Refugees

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Civilian Casualties Are a Feature, Not a Bug, of War

“The first pattern is that forbearance toward the helpless has always been instrumental rather than absolute.” Historians Mark Grimsley and Clifford J Rogers (2002: xii), on treatment of civilians in war over time. 

 

Much of the world’s attention has been focused on two recent tragedies: the Malaysia Airlines flight shot down over Ukraine and the civilian casualties in Gaza. In his Foreign Policy essay “The Slaughter of Innocents”, David Rothkopf couched these events within the concepts of ‘limited war’ and ‘collateral damage,’ writing:

From a purely political perspective, such tragedies, isolated though they may be, instantly dominate the narrative of a conflict because they speak to the heart of observers — whereas government speeches, Twitter feeds, and press releases seem too coldly rational and calculated, too soulless and self-interested. There are no arguments a political leader or a press officer can make that trump horror or anguish. There is no moral equation that offers a satisfactory calculus to enable us to accept the death of innocents as warranted.

I agree with much of this, except for one non-trivial point: tragedies involving civilian casualties are not that isolated, unfortunately. Not all incidents will be nearly as visible as the deaths of four young children playing football on a beach near a hotel filled with journalists, or a commercial airplane shot out of the sky. But they are all tragedies nonetheless. Civilian casualties are a feature of modern war, not a bug.

War deaths 2

Civilian casualties. See references below for sources.

 

And this is not exactly a new pattern or feature of ‘limited war.’ Instead, nearly a century of data suggests that civilians, not soldiers, have suffered the brunt of war, experiencing 67% to 90% of casualties across various conflicts since WW2. And many more civilians suffer through forced displacement, along with its short- and long-term effects on health (Bradley 2014). Perhaps we shouldn’t be surprised at these patterns, for the very simple reason that war is a sledgehammer, not a scalpel. It cannot easily excise some unwanted faction from a society without also cutting out several times more innocent lives. The real tragedy are not those ‘rare mistakes’ (which are not rare, really) that injure or kill civilians. It is the decision to go to war at all.    Continue reading →

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The Rights of the Displaced

T. Alexander Aleinikoff, UN Deputy High Commissioner for Refugees, wrote the following on June 20th (World Refugee Day):

The protection of refugees and other persons forced from their homes is not an act of charity; it is not an act of noblesse oblige; and it is more than a moral obligation that the fortunate owe the less fortunate.

It is a matter of rights.

  • Persons forced to flee have a right to seek and receive asylum.
  • They have a right not be “pushed back” at sea or arbitrarily detained upon arrival.
  • They have rights, under the Refugee Convention, to freedom of movement and to work within countries in which they have been recognized as refugees.
  • Persons forced to flee have a right not to be discriminated against because of their race or their religion or their gender or their sexual orientation.
  • Women forced from their homes have a right not to be forced into survival sex.
  • Children forced to flee because of conflict have a right not to be forced to serve as child soldiers.

 

As persons forced from their homes have rights, so too the international community has responsibilities.

  • Nations must share the burden imposed on countries that have opened their borders to those forced to flee.
  • They are responsible for the humane treatment of asylum-seekers, and the development of fair and efficient asylum systems.
  • And the international community has a responsibility to provide solutions to refugees, internally displaced and stateless persons—who sometimes remain in uncertain legal status for decades.

These rights and responsibilities belong to all of us; they are affirmed collectively to provide for our protection and to remind us of our duties.

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Civilians, Refugees, and the 2nd Indochina War in Laos

[Note (June 2020): I’m seeing an uptick in the number of views on this essay. Is there any reason? Since this site is a labor of love, I’m just curious how it is being used.]

“In Houa Phanh and Xieng Khouang provinces, the war (in Laos) has reached into every home and forced every individual, down to the very youngest, to make the agonizing choice of flight or death.” (Yang 1993: 104)

“Those who suffered the most from the escalating conflict were populations living in the east of the country: overwhelmingly highland minorities, Lao Thoeng and particularly Lao Sung (Mien as well as Hmong), but also upland Tai, the Phuan of Xiang Khouang and the Phu-Tai of east central Laos.” (Stuart-Fox, 1997: 139)

“Military Region II (northeastern Laos) bore the brunt of the war for almost fifteen years. Nearly 80% of the refugee population in Laos originated in MR II, including the refugees on the Vientiane Plaine. Almost the entire population of Houa Phan (Sam Neua) and Xieng Khouang Provinces were gradually forced south into the Long Tieng, Ban Xon, Muang Cha crescent.” (USAID, 1976: 210)

Displaced Hmong in Laos, probably in the early 1970s. Source: Roger Warner. 1998.

Displaced Hmong in Laos, probably in the early 1970s. Source: Roger Warner. 1998.

A consistent feature of war is the harming of civilian lives. The extent of harm is not always easy to ascertain, but is sometimes quantified in the number of “excess deaths” that occur during a war. For example, Hagopian et al (2013) surveyed two thousand randomly selected households throughout Iraq, interviewing residents about their family members before and during the US-led invasion and occupation. They estimated that from March 2003-2011 approximately 405,000 deaths occurred as a result of the war, mostly from violence.

However, such studies always have limitations – recall bias, survivor bias (the dead cannot be interviewed), and logistics in surveying high violence areas – meaning that mortality estimates will never be perfect, and Hagopian et al. gave a range around their figure (a 95% uncertainty interval of 48,000 to 751,000 excess deaths). Whatever the exact number, which we will probably never know, we can still be confident that mortality rates increased during the war years.  

The same challenges apply to all wars, including one that I have been interested in for a while – the Second Indochina War in Laos. The Australian historian Martin Stuart-Fox wrote that: “loss of life can only be guessed at, but 200,000 dead and twice that number of wounded would be a conservative estimate” (1997: 144). Mortality estimates for Laos are further complicated by the fact that it was one the least developed countries in Asia at the time of the war, likely with unreliable census data and other record keeping (though, for those who are interested, see the 1961 Joel Halpern “Laos Project Papers” from UCLA, which contain demographic and health statistics).

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Global Refugee Trends

At the end of 2013, there were more than 50 million displaced people globally, the highest number since WW2. I’m working on another post on how these experiences may impact biology and health, particularly for children. In the meantime, this UNHCR video shows some of the places that are most affected by forced displacement.

“Displacement is brutal. Many children stumble into exile barely alive after weeks in the bush.”

 

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Ancient Ethnic Hatreds

This photo from a BBC report on the ongoing fighting in South Sudan made its rounds on the internet today, showing refugees being segregated by ethnicity at a UN compound. As of last month, an estimated 93,000 people had been displaced by the conflict, indicating the scale of the crisis (source: reliefweb).  

Signposts in Bentiu camp

Sign at a camp in Bentiu, South Sudan, segregating refugees by ethnicity. (Source: BBC)

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Faces of Displacement

From UNHCR:

“Fifteen countries now have internal displacement crises.”

“To change this, the world must pay attention. It must help now.”

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Infant Mortality Rates, War & Laos

I finished my dissertation on how the war in Laos was correlated to the physical growth of Hmong refugees in 2004. The general idea was that early stressors, particularly prenatally and in infancy, can have long-term impacts on growth and health. The model I was working with came largely from David Barker’s (and others’) ‘fetal origins hypothesis,’ based on evidence that low birth-weight infants tended to grow up to have higher rates of things like type 2 diabates, coronary heart disease, hypertension, etc. A classmate in graduate school, Stephanie Rutledge, introduced me to Barker’s work and told me that I’d find it really enlightening. I did. Sadly, Barker passed away earlier this year, but his work helped spawn a new direction in research. 

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Forgiveness in Boston

Boston-Magazine Shoes http://www.bostonmagazine.com/news/blog/2013/04/25/behind-our-may-boston-marathon-cover/

Cover of ‘Boston Magazine,’ by Mitch Feinberg

Less than a week after the Boston Marathon bombings, which left 3 people dead and over 280 injured, Cardinal Sean O’Malley emphasized the importance of forgiveness during Mass at the Cathedral of the Holy Cross. According to the Boston Globe, Cardinal O’Malley gave the congregation  two reasons to consider forgiveness. The first was  to avoid the “eye for an eye, tooth for a tooth mentality.” In that way, forgiveness offered a potential means to avoid further hostilities between groups. In fact, local tensions seemed to be simmering. O’Malley was likely cognizant of this, hoping to help defuse things before they progressed any further.  

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War as a Public Health Problem

The surgeon Gino Strada, who has worked in war zones around the world, once referred to war as “the biggest tragedy in public health.” It is debatable whether this empirical claim is true, but by re-framing the issue in this way we can see war with fresh eyes and as more than a conflict between political entities. Rarely, if ever, is war a matter that affects solely competing militaries. Recent images from Syria, Gaza, and Israel are the latest reminders of the impact of war on civilians. See these compelling photo essays here and here.

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Aside from the obvious culprits of death, injury, and post-traumatic stress disorder, there are many ways that war can affect public health. As early as February of this year, food shortages were reported in Syria. One displaced woman told a reporter: “I can guarantee you this, people will starve to death.”

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Food shortages in Syria. From CNN (Feb 21, 2012).

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Reconciliation, Biology, and the Second Indochina War

Of all the things I’ve written on this site, this remains one of the most meaningful to me. (May 29, 2017)

“The weak can never forgive. Forgiveness is the attribute of the strong.” …………………………………………………………………………– Mohandas K. Gandhi

On my desk sits a spoon I bought in a restaurant in northern Laos. It’s lightweight, bigger than a tablespoon, and full of tiny dents that some unknown metalsmith hammered into it. The owner was bemused that in addition to the bowl of pho noodle soup, I also wanted to buy one of her utensils. But I had my reasons.

Earlier on my trip, my guide1 informed me that people in the town of Phonsavanh half-jokingly called these ‘B-52 spoons,’ as they were made of metal recovered from bombs dropped decades ago by U.S. planes during  ‘the Secret War.’ To me, the spoon was more than a quirky souvenir. Instead, it represented an attempt by Laotians to take the physical remnants of a tragic period in history and forge them into something more positive, in effect turning swords into plowshares (or bombs into spoons). Continue reading →