the inner city. Perhaps some of the researchers studied people in less developed parts of the world. Even so, they likely thought that they were heading to a convention in a peaceful part of the world, Australia. They may have even been bringing their families, evidenced by many children on the flight. They likely had taken many flights before, and so were not worried about the risks of flying.

The passengers were likely watching a movie, reviewing notes on a computer or sleeping as the plane flew at 30,000 feet. They didn't think about what they were flying over. So many war zones between the Netherlands and Malaysia. Passenger planes surely avoid the major war zones. Few of the passengers thought of the risk, until it happened. Until a passenger jet was shot from the sky.

It may have been a case of mistaken identity. Even so, the shooting down of the Malaysian Airlines jet over Ukraine may have an effect on the health of the world's citizens for years to come.

Ukraine and the Budapest Memorandum

What does violation of the Budapest Memorandum mean for the future of nuclear non proliferation and arms reduction?

As the war in Ukraine becomes more obvious to those who have not been following the situation with the downing of the Malaysian jet with the loss of 295 civilian lives, people who were uninvolved in this conflict, I feel that I need to bring up some of the other issues that I see. This is now a regional war, not even involving the territory of a whole country, but the risks extend much further.

In 1994, Ukraine, together with Russia, the United States and United Kingdom signed the Budapest Memorandum. It guaranteed the territorial integrity and political independence of Ukraine in return for signing over the nuclear weapons in its possession to Russia. Later, this was expanded to include France, China as guarantors, and Belarus and Kazakhstan along with Ukraine as nations that would give up their nuclear weapons.  Since, the launch codes for many of these warheads were kept in Moscow, the weapons in Ukraine, Kazakhstan and Belarus were really not under the control of the respective governments. In this sense, the transfer was perhaps less significant. Nevertheless, it was the first time that governments gave up nuclear weapons for the promise of peace.

More recently, with the expansion of the European Union and NATO into formerly communist countries of East Central Europe and even into the Baltic countries, which were part of the Soviet Union after World War II, Moscow has expressed concern about western interference. Similarly, it has felt pressure from the south, both in terms of Islamic influence in the republics with large Muslim populations, and with American bases being placed in some of these countries to support the wars in Afghanistan and Iraq. To counter the European Union’s trade benefits, Russia has proposed a Eurasian Union including Russia, Ukraine, Belarus and Kazakhstan as the core.

But, some former republics wanted more change. First there were the Chechen wars of 1991 to 1994 and 1999 to 2000 and the ongoing Chechen terrorist attacks and suppression in Chechnya. And more recently the Maidan movement in Ukraine. Due to both the size and historical significance of Ukraine to Russia, this was a blow to heart. Propaganda has been intense on both sides. Finally, Russia took over the Crimean peninsula and parts of eastern Ukraine are still being contested.

Russian annexation of Crimea is a clear violation of Ukraine’s territorial integrity making this a violation of the Budapest Memorandum. It is clear why Russia has not come to the aid of Ukraine. But, while both the US and UK issued statements and applied political and economic pressure, what more could they do? After all, Russia was on the other side and the possibility of war with Russia is something they want to avoid. Once again, those in former communist dominated countries feel they are again being sacrificed to political expediency.
Clearly, as Ira Helfand said in his May editorial (http://www.desmoinesregister.com/story/opinion/columnists/2014/05/04/another-view-ukraine-crisis-danger-nuclear-war/8665185/), nuclear war would be disastrous for the planet. A nuclear war between the United States and Russia, once again a possibility, is something we must avoid.But, are there other concerns in the Ukraine crisis? Does a nuclear power have the right to attack or annex a non-nuclear one simply because of the fear of nuclear war? This precedent is very disturbing. Just as when the US invaded Iraq a decade ago in search of weapons of mass destruction, while it did little about the real nuclear weapons in North Korea. Comments were made then that possession of nuclear weapons was protective. Not exactly the message we should want to send if we want nuclear disarmament. Now, again with the annexation of Crimea and further incursions into Ukraine’s territory, we again have a situation that appears to demonstrate that not having nuclear weapons, this time by giving them up, makes a country vulnerable. How can we convince these countries that the path to peace and security is through eschewing such weapons rather than by building more?

And, what is the impact of violation of the Budapest Memorandum on the behavior of smaller nuclear or near nuclear states? There was a multilateral agreement guaranteeing the territorial security and freedom from external influence protecting Ukraine. How can the larger nuclear nations be trusted when they offer security to a smaller nation again? What of other multinational agreements?

Other questions also arise? Are some people expendable? This has been a concern for half a century as the great powers have fought their wars through surrogates. Most of these people had dark skin and died so the great powers did not fight directly. Now again, the question arises in relation to those who live in proximity to Russia, and who remember, through their grandparents, the massive population destruction and relocation of the Second World War, its precursor Holodomor in the Ukraine and the aftermath of World War Two under communism. Timothy Snyder called this region “Bloodlands” since so many people died in the area of Ukraine, Poland and Belarus before and during the Second World War as Germany and the Soviets first divided then fought over this land. These memories are also causing Poland to lead pressure on the West and its guarantees to newer members of NATO and the EU. Poland remembers both the lack of help, despite treaty agreements, in 1939 from Britain and France, and the Yalta agreement which relocated it, and many of its people to the west, yet gave the Soviets control of its government. As a result, NATO is putting more troops and weaponry in Poland and the Baltic countries, and carrying out war games in the region. While this is very understandable, it further enflames the situation.

So how are those of us in the peace community to reconcile these issues? It isn’t easy. So far, the world has chosen appeasement, in essence encouraging Ukraine not to fight Russia. But is appeasement the right answer? But how can we change this path without taking to task one of the world’s largest nuclear powers? And what would that choice mean for the world? What does that choice mean for the people of Ukraine and Eastern and Central Europe?

How do we convince countries considering nuclear weapons not to develop them? So many of the messages of the past decade seem to suggest that a country is safer with nuclear weapons than without. We are sending the wrong message. I worry that more countries will embark on the course toward developing nuclear weapons, and this will also increase the risk of nuclear war in the future.

I find that reviewing this situation has left me with far more questions than answers. And more concern for the future of the world.