Crazy Day!

I'm again hearing helicopters. For the second night. Today, the hospital was still on lockdown, but not like yesterday. It was more relaxed, but, everyone who entered was checked. Today, the clinic was slower than average. That was no surprise with the line to get into the building.

Yesterday, my kids spent part of their school day on lockdown. I was at work at one of the trauma centers near the shooting and couldn't leave until the all clear. We had no idea how many casualties were coming, so we had to be prepared. I didn't know when I would get home.

Both my children had heard about the shooting (http://www.cnn.com/2015/12/03/us/san-bernardino-shooting/index.html) at school. My daughter mentioned that she worried about a classmate who lived near some of the shooting yesterday. My son said he was afraid and didn't want to talk about it. Yet, he was in tears over math homework. Today, my son told me that one of his friends lived very near the site of the shooters home, and heard some of the shooting yesterday afternoon. 

Today we learn of the massive amount of ammunition that the shooters had with them. And, the improvised bombs that they had made. While the motive remains unclear, there is some suggestion of both terror connections and workplace issues (http://www.cnn.com/2015/12/03/us/syed-farook-tashfeen-malik-mass-shooting-profile/index.html). It also appears that all these arms were obtained legally, though not all by the shooters (http://www.nytimes.com/interactive/2015/10/03/us/how-mass-shooters-got-their-guns.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=b-lede-package-region&region=top-news&WT.nav=top-news&_r=1).

Elsewhere in the world, such events are not uncommon, whether the assault is by gun or by bomb. I worry about the effects of this violence on my children. Yet, I know that many children must live in places where they may see people killed or be killed themselves. And, so we have more refugees than at any time since WWII. I worry because I feel violence begets violence and I would like the cycle of violence to come to an end.

Yesterday was a day we will all remember here. There was anxiety and concern for how serious the event was. And, yet, there were signs of the kindness of strangers. Pizza and flowers sent to the main trauma centers. A thank you message written on a nurse's coffee cup. We will continue and we will support each other.

Travels in the time of communism

For some time, I have followed Anne Applebaum, and her husband Radek Sikorski. Anne is a journalist/historian who has written about Eastern Europe.  Here (https://www.commentarymagazine.com/articles/russia-great-forgetting/), she tells of how the time she spent studying in Leningrad in 1985 helps her to understand the modern world. Like Anne, I spent time behind the "Iron Curtain" in the time of communism. And, like Anne, I think it has had a long term effect on my life. However, I am only now starting to write about some of those topics.

I grew up in the US, but, during my teens and twenties, my father made several trips for scientific exchange visits to various countries in Eastern Europe. My mother and I were fortunate to accompany him on several trips. My mother had the advantage of being fluent in Polish. I came to learn some Polish, and also improved my German. I learned to read Cyrillic on one trip to the Soviet Union when I was handed a map in Russian and learned the road signs were in Russian. I was the navigator. We were given a deadline by which time we had to arrive at our hotel or else... So, I quickly learned to match the letters on the map and the signs, and we arrived on time. Later, I studied Russian in school.

That is one of many stories of my travels in that era. I came to realize that the people in the various countries of Eastern Europe were no different than the people at home, with one major difference, they were very cicumspect about what they spoke about in public, or until they knew they could trust you. Very few had been allowed to travel abroad. And, often they had trouble believing that Americans could travel as we did.

Those travels taught me, too, about life under communism. Even though I never saw the worst of communism. That I got to hear about from relatives, both in Europe and from Europe. From relatives who had survived gulags and made it to the West, and from relatives in Poland who were still hiding a cousin who had spoken out against the Soviets and so had an execution order hanging over his head. I wonder if I would have spoken and written these stories sooner if I, too, had not internalized the censorship.

So, like Anne, I see frightening comparisons in some of the propaganda and actions of Russia now. I see the suppression of Memorial, and know that there is an effort to again forget those who suffered in gulags and labor settlements. I see the attempt at rehabilitating Stalin, regarding him as a great leader and again showing his portraits. And, I, too, see the invasions of the little green men and weaponry to help Russian speakers in Ukraine. And, now, Russian forces shoring up the regime of Assad in Syria. I agree with Anne Applebaum that these events are reminiscent of the past. And, so, these actions concern me with what they might mean for the future.

City of Lights

On Friday, there were coordinated attacks in Paris killing more than 100 people (http://www.nytimes.com/2015/11/14/world/europe/paris-attacks-what-we-know-and-dont-know.html?_r=0), following attacks in Beirut killing more than 40 people on Thursday (http://www.nytimes.com/2015/11/13/world/middleeast/lebanon-explosions-southern-beirut-hezbollah.html). Apparently, ISIS has claimed responsibility for both these attacks, as they did for the apparent bombing of the Russian airliner (http://www.cnn.com/2015/11/06/middleeast/russian-plane-crash-egypt-sinai/).

These attacks show how we cannot simply say that the war is "over there," but must realize that we are at risk, no matter where we live or what we do. They seem to be to show us in the West that the war has come to us. But, the people continue to flee the war zones in the Middle East, since it is not safe to live there. They are making their choices with their feet, leaving the place that has been home for generations to try to make a life elsewhere. 

As I see what appears to be the spreading of war, I think back to my youth. and remember a slogan of the peace group, Another Mother for Peace, "War is not healthy for children and other living things." Especially with a "war on terrorism," I have difficulty understanding how war reduces terrorism and safeguards the population. Instead I see war as causing people to fight for their homeland. These people may be seen as heros or villians, depending on one's viewpoint.

Unfortutunately, terrorism is not easy to fight. It is a hydra. Cutting off one head simply allows another to take over. It even encourages others, since many feel suppressed. So we have seen one terrorist group after another. Each is worse than the last.

So what is the solution. I think it must be addressed at the base. Why is it that youth are disaffected? Why do they choose to join radical groups?  I would extrapolate from what I saw in the inner city. Youth are disaffected if they see no hope for the future. Then, they choose what they see as another path to success. Their anger can easily lead to violence. So, vulnerable youth  must be shown another path. They must be convinced that they can succeed and that their families can succeed.

Governments can't simply suppress, but must support the springs of hope. I think of the option given on Homeland of sending in not just soldiers, but also doctors and teachers.
https://www.facebook.com/nationalreview/videos/10156321613335093/.
The second option of more destruction is only cutting off a head of the hydra.

We need to change our strategy and address the causes. Or new heads will simply appear.

What can the plane reveal?

It has been over five years since a crash which killed the Polish President and numerous other Polish political figures, and the wreckage of the plane has still not been returned from Russia. Poland is now planning to sue in the European Court of Human Rights (http://uk.reuters.com/article/2015/11/10/uk-poland-russia-smolensk-idUKKCN0SZ2CY20151110 and http://news.yahoo.com/official-poland-russia-court-over-plane-wreckage-123457732.html?soc_src=mediacontentstory&soc_trk=fb).

The investigation was long since settled by Russia as showing pilot error and weather as the cause. But, other groups say this doesn't quite fit. Conspiracy theories abound. Immediately after the crash, "the plane’s black boxes, laptops, sensitive documents, mobile phones, address books, telephone numbers, correspondence, and the top-secret military, NATO and diplomatic codes on board were salvaged from crash site immediately by the Kremlin’s operatives in what was a “coup for Russia’s intelligence service” according to retired CIA analyst Gene Poteat. What Nowaczyk calls “years worth of work for security services” was completed in a single day by Russia’s OMON Special Purpose Police, which were immediately deployed to the site." (http://www.thedailybeast.com/articles/2014/04/11/did-putin-blow-up-the-whole-polish-government-in-2010-a-second-look.html)

An engineer from the University of Akron, Wieslaw Bienieda, did simulations which suggest that crash could not have happened the way it was described by the Russians (http://www.cleveland.com/science/index.ssf/2012/04/university_of_akron_engineerin.html). He reported that a large debris field and no crater would be unlikely if the plane clipped a birch tree 30-40 meters (100-130 feet) in the air. In addition, he thought that many of the passengers in the midsection would have survived a fall into soft soil.

A Danish scientist, Glenn Joregensen, also was left with several questions which were not explained by the official report (http://www.smolenskcrashnews.com/6-questions-for-maciej-lasek-and-the-authors-of-the-official-polish-smolensk-crash-report.html).

I have no way of knowing what the truth is. The Dutch investigation of the MH-17 crash showed how detailed an investigation could be, and led Poles to ask if the Smolensk crash should be further investigated (http://www.smolenskcrashnews.com/Smolensk-Crash-Investigation-Requires-Correction.html). So, I do think that returning the plane to Poland where it can be subjected to a full investigation is appropriate. It's time to clear the air. Unless there is something to hide.

Civilian victims

Civilians are increasingly the victims of the more targeted wars of the last one hundred years. And now, NGOs which have offered help have been attacked, whether accidentally or on purpose (See recent blog Kunduz and http://www.telegraph.co.uk/news/worldnews/middleeast/syria/11951963/Syrias-doctors-utterly-abandoned-after-Russian-air-strikes-hit-hospitals.html; http://www.nytimes.com/2015/10/23/world/middleeast/group-cites-7-attacks-on-hospitals-across-syria.html?_r=0). Now, MSF and the World Food Program have been kicked out of parts of eastern Ukraine (http://www.rferl.org/content/donetsk-rebels-ban-doctors-without-borders/27323079.html). More recently, another hospital in Yemen was hit (http://www.doctorswithoutborders.org/article/yemen-msf-hospital-destroyed-airstrikes?utm_medium=social&utm_source=twitter&utm_campaign=social).

These attacks, whether physical or simply ejecting NGOs serve to undermine the already weak infrastructure needed by civilians in order to survive. This compounds the attacks on civilians in many of the world's war zones, causing many to see few options but to flee their homes.

Syrian refugees and others fleeing North Africa are leaving in such numbers as haven't been seen since WWII. They suffer significant risk in trying to make the journey. Large numbers die in transit and may wash up on the beaches. A fellow student in an online class reported that she and her son were walking along the beach in Malta when they found the torso of a woman recently. She said that up to 150 bodies may wash ashore on a single day.

Top ten countries of origin (red) and asylum (green) of refugees worldwide at the end of 2014, according to UNHCR data (which exclude Palestinian refugees under UNRWA mandate).^[32]

According to the UNHCR, the number of forcibly displaced people worldwide reached the highest level since World War II. At the end of 2014, 59.5 million people were refugees. ("The Global Refugee Crisis, Region by Region". The New York Times. 26 August 2015.) 

Resources of neighboring countries, and of countries more distant, are increasingly strained. Several European countries have tried to restrict the flow to their countries.

The scale of the refugee crisis adds to my concern for the future. I don't believe people flee their homes unless they see no other choices. Especially, taking the perilous routes that are the only ones available to them, and risking their lives and those of their children.

Despite having grown up during the Cold War, and experienced both sides of the Iron Curtain, I worry that the world is working its way up to another global conflagration. I hope and pray that is not the case, but...

Rehabing the Gulag

Prisons are in theory supposed to rehabilitate prisoners. Yet, in reality, few do. Many criminals, for whatever reason, repeat their crimes. Except for crimes of passion. Or where the state feels wronged--political crimes. Here in the US, we have only had short forays into punishing people for political crimes. Joe McCarthy comes to mind here. And, yes, there is a story there. But, that is for another day. Today, the issue is rehabilitating the prisons.

"The fence at the old GULag in Perm-36" by Gerald Praschl - Own work. Licensed under CC BY-SA 3.0 via Commons - https://commons.wikimedia.org/wiki/File:The_fence_at_the_old_GULag_in_Perm-36.JPG#/media/File:The_fence_at_the_old_GULag_in_Perm-36.JPG

Russia is attempting to rehabilitate the past, including the history of the gulag (http://www.theguardian.com/world/2015/oct/29/russia-gulag-camps-putin-nationalism-soviet-history?CMP=share_btn_tw). It has persecuted Memorial, an organization founded to remember the victims (https://en.wikipedia.org/wiki/Memorial_(society)). It has forced the Museum of the Gulag at Perm to close (http://www.themoscowtimes.com/article/516920.html).

My grandfather's second wife and her family were some of the victims of the gulag. They were taken from a town in the Kresy (eastern Poland) in 1940, in compliance with the Molotov-Ribbentrop pact (https://en.wikipedia.org/wiki/Molotov%E2%80%93Ribbentrop_Pact), which allowed for the start of WWII and divided East Central Europe, in particular Poland, between the signatories.

The family of husband, wife (my grandfather's second wife) and two sons were taken by train from their home in winter. Both sets of grandparents had said they were too old to travel, and so were shot. The remainder of the family was loaded onto a cattle car and shipped east. Many of the people from the town were taken.

In the middle of the taiga near Arkhangelsk, the train came to a stop. The people were offloaded. They asked, "Where do we live?" The answer was, "There are trees, you can build houses." The people asked, "What do we eat?" The response was, "There are rabbits."

Of the 4 members of the family to arrive in the taiga, only 2 made it out of the Soviet Union. Only 3 people from the town survived. I am uncertain why my grandmother's first husband died. What I have found online suggests he survived to be freed. The younger of the two children was only 3 years old when he was sent to the taiga. According to family, he was "just too young to live." The older child was eleven when he was taken from his home. He survived this and joined the Anders army, a Polish army organized under the British. Despite his young age, he fought with them during WWII. See an earlier blog, from 2012, on Child Soldiers.

Timothy Snyder was asked a few years ago whether Hitler or Stalin was worse (http://www.nybooks.com/blogs/nyrblog/2011/jan/27/hitler-vs-stalin-who-was-worse/). He approached the question by telling the history and letting the reader decide. I won't presume that I can answer the question any better. I know that I can't.

Both Hitler and Stalin were evil dictators who each killed millions. Each believed that their philosophy justified the killing. And, like memorials for the victims of the Holocaust, there should be memorials for the victims of the gulags. And, not just in Moscow or Perm. Their deaths should not, again, be denied to the world. They should be remembered, so that such crimes are never repeated.

Crash?

Last weekend, a Russian passenger jet crashed in the Sinai. Despite ISIS claims of shooting the jet down, the Russians reported otherwise. But, today, there was an article (http://www.dailymail.co.uk/news/article-3307741/Rocket-attack-UK-tour-jet.html#ixzz3qnMzgkak) that makes me wonder. If a British jet had to avoid a rocket, perhaps the Russians were not so lucky. Thus, the British decision to suspend air travel to Sharm El Sheikh makes sense. It makes sense that the American government is also raising the suspicion of a terrorist attack. It suggests that the Russian crash may not have been an accident, but an attack. And, not an isolated one at that.

And then, there is a statement that the rocket was part of Egyptian military exercises (http://www.independent.co.uk/news/world/africa/rocket-which-came-within-1000ft-of-thomson-flight-fired-during-egyptian-military-training-exercise-a6725061.html). This is also very puzzling. Why would a military hold exercises near flightpaths to a civilian airport? They should know the flightpaths and schedules since they are public.

And, Sputnik asks a stranger question (http://sputniknews.com/columnists/20151106/1029694767/sinai-isil-russia-a321-crash.html), suggesting the British would attack a Russian jet. If they had, why would they stop their own passenger traffic? There would be no need, since their people would be safe. But, asking such a question can only further inflame tensions between Russia and the West.

The official investigation has not shown evidence of a terrorist attack (http://sputniknews.com/world/20151107/1029748448/airbus-a321-investigation.html). But, what then? Why would the plane crash? And, then, the Russians also suspend flights after evidence of an explosion (http://www.independent.co.uk/news/world/africa/russian-plane-crash-black-box-data-reveals-metrojet-a321-was-brought-down-over-egypt-by-explosion-a6724506.html).

As I write this, friends are on their way to Israel. I worry for their safety, not just from the stabbing attacks in Israel, but, now, also from attacks at 30,000 feet. The answer is unclear what happened to the Russian passenger jet, but a terrorist attack is certainly a possibility.

Modern Slavery

Earlier tis week, I saw a series of articles which compelled me to write this blog. The first is a story from LA, near where I live. The sheriff is no longer allowing the description of children as prostitutes (http://www.latimes.com/local/lanow/la-me-ln-sheriff-children-sex-trafficking-20151021-story.html and http://www.huffingtonpost.com/entry/la-will-no-longer-arrest-children-forced-into-sex-trafficking_5630fde3e4b0c66bae5a7469?section=women&ncid=fcbklnkushpmg00000046), instead he says they should be called and treated as victims. This is a change for the LAPD, which previously labelled teens as prostitutes, and they were treated as criminals. Moreover, shelters turned trafficked teens away as they were unprepared to handle a pimp returning for his "property" (https://en.wikipedia.org/wiki/Sex_trafficking).

While older teens may consent to sex, it doesn't make sense to me, as a mother, that a preteen or young teen can, or would want to voluntarily. And, prostitution is sex without a relationship, which is what most teens who consent to sex are really wanting. Hence, I was glad to see this decision. Hopefully it will save many children from a life as a trafficking victim.

Then, there were a couple articles about human trafficking increasing since the earthquake in Nepal (http://www.theguardian.com/global-development/2015/oct/25/nepal-earthquake-six-month-anniversary-children-orphans-people-traffickers and
http://www.nytimes.com/2015/10/25/opinion/sunday/meet-a-21st-century-slave.html?ref=opinion&_r=0). Both of these discuss how the disruption of society with many orphans due to the earthquake puts more children at risk, since the normal caregivers for children are absent, either due to death, or being even more stressed since the earthquake.

During World War II, Korean and Chinese women were forced to become prostitutes for the Japanese military. Each was raped approximately 50 times per week for an average of 3 years (https://en.wikipedia.org/wiki/Comfort_women). In some cases these women were abducted, in others, lured with the promise of work. If they became pregnant, they were forced to have abortions and they were checked regularly for venereal disease. An estimated 200,000 women were Comfort Women in Asia. Finally, in 1994, Prime Minister Tomiichi Murayama of Japan issued an apology and some of the women received compensation. Many of the women still suffered Post Traumatic Stress Disorder 60 years after the war.

Germany also forced women to become prostitutes. Prisoners in Ravensbruck Concentration Camp were frequently forced to provide sexual services for Germans (https://en.wikipedia.org/wiki/German_camp_brothels_in_World_War_II and http://www.spiegel.de/international/germany/concentration-camp-bordellos-the-main-thing-was-to-survive-at-all-a-632558.html). Some of these women were sent to other concentration camp brothels. For some women, this was their only chance at survival. Should they become pregnant they were forced to have abortions.

In addition, brothels were established for the soldiers. In France, most of the women had been prostitutes before the war, but were forced to register and work in the German controlled brothels. In Eastern Europe, things were worse (http://www.scribd.com/doc/89860120/Victims-Heroes-Survivors-Sexual-Violence-on-the-Eastern-Front-During-World-War-II). Raids were held in Polish cities to capture young women and girls to supply them (https://en.wikipedia.org/wiki/Sexual_slavery#Germany_during_World_War_II). On at least one occasion, Polish and Russian women tried a mass escape in Norway (https://en.wikipedia.org/wiki/German_military_brothels_in_World_War_II#cite_note-Wprost-5). Frequently women had to service over 20 men in a day, sometimes up to 40 (http://www.scribd.com/doc/89860120/Victims-Heroes-Survivors-Sexual-Violence-on-the-Eastern-Front-During-World-War-II). Again, the women were checked regularly for venereal disease. If a woman contracted a venereal disease, and she was a Pole, Russian or Jew, she was simply shot. Similarly, she would be executed if she received 3 complaints. Some of the women were sterilized without anesthesia. The survivors have not received an apology or compensation, since they were deemed of  "ill repute," even though they had been forced into the brothels, either directly, on threat of death, or in order to get the necessities of life.

The wife of one of my mother's cousins was forced to tolerate this slavery. The two were married shortly before the start of WWII. He fought with the Polish army, first in Poland, then France and finally with the British. After the war, he returned to find his wife. She had been swept up in one of the street raids and forced to work in a brothel for German soldiers. She was unable to relate to her husband after the war, and so the marriage was dissolved. He went on to rebuild his life; she went on to commit suicide.

More recently, rape on a large scale occurred in the former Yugoslavia (https://web.archive.org/web/20080529014548/http://www.wilpf.int.ch/publications/1992ruthseifert.htm). It also has occurred in many other wars, as war is an extreme case of male bonding.

However, even in countries not at war, sexual slavery exists on a large scale throughout the world. The UN estimates that approximately 2.4 million people are victims of human trafficking at any moment; 80% of these are trafficked for sex (https://en.wikipedia.org/wiki/Sex_trafficking). Low status for women is thought to put women at risk. Children are at even more risk, since they are vulnerable due to naivete, small size, and tendency to be intimidated. It has been estimated that there are 100,000 children who are trafficked in the US.

I am hopeful that viewing these children as the victims they are, rather than blamed for the repeated sexual assaults they endure. I see the new LAPD policy as a step that I hope to see replicated. Hopefully, efforts like the World Vision program in Nepal can be replicated to give vulnerable children a chance to have a life of their own (http://www.theguardian.com/global-development/2015/oct/25/nepal-earthquake-six-month-anniversary-children-orphans-people-traffickers).

Russian Jet Shot Down over Turkey

Yesterday, a Russian jet was shot down over Turkey. It had invaded Turkey's airspace without permission and even had locked radar. It was apparently flying from Russia to Syria where Russia is shoring up the Assad regime against ISIS and other groups.

There are a series of school bombings (http://www.theguardian.com/world/2015/may/03/syria-children-killed-in-government-barrel-bomb-attack-say-rights-groups; http://www.aljazeera.com/news/2015/04/killed-syria-aleppo-school-bombing-150412112453365.html; http://www.abc.net.au/news/2014-10-02/school-bombing-kills-41-children-in-syria/5784266). Some by government forces, others by insurgents.

So people flee, hoping for safety. Because they see no hope at home. And they go to sea in flimsy boats, and many die (http://www.nytimes.com/2015/09/03/magazine/the-boy-on-the-beach.html?_r=0). He was far from the only refugee from Syria. Many flee other countries such as Libya.

And, this isn't the only part of the world where people are fleeing their homes for safety. Australia has many refugees and has trouble processing them, so they languish on Nauru and other centers. It is now trying to send these peoples on to the Philippines and Cambodia (http://www.smh.com.au/federal-politics/political-news/coalition-government-in-talks-to-resettle-refugees-in-the-philippines-20151008-gk4u5m.html).

OOPS!

Russian maps show Russian military bases in Ukraine.
http://uatoday.tv/politics/russia-s-yandex-maps-accidently-reveal-russia-s-new-military-bases-in-ukraine-518503.html

Kunduz

Many years ago, after my fellowship, I looked into volunteering for Doctors Without Borders. It was as the war in Bosnia was heating up. I had no dependents at the time, and knew that, as a surgeon, the greatest demand might be in a war zone. I mentioned that I knew two Slavic languages. As it worked out, I did not end up as a volunteer. But, I have followed the activities of both MSF (Doctors Without Borders) and EMERGENCY, a similar group. So, it greatly disturbed me that a US airstrike had repeatedly hit a MSF hospital in Kunduz, Afghanistan (http://edition.cnn.com/2015/10/07/asia/doctors-without-borders-afghanistan-airstrike/index.html?eref=edition).

As a physician, I take seriously the responsibility of caring for all, even at some risk to myself. I have worked in inner city hospitals where I have been threatened by some gangs, but, excused that due to the drug induced impairment of those who threatened me. And, I have known that many would not have wanted to harm me, knowing that they might later need my services.

International law protects hospitals, both military and civilian, from deliberate attack. Physicians should provide impartial care, and thus, might provide care to both civilians and combatants. Like my experiences in the inner city, those who wage war are at risk of injury, and so they want hospitals and physicians who will care for them. That is why the events of last week are so disturbing. Despite the coordinates of the MSF hospital being provided, there were several bombing runs targeting the hospital reported. Hence, MSF is asking for an investigation of a possible war crime (http://www.motherjones.com/politics/2015/10/us-bombing-afghan-hospital-war-crime).

The US has bombed hospitals before (http://thinkprogress.org/world/2015/10/08/3710486/hospitals-bombed/), and is not alone in this (http://www.theguardian.com/global-development/2015/oct/05/kunduz-hospital-bombing-latest-long-line-attacks-msf-staff; http://www.bbc.com/news/world-asia-34444053). Civilians have increasingly become the victims of war during the last century.

I hope the truth about this event will come out. And, that a hospital can be rebuilt for the people of the region.