Iraq Update 1:
Greetings from Kuwait!
It’s nice to be back in a “civilized” country. I actually wrote most of this in a Starbucks not too far from our hotel;
hanging out in a comfy chair with air conditioning (temp’s going over 100 today) and enjoying an ice coffee. So I
guess some of you may be a little confused as to what I’m doing here. The story is I am part of an assessment
team for an organization called Physicians for Human Rights (PHR). It’s the group that I went to Kosovo and
Azerbaijan with back in 1999. At that time I was testing surveys documenting the effects of landmines and also
began looking into the issue of cluster bombs. Now I am part of a human rights assessment team.
The press release that I initially forwarded requesting Coalition Forces to release maps with known cluster bomb
drop sites (Appendix II) was based on my experiences in Kosovo. In 1999 maps indicating known drop sites of
munitions and minefields were released to aid workers. While these types of maps are by no mean definitive, they
are better than nothing, and do give some insight into the areas which were hardest hit and thus most potentially
dangerous. So, the first thing I did when I arrived in Kuwait was to ask for maps with the drop locations marked on
them and I was referred to a single map of the entire country. Now, it’s was a nice map, but practically speaking
useless. It reminded me of a map I had once seen of Laos with the bomb sites marked with black dots, the actual
map just had a solid black band over 2/3rds of the country. Anyway, it seemed as if the Coalition Forces were
having a bit of an internal dispute and some people didn’t want to release the information. The good news is that
the info is now on the website for the Humanitarian Operations Center (HOC) based in Kuwait, although hard copies
are not available, the data can be downloaded or printed off a computer. If any one is interested the site is, and it’s
no joke, www.agoodplacetostart.org really, that the site. The maps are in the map section under mine action.
But anyway, what am I doing here? Well, as a member of the PHR advisory board, a few months ago I contacted the
headquarters office and asked if they were planning to send a team into Iraq, the reply was affirmative; and so of
course I offered my services. I was to be part of a second assessment team and we arrived in Kuwait City on April
29, 2003. The initial team composed of two women, Lynn and Sidney had arrived in Kuwait in early March. The
second team consisted of me, a statistician, and a woman who heads the Human Rights program at Trinity College
in Connecticut: Maryam Elahi. After a couple of days in Kuwait to get oriented; Maryam and I headed north to Basra
with Save the Children - a non-governmental organization (NGO) that provides humanitarian relief. Our plan was to
evaluate the situation, look into the issue of clerics who were limiting women from entering health centers and
hospitals (a reported problem in Baghdad – but did not appear to be a problem in Basra, yet), mass graves, and
physician complicity and association with torture.
The ride to Basra was pretty uneventful, we were able to stay in a hotel that another organization had recommended
and hired a car and driver. The hotel actually had electricity, air conditioning, telephone service, hot water, TV and
a decent restaurant.
We started out at a UN meeting, they had arrived the same day we did. We then proceeded to visit the British
military unit that provided information for the non-governmental organizations (NGOs), the CMOC, civilian military
operations center. After that we went to the Basra Teaching Hospital. We met up with one of the Chief surgical
residents who chatted with us for a while and began telling us about some of the atrocities that had occurred during
the Saddam era. He invited us to come back the next day and he introduced us to a neurosurgery resident and an
attending surgeon who both relayed stories about torture and abuses.
We met with this attending surgeon again over the next few days and he told us about a government program that
had targeted many of the surgeons in the country. As a way of punishing deserters from the Iraqi army, part of the
deserter’s right ear was cut off. The program for doing this was nationwide and almost all attending surgeons –
general, cardiac, neurosurgical, orthopedic, ENT and plastics – were included. This doctor spoke about this period
as he was a surgical resident at the time and was able to avoid participating by running from the hospital and even
spent one 24 hour period hidden in a closet. He stated that roughly 100 patients were mutilated in this way in his
hospital and similarly throughout the other hospitals in Iraq. It was targeted mainly at the Shiite minority living in the
south. If a surgeon refused to perform the procedure, his ear would be cut and his forehead branded. Many
surgeons were forced to follow the orders, although some fled the country.
This doctor told us about other abuses by and to physicians and on our last day in Basra he introduced us to three
of the victims of the mutilation who had their ear cut. We drove with him and also met one of the three psychiatrists
in Basra (a city of 1.5 million people) he said they only have 16 psych beds Basra and there are only 19
psychiatrists in all of Iraq. (Some of you may be surprised, but I truly believe that psychiatrists and therapists are
needed in Iraq much more than surgeons.) We then drove to look at a statue where the base was covered with lists
of names of people who were executed and then to the site of an alleged mass grave.
In addition to the interviews at the Teaching Hospitals we visited the Basra General Hospital, the International
Committee of the Red Cross, The Red Crescent Society of Iraq. We spoke to the Minister of Health for Basra and
the head of Primary Health Care centers for the Basra province. We also met with people from UNICEF, WHO and
other UN organizations. While we were there news was announced about confirmed cases of cholera. Now, cholera
is usually present every summer in Iraq, but given the problems with lack of clean water and the other problems, it is
felt that there will be a worse out break in the coming months.
As for the city itself, we felt pretty safe. We followed the recommendations of the UN and we stayed at the hotel after
dark and did not travel around. We did not see any unexploded ordinance or weapons ourselves, but other NGO
people did. As for the conditions in the hospitals, I didn’t get a chance to visit the ORs or the wards, though it
sounded at least at the Teaching hospital that they were able to perform emergent surgery and we saw plenty of
people (patients) there during the day. We didn’t see any specific civilians who were injured either during the war or
after from landmines etc, but we weren’t specifically looking for them.
The chief resident told use about one case of a 14 year old boy who, though the story was a bit uncertain, may have
been shot by a British soldier. Supposedly he was shot in the abdomen. We were told that he had a small bowel
and aortic injury, but were able to operate on him successfully. When I asked then next day if we could visit him, I
was later informed that he had died the next day. The British Royal Military Police are currently investigating the
case. One main problem that most people spoke about was the general lack of security, especially at night. There
really isn’t a police for or even a government up and running yet, but it appears to be a major issue on the agenda.
One highlight of the visit was when we went to Saddam’s Palace to talk to the Major in charge of Civilian-Military
operations, a member of the British 7th Armor Brigade (the desert rats). He was busy when we showed up, but he
invited us to have lunch while we waited to speak to him. Surprisingly at one point we were joined by the Brigade
Commander (a one star general) with whom we had an interesting discussion. The Palace grounds were pretty
remarkable; about 10 huge mansions on the grounds of a man-made lake. The insides were all decked out with
marble and quite ornate. We avoided taking pictures as there were multiple signs saying that “military tourism” was
prohibited.
Anyway, that’s all for the moment. As for my plans, I’m not certain what will happen next. Things are still a bit dicey
in Baghdad, though we had a team up there for a few days and they went to Najaf and Karbala . They too heard
about the ear mutilation issue and found many mass graves. PHR has been involved in identifying mass graves in
many countries including Bosnia and Kosovo and their expert may be coming out here in the next few weeks. I’ll be
deciding in the next few days whether I will stay here or head back to the States. I’ll keep you all posted.
Iraq Update 2:
Although I am sending this update from Kuwait, it was started in the Al-Janoob Hotel in Nasiriya. The hotel is
situated on the northern bank of the Euphrates River and is where most of the non-governmental organizations
(NGOs) are staying. We were there six days and were quite productive in interviewing doctors and other victims of
Saddam’s brutality. Nasiriya which was the site of some of the toughest fighting in the war and the site of an initial
car bomb that killed some American soldiers now seems very quite and secure; even more so than Basra.. Though
we still take security very seriously and don’t travel after dark.
The city has a population of 500,000. A layer of dust seems to coat everything – making everything appear
brown/grey in color. But the main market streets are full of people and quite vibrant. At dusk the city takes on a
bluish grey hue and the site along the Euphrates with the call to prayer in the background is really quite beautiful.
The temperature meanwhile continues to climb, now it is in the low 100’s but people say that by August it will reach
45-50 Celsius. I am unwilling to do the conversion into Fahrenheit, but when the Celsius temperature would be a
comfortable temperature in Fahrenheit I don’t want to be around.
I came up here with Sidney, a woman who does human rights work in Boston and who was part of the initial
Physicians for Human Rights (PHR) team that came to Kuwait before the war. Last Tuesday we got word that we
were to try to find a way to get to Nasiriya and continue looking into the problem of physician complicity with torture
and to follow up on the ear mutilation issue. We scrambled to catch a ride with one of the humanitarian aid
organizations but ended up being allowed to fly into the Airbase in Tallil. On Wednesday we flew courtesy of the
USAF - my first time on a C-130. The nice thing is that there is much more leg room than in economy class.
The old “hurry up and wait” was certainly in evidence as we left the hotel at 6:30 AM, arrived at the airbase by 7:15,
and waited for the plane which did not leave until about 1:30 PM. Conditions were not too bad - under 100 in the
shade, however, it did get fairly dusty waiting by the runway in the desert for a few hours, but the marines also
heading for Tallil were pretty entertaining. We also picked up a few MREs (Meals Ready to Eat). Once we arrive in
Tallil we got a ride into Nasiriya. Some of you may be amused that a bored airman gave us a ride around the base
and when I asked him what he did he stated “I just load and unload the planes.” Once we got to the hotel, we met
up with folks from IMC (International Medical Corp) a non-governmental humanitarian aid organization. We had
dinner with them and they helped us to get a driver for the following day.
Our hotel isn’t too bad. Luckily there is now fairly constant electricity (Saddam would cut the electricity during the
summer to the people in the south) and the A/C in my room works well. We’ve been eating one big meal a day at a
local restaurant that has re-opened, the specialty is rotisserie chicken, flat bread, rice and beans. At night we’ve
been partaking of the MREs. They really aren’t too bad and some even contain M&M or other candy.
Basically our work here has consisted of going to hospitals and clinics and speaking to doctors. There are currently
three functioning hospitals in town. The general hospital, formerly Saddam Hospital where most of the medical
services are provided (and where Jessica Lynch was kept) and the Republic Hospital which was severely damaged
during the war and only has 7 or 8 patients. We also visited the Maternity and Children’s Hospital on Friday. The
issues we have been discussing have mostly been related to what the doctors saw and how they were forced to
work with the old regime.
Aside from the ear issue, which was also prevalent here, we have discovered the fact that doctors were routinely
used to falsify death certificates to indicate that people died of pneumonia or heart attacks instead of torture.
Doctors were also forced to watch when prisoners were brought to the hospital and tortured. One doc told me how
he was forced to watch as a prisoner who had torn up a picture of Saddam had his finger cut off. Afterwards he was
allowed to bandage the wound.
When talking to people they all have stories. Every family was affected. They all relate how their brother or uncle or
sister was tortured or disappeared or killed. It’s really amazing that the entire population lived in a constant state of
fear.
I’ve been trying to highlight the issue of mental health as it does not seem to be on the agenda of any NGO at this
time. This is basically an entire society suffering from some form of mental trauma with limited ability to receive
treatment. We spoke to one of the two remaining and practicing psychiatrists in town. We met him in his private
office, where he does ECT (shock therapy), it’s pretty much their first line of therapy since there is such a limited
supply of medications. He stated, “Not to be paranoid, but I believe it was deliberate on the part of the government
not to have resources for psychiatry.” They really have nothing. There are no acute psych beds in the city. There
are no therapists, psychologists, psych nurses, crisis centers, or even social workers. He was so excited by the time
we had finish our talk that he didn’t want us to leave. I think we may have been among the first if not the only people
ever to have a talk about the psychiatrics problems and future mental health needs of the Iraqi people with him. I
have already made some contacts with the Mental Health community and will assuredly pass his contact information
along to those who might be able to help.
It has also been fascinating to talk with the doctors here who have struggled under adverse conditions for so long.
They were telling us about the defective or ineffective supplies and medicines that had been supplied during the
Saddam times. They told us how all infants were required to be vaccinated with BCG (for tuberculosis) and in
1988/89 they began to see many cases of infants with active TB presumably from the vaccines.
They talk about issues of security, a sense of relief that Saddam is gone, but also frustration with the many
problems remaining. One doctor told me that the people feel like a husband, whose wife dies in labor, he is happy
to have a child, but sad at the death of his wife. He also described the present situation as that Iraq is like an old
man with cancer and metastasis. He has had to undergo a larger operation in order to be cured. Some are more
hopeful than others. It was sad to talk with the Chief Neurosurgeon at the General Hospital about the future, he
admitted being depressed and pessimistic about the future, however, when we began to talk about some of his
patients he became more animated. These truly are extraordinary people. The doctors at the hospital told me they
worked for about fifty days straight during the war. They continued to care for patients even while the Ba’athists and
Fedeyeen had taken over the basement of the hospital and were firing at Coalition aircraft from the hospital grounds.
When we went to the Maternity Hospital on Friday (their holy day) we ended up sitting and talking with about 15 of
the junior residents. We spoke about many issues including the atrocities carried out against physicians in the
past. They were eager to hear about the States and looked forward to learning about the latest medical advances.
We had the opportunity to interview four Iraqis who had their right ear cut during the mutilation program in 1994.
Their stories echoed the ones we had heard in Basra, except that two victims told of having a bulky dressing on their
chest after the operation and when the bandage fell off two days later and they saw that it contained the remnant of
their ear. The two other victims relayed that after their ear was cut they found some gauze in their pocket and when
they took it out, it contained their ear. I plan to see if any of the organizations that work with people with disabilities
have any ideas for helping these men with reintegration into society. For years they were banned from holding jobs
and were discriminated against. The psychiatrist we met said that he had ten of these patients in his practice who
saw on a fairly regular basis. The other issue, though much further down the line is to approach the plastic
surgeons. There are probably anywhere from one to two hundred of these guys around the country. With time it
may be beneficial to set up some program to teach the local surgeons how to do reconstructive surgery for these
guys.
On a different note, for you history buffs, Nasiriya is located near to Ur of the Challides, which for those of you who
don’t remember your Old Testament is the town that Abraham came from. The Ziggurat (stepped pyramid) is
located near the airbase and we saw it briefly on the way out of town.
The plan for the moment is for me the stay in Kuwait City for a few days and then head back to Nasiriya by Friday or
Saturday. We have put together a survey of human rights violations and abuses and the plan is to do a study of all
the doctors in the Nasiriya area. I feel we can probably get about 100+ respondents or roughly 80% or more of the
docs in the city
By conducting the survey we can more accurately describe how vast the problem really was. Saying that there were
a lot of abuses is not a strong as having all the documented abuses for all the doctors in a major city. Hopefully I’ll
be able to get most of it done by the middle of next week.
What may not come as a surprise for many is the fact that while I feel that we are doing a good thing here, my
surgeon side is eager to be able to do something with a more immediate impact. I think there is a real need to
accurately survey and document the human rights violations which occurred, for use in future trials, to help people
understand the past and also try to put in safeguards so that such things will not happen again in the future. But,
some clinical stuff would be nice too.
As it turns out, IMC has an Emergency Medicine doc who works at Cook County in Chicago. He’s been doing
assessments of the hospitals and is planning to set up a training program for people working in the ERs. I agreed to
help out and we are going to put together a series of lectures on issues relating to Trauma. We’ll try to do blunt and
penetrating and start with abdominal and see if we have time for more. I’ve also been invited to scrub on some
cases so I may also try to sneak in to the OR at some point.
Anyway, that’s all for now, I’ll keep you posted.
Iraq Update #3
One quick note, please feel free to forward these updates, however, since I am part of a Physicians for Human
Rights team, everything must be considered to be “off the record.”
Since the last update I’ve done a fair amount of moving around. I initially spent two days in Kuwait City. We took
one day to just relax and catch up on emails and such. Then it was a quick trip to Basra. We hitched a ride with
“Save the Children” an international aid organization. I guess in some respect my maturity level allowed me to
qualify for the ride.
I only spent one night in Basra. During that time I spoke on the phone with one of the surgeons we met on my
previous visit. He was overjoyed to hear my voice. The rest of the time was spent arranging for a trip for a forensic
medicine and mass grave specialist. The guy who is coming out works full time with PHR and has led investigations
in Kosovo, Bosnia , and about 10 other countries. Sasha, a guy from Human Rights Watch (another human rights
group also concerned about mass graves) met Sidney and me in Basra. The plan was for the two of them to
continue looking at mass graves, set up meetings for the following week and then to head north to Baghdad. I went
back to Kuwait, hitching a ride courtesy of the United Nations (WFP-World Food Program to be specific).
It was interesting to note that while I was only in Basra a short time, it seems as if the security conditions have
deteriorated slightly. This was confirmed by others as well. The night before we arrived, the night after UN
sanctions were lifted, we heard that there was a massive amount of gunfire, tracers and automatic weapons. Some
people said it was in celebration, however, in speaking to others it probably started with armed looting and a shoot
out and then developed into a “celebration” of sorts. Turns out the British troops reportedly returned fire as well.
On an even less pleasant note, while talking with another aid worker, he mentioned that his translator told him that
the word on the street is that former Ba’athists on one end and Shiite clerics on the other are beginning to say that
people should target aid workers or those working with them. Now, obviously this is concerning and I did pass it
along to the military guys in the Humanitarian Operations Center and the UN security team, although they had not
heard of these threats before. Needless to say, looting still continues in Basra and there is still a significant heavy
armor presence on the streets.
Nasiriya on the other hand doesn’t have the same feel. In fact, when I got back to my hotel one evening and saw a
column of Humvees my first instinct was to wonder what the trouble was. It turns out that the troops were parked
there in order to partake of the ice cream served at a small shop right next to the hotel. It was good to see that the
troops were getting a little treat besides the MREs.
Back in Kuwait City, I was able to print out a finalized copy of our survey and make copies. I then arranged a ride
again with the UN to Basra and from there hired a taxi to Nasiriya. It was about a 2 hour drive. The highway was
wide and modern, but at times visibility was cut to almost nothing because of blowing sand.
While I was in Basra waiting for my ride I had time to reflect on my situation and had one of those “What the hell am I
doing here?” moments. Here I was, traveling by myself in Iraq, looking to hire a taxi to go up north, to do a survey of
doctors’ participation in torture and abuses. It really didn’t make too much sense, but then again I’ve been in this
type of situation so many times that I’ve actually grown accustom to such thoughts and I’ve discovered that it usually
means I’m on the right track. Usually.
Unfortunately this was one of the times when things did not work out perfectly. On my first full day in Nasiriya I
stopped by the General Hospital. The plan was to meet up with some of the staff and pilot test the surveys to see if
there were any problems. Well, I showed the survey to a young radiologist and an older internist and orthopaedic
surgeon and it was not pretty. While people had previously stated that they would be willing to partake in a survey
of human rights violations, when they actually saw the questions, regarding torture, falsifying death certificates and
complicity with the regime and also questions about their families, they were very upset. So much so that they
began accusing me of wanting intelligence information and hinting that I was with the CIA. It got pretty ugly for a little
while. Luckily the Director of Health came by and he understands the needs and benefits of such a study. He took
a quick look at it and while he said that some questions should be eliminated or changed, he felt that it could and
should be administered in the future. He agreed to look it over and show it to other physicians and we agreed to
meet up again in about a month.
Needless to say, it was pretty disappointing, but given the current situation, part of me was not really surprised.
Since I had already committed to giving a lecture on abdominal trauma to the medical staff I decided to stay in town
for a few more days.
The lecture, “Update on Abdominal Trauma” went very well. More than 50 doctors, both surgeons and internist, and
residents attended. The questions at the end certainly underscored the high level of training that they guys have. I
made sure, however, that I stressed that the information I was providing was the latest from the States and that it
should not be taken as definitive nor was it all appropriate for implementation in Iraq. The truth is, they are probably
more experienced in high velocity weapon injuries and blast and landmine injuries than just about any surgeon in
the states. However, they also don’t really have a reliable CT scanner, ultrasound or any angiography. I apologize
to the non-surgeons, but…They seemed hesitant to try non-operative management of splenic and liver injuries (with
god reason) and were skeptical about primary repairs for colon injuries and in trying damage control surgery. We
had a good discussion after my talk, and I think, with the proper supplies and equipment and some evidence in the
form of journal articles with studies, they may, just may be convinced.
Before my talk I also had a lengthy discussion with some of the surgeons. We spoke about the state of surgery both
in the States and in Iraq and new advances including laparoscopy. Supposedly there is laparoscopic equipment in
the hospital, but no one knows how to use it. I didn’t even both to look at the equipment and stressed that at this
juncture there were many other priorities other than laparoscopic surgery. But we did agree than it would happen
someday.
After the lecture I left for Basra and then hitched a ride with UNICEF back to Kuwait. The ride between Nasiriya and
Basra was pretty uneventful; driving past bombed out tanks and trucks along the highway, passing through a dusty
and bleak desert, listening to Shania Twain on the radio. Ah, the simple joys of travel.
Some of the most lasting impressions that I had in the cities were of the dusty brown color of everything mixed with
the heat. Many of the major streets are wide and there are multiple traffic circles with monuments or statues of
famous Iraqis. In some places the traffic lights are working, but no one pays attention to them. It’s a good indicator
of how the electricity is functioning but clearly demonstrates the lack of any system of law and order. There is a lack
of upkeep in the buildings and sometimes one is unsure whether a building was bombed or just neglected. Debris is
strewn on many of the side streets and in vacant lots. One is constantly amazed by the women, despite the heat,
shrouded from head to toe in black. The shops are small and sell fresh fruit or warm bottles of water or Pepsi.
Slowly more places to eat were opening up, in some ways life was normalizing.
The children are ubiquitous, with almost everyone saying “hello mista” and “what iz your name?” wherever you pass
by. They frequently wave to passing NGO vehicles. In the South along the Kuwaiti border it was reported that young
boys were throwing rocks and had broken some car windows. I never experienced this problem. The people
generally were all very friendly. The doctors I met were great as were the people in the hotels and restaurants,
many asked if I would return. When I said I might, it was almost always responded to with “Enshallah,” god willing. It
was both touching and amusing that people tended to say “hello” when meeting some one and when saying
goodbye. I can still vividly recall the highly accented “hallo, hallo” as I walked away from many meetings.
For those of you that have been in a post-war or humanitarian crisis setting, one major difference is the lack of white
four wheel drive vehicles. As white vehicles were used by many Saddam supporters to attack Coalition Forces, the
UN adopted royal blue with orange lettering as their color scheme. Many of the NGOs have been using dark colored
vehicles, but ICRC, MSF and MDM still use white.
Another interesting thing of note that was discussed at a military briefing in Nasiriya was the payment scheme for
civil servants, including teachers, doctors and managers. The plan was to give them all at once, their April, May and
June salaries in Iraqi Dinars (starting at 100,000 ID per person – 1,000 ID = 1 US $) and a one time US$ 50 bonus.
Now maybe I’m wrong, but I thought I learned in my high school economics class that when too many dollars or in
this case dinars are chasing too few goods, the result is inflation. Now I know people haven’t been getting paid,
but…I’m just not so sure of the results of this plan. Hopefully things will work out.
Another problem related to the currency is that the only notes in circulation are the 250 dinar. Luckily most meals
(my main expense in local currency) have been in the US$3-5 range, but imagine having only paper bills worth 25
cents. I cashed a US$20 for a stack of 80, 250 dinar notes.
Anyway, I’m now back in Kuwait City and am beginning to make plans to head to the States. The tentative itinerary
will be to leave on June 3rd, spend a few days in Germany and then be back in NYC by the middle of June. After
that, well…
Regards to all,
For those of you that didn't see this, here is the op-ed from Sunday's Washington Post.
Doctors With 'Dirty Hands'
By Maryam Elahi and Adam Kushner
Sunday, June 8, 2003; Page B07
For most people, it's unimaginable to think of physicians assuming the role of torturers and executioners. Yet under
Saddam Hussein this is what took place. Whether the complicity was forced or voluntary, physicians participated for
years in the state's apparatus of cruelty and terror. As researchers for Physicians for Human Rights in Iraq, we
spoke to many doctors who reported on complicity in these heinous acts. The state wanted them to have "dirty
hands," said one senior surgeon, who told us that they acted on a government mandate ordering all surgeons to
participate in cutting off the ears and branding the foreheads of army deserters. In one hospital, all surgeons --
general, orthopedic, plastic, cardiac and neurosurgeons -- were reportedly required to perform the mutilation.
This was an extreme example of dual loyalty, whereby doctors were called on to subordinate their core ethical
responsibility to the interests of the state. According to a 1994 decree, surgeons who refused to engage in state-
sponsored torture would have their own ears cut and be branded, and if they sought plastic surgery, the plastic
surgeon would be executed. In one hospital we visited, virtually all senior surgeons complied. We spoke to one
surgeon who had hidden in a closet for an entire day to avoid the act. He knew of many others who had been
haunted by the practice and suffered greatly. Many, deeply traumatized, quit their medical practices.
We also spoke to those who had been tortured and mutilated. One young man told us that in an operating room, the
anesthesiologist said to him, "You shouldn't have left the army. If I could let you leave the hospital now, I would, but it
is surrounded so you cannot run away. I am sorry about this." When he came to, he was cuffed to the bed with his
arms spread wide apart. Someone told him his ear was gone. That night when he took the gauze off his head and
looked in the mirror, he said, he felt "very sad, angry and destroyed." Then he found a piece of gauze in his pocket.
When he took it out and unwrapped it, he found his ear.
Throughout Iraq, in all professional settings, there were informants. In some cases doctors reported on medical
professionals and students in their midst and accused them of disloyalty to the regime. We were given a copy of a
letter written in 1999 by a physician who reported three medical students to the authorities. He stated that the
students had notified him that they intended to kill a member of the Baath Party. The three students were
subsequently arrested and executed.
Physicians revealed to us that the Baath Party practice of creating terror and intimidation extended to hospitals,
where physicians and hospital staff suspected of "disloyalty" to the regime were publicly executed at the workplace.
Staff were then ordered not to bury the corpses for three days -- to let them serve as a warning to others.
We are only beginning to put together pieces of a gruesome picture that may take years to fully reveal. The stories
of torture and arbitrary killings -- most recently graphically verified through the discovery of the mass graves of
thousands -- are evidence of the extent to which the state inflicted horrific injury on its own people.
The extent to which Iraqi surgeons participated in mutilation in Iraq appears to be unprecedented, but this is hardly
the first instance of complicity, forced or voluntary, by physicians in human rights violations. In South Africa,
hearings held by the Truth and Reconciliation Commission showed how deeply the profession's leadership was
implicated in the perversion of medical values under apartheid. The response of some institutions in South Africa,
however, demonstrates one route forward -- a thorough review and accounting of the role of members of the
profession in human rights violations and a commitment to human rights through new institutional structures and
policies. Now the Iraqis must decide on an accountability mechanism that fosters reconciliation and stability, and the
United States and its allies in Iraq should create a safe environment for this process to begin.
Maryam Elahi, a lawyer, and Adam Kushner, a physician, are research consultants for Physicians for Human Rights.
© 2003 The Washington Post Company
Greetings from Kuwait!
It’s nice to be back in a “civilized” country. I actually wrote most of this in a Starbucks not too far from our hotel;
hanging out in a comfy chair with air conditioning (temp’s going over 100 today) and enjoying an ice coffee. So I
guess some of you may be a little confused as to what I’m doing here. The story is I am part of an assessment
team for an organization called Physicians for Human Rights (PHR). It’s the group that I went to Kosovo and
Azerbaijan with back in 1999. At that time I was testing surveys documenting the effects of landmines and also
began looking into the issue of cluster bombs. Now I am part of a human rights assessment team.
The press release that I initially forwarded requesting Coalition Forces to release maps with known cluster bomb
drop sites (Appendix II) was based on my experiences in Kosovo. In 1999 maps indicating known drop sites of
munitions and minefields were released to aid workers. While these types of maps are by no mean definitive, they
are better than nothing, and do give some insight into the areas which were hardest hit and thus most potentially
dangerous. So, the first thing I did when I arrived in Kuwait was to ask for maps with the drop locations marked on
them and I was referred to a single map of the entire country. Now, it’s was a nice map, but practically speaking
useless. It reminded me of a map I had once seen of Laos with the bomb sites marked with black dots, the actual
map just had a solid black band over 2/3rds of the country. Anyway, it seemed as if the Coalition Forces were
having a bit of an internal dispute and some people didn’t want to release the information. The good news is that
the info is now on the website for the Humanitarian Operations Center (HOC) based in Kuwait, although hard copies
are not available, the data can be downloaded or printed off a computer. If any one is interested the site is, and it’s
no joke, www.agoodplacetostart.org really, that the site. The maps are in the map section under mine action.
But anyway, what am I doing here? Well, as a member of the PHR advisory board, a few months ago I contacted the
headquarters office and asked if they were planning to send a team into Iraq, the reply was affirmative; and so of
course I offered my services. I was to be part of a second assessment team and we arrived in Kuwait City on April
29, 2003. The initial team composed of two women, Lynn and Sidney had arrived in Kuwait in early March. The
second team consisted of me, a statistician, and a woman who heads the Human Rights program at Trinity College
in Connecticut: Maryam Elahi. After a couple of days in Kuwait to get oriented; Maryam and I headed north to Basra
with Save the Children - a non-governmental organization (NGO) that provides humanitarian relief. Our plan was to
evaluate the situation, look into the issue of clerics who were limiting women from entering health centers and
hospitals (a reported problem in Baghdad – but did not appear to be a problem in Basra, yet), mass graves, and
physician complicity and association with torture.
The ride to Basra was pretty uneventful, we were able to stay in a hotel that another organization had recommended
and hired a car and driver. The hotel actually had electricity, air conditioning, telephone service, hot water, TV and
a decent restaurant.
We started out at a UN meeting, they had arrived the same day we did. We then proceeded to visit the British
military unit that provided information for the non-governmental organizations (NGOs), the CMOC, civilian military
operations center. After that we went to the Basra Teaching Hospital. We met up with one of the Chief surgical
residents who chatted with us for a while and began telling us about some of the atrocities that had occurred during
the Saddam era. He invited us to come back the next day and he introduced us to a neurosurgery resident and an
attending surgeon who both relayed stories about torture and abuses.
We met with this attending surgeon again over the next few days and he told us about a government program that
had targeted many of the surgeons in the country. As a way of punishing deserters from the Iraqi army, part of the
deserter’s right ear was cut off. The program for doing this was nationwide and almost all attending surgeons –
general, cardiac, neurosurgical, orthopedic, ENT and plastics – were included. This doctor spoke about this period
as he was a surgical resident at the time and was able to avoid participating by running from the hospital and even
spent one 24 hour period hidden in a closet. He stated that roughly 100 patients were mutilated in this way in his
hospital and similarly throughout the other hospitals in Iraq. It was targeted mainly at the Shiite minority living in the
south. If a surgeon refused to perform the procedure, his ear would be cut and his forehead branded. Many
surgeons were forced to follow the orders, although some fled the country.
This doctor told us about other abuses by and to physicians and on our last day in Basra he introduced us to three
of the victims of the mutilation who had their ear cut. We drove with him and also met one of the three psychiatrists
in Basra (a city of 1.5 million people) he said they only have 16 psych beds Basra and there are only 19
psychiatrists in all of Iraq. (Some of you may be surprised, but I truly believe that psychiatrists and therapists are
needed in Iraq much more than surgeons.) We then drove to look at a statue where the base was covered with lists
of names of people who were executed and then to the site of an alleged mass grave.
In addition to the interviews at the Teaching Hospitals we visited the Basra General Hospital, the International
Committee of the Red Cross, The Red Crescent Society of Iraq. We spoke to the Minister of Health for Basra and
the head of Primary Health Care centers for the Basra province. We also met with people from UNICEF, WHO and
other UN organizations. While we were there news was announced about confirmed cases of cholera. Now, cholera
is usually present every summer in Iraq, but given the problems with lack of clean water and the other problems, it is
felt that there will be a worse out break in the coming months.
As for the city itself, we felt pretty safe. We followed the recommendations of the UN and we stayed at the hotel after
dark and did not travel around. We did not see any unexploded ordinance or weapons ourselves, but other NGO
people did. As for the conditions in the hospitals, I didn’t get a chance to visit the ORs or the wards, though it
sounded at least at the Teaching hospital that they were able to perform emergent surgery and we saw plenty of
people (patients) there during the day. We didn’t see any specific civilians who were injured either during the war or
after from landmines etc, but we weren’t specifically looking for them.
The chief resident told use about one case of a 14 year old boy who, though the story was a bit uncertain, may have
been shot by a British soldier. Supposedly he was shot in the abdomen. We were told that he had a small bowel
and aortic injury, but were able to operate on him successfully. When I asked then next day if we could visit him, I
was later informed that he had died the next day. The British Royal Military Police are currently investigating the
case. One main problem that most people spoke about was the general lack of security, especially at night. There
really isn’t a police for or even a government up and running yet, but it appears to be a major issue on the agenda.
One highlight of the visit was when we went to Saddam’s Palace to talk to the Major in charge of Civilian-Military
operations, a member of the British 7th Armor Brigade (the desert rats). He was busy when we showed up, but he
invited us to have lunch while we waited to speak to him. Surprisingly at one point we were joined by the Brigade
Commander (a one star general) with whom we had an interesting discussion. The Palace grounds were pretty
remarkable; about 10 huge mansions on the grounds of a man-made lake. The insides were all decked out with
marble and quite ornate. We avoided taking pictures as there were multiple signs saying that “military tourism” was
prohibited.
Anyway, that’s all for the moment. As for my plans, I’m not certain what will happen next. Things are still a bit dicey
in Baghdad, though we had a team up there for a few days and they went to Najaf and Karbala . They too heard
about the ear mutilation issue and found many mass graves. PHR has been involved in identifying mass graves in
many countries including Bosnia and Kosovo and their expert may be coming out here in the next few weeks. I’ll be
deciding in the next few days whether I will stay here or head back to the States. I’ll keep you all posted.
Iraq Update 2:
Although I am sending this update from Kuwait, it was started in the Al-Janoob Hotel in Nasiriya. The hotel is
situated on the northern bank of the Euphrates River and is where most of the non-governmental organizations
(NGOs) are staying. We were there six days and were quite productive in interviewing doctors and other victims of
Saddam’s brutality. Nasiriya which was the site of some of the toughest fighting in the war and the site of an initial
car bomb that killed some American soldiers now seems very quite and secure; even more so than Basra.. Though
we still take security very seriously and don’t travel after dark.
The city has a population of 500,000. A layer of dust seems to coat everything – making everything appear
brown/grey in color. But the main market streets are full of people and quite vibrant. At dusk the city takes on a
bluish grey hue and the site along the Euphrates with the call to prayer in the background is really quite beautiful.
The temperature meanwhile continues to climb, now it is in the low 100’s but people say that by August it will reach
45-50 Celsius. I am unwilling to do the conversion into Fahrenheit, but when the Celsius temperature would be a
comfortable temperature in Fahrenheit I don’t want to be around.
I came up here with Sidney, a woman who does human rights work in Boston and who was part of the initial
Physicians for Human Rights (PHR) team that came to Kuwait before the war. Last Tuesday we got word that we
were to try to find a way to get to Nasiriya and continue looking into the problem of physician complicity with torture
and to follow up on the ear mutilation issue. We scrambled to catch a ride with one of the humanitarian aid
organizations but ended up being allowed to fly into the Airbase in Tallil. On Wednesday we flew courtesy of the
USAF - my first time on a C-130. The nice thing is that there is much more leg room than in economy class.
The old “hurry up and wait” was certainly in evidence as we left the hotel at 6:30 AM, arrived at the airbase by 7:15,
and waited for the plane which did not leave until about 1:30 PM. Conditions were not too bad - under 100 in the
shade, however, it did get fairly dusty waiting by the runway in the desert for a few hours, but the marines also
heading for Tallil were pretty entertaining. We also picked up a few MREs (Meals Ready to Eat). Once we arrive in
Tallil we got a ride into Nasiriya. Some of you may be amused that a bored airman gave us a ride around the base
and when I asked him what he did he stated “I just load and unload the planes.” Once we got to the hotel, we met
up with folks from IMC (International Medical Corp) a non-governmental humanitarian aid organization. We had
dinner with them and they helped us to get a driver for the following day.
Our hotel isn’t too bad. Luckily there is now fairly constant electricity (Saddam would cut the electricity during the
summer to the people in the south) and the A/C in my room works well. We’ve been eating one big meal a day at a
local restaurant that has re-opened, the specialty is rotisserie chicken, flat bread, rice and beans. At night we’ve
been partaking of the MREs. They really aren’t too bad and some even contain M&M or other candy.
Basically our work here has consisted of going to hospitals and clinics and speaking to doctors. There are currently
three functioning hospitals in town. The general hospital, formerly Saddam Hospital where most of the medical
services are provided (and where Jessica Lynch was kept) and the Republic Hospital which was severely damaged
during the war and only has 7 or 8 patients. We also visited the Maternity and Children’s Hospital on Friday. The
issues we have been discussing have mostly been related to what the doctors saw and how they were forced to
work with the old regime.
Aside from the ear issue, which was also prevalent here, we have discovered the fact that doctors were routinely
used to falsify death certificates to indicate that people died of pneumonia or heart attacks instead of torture.
Doctors were also forced to watch when prisoners were brought to the hospital and tortured. One doc told me how
he was forced to watch as a prisoner who had torn up a picture of Saddam had his finger cut off. Afterwards he was
allowed to bandage the wound.
When talking to people they all have stories. Every family was affected. They all relate how their brother or uncle or
sister was tortured or disappeared or killed. It’s really amazing that the entire population lived in a constant state of
fear.
I’ve been trying to highlight the issue of mental health as it does not seem to be on the agenda of any NGO at this
time. This is basically an entire society suffering from some form of mental trauma with limited ability to receive
treatment. We spoke to one of the two remaining and practicing psychiatrists in town. We met him in his private
office, where he does ECT (shock therapy), it’s pretty much their first line of therapy since there is such a limited
supply of medications. He stated, “Not to be paranoid, but I believe it was deliberate on the part of the government
not to have resources for psychiatry.” They really have nothing. There are no acute psych beds in the city. There
are no therapists, psychologists, psych nurses, crisis centers, or even social workers. He was so excited by the time
we had finish our talk that he didn’t want us to leave. I think we may have been among the first if not the only people
ever to have a talk about the psychiatrics problems and future mental health needs of the Iraqi people with him. I
have already made some contacts with the Mental Health community and will assuredly pass his contact information
along to those who might be able to help.
It has also been fascinating to talk with the doctors here who have struggled under adverse conditions for so long.
They were telling us about the defective or ineffective supplies and medicines that had been supplied during the
Saddam times. They told us how all infants were required to be vaccinated with BCG (for tuberculosis) and in
1988/89 they began to see many cases of infants with active TB presumably from the vaccines.
They talk about issues of security, a sense of relief that Saddam is gone, but also frustration with the many
problems remaining. One doctor told me that the people feel like a husband, whose wife dies in labor, he is happy
to have a child, but sad at the death of his wife. He also described the present situation as that Iraq is like an old
man with cancer and metastasis. He has had to undergo a larger operation in order to be cured. Some are more
hopeful than others. It was sad to talk with the Chief Neurosurgeon at the General Hospital about the future, he
admitted being depressed and pessimistic about the future, however, when we began to talk about some of his
patients he became more animated. These truly are extraordinary people. The doctors at the hospital told me they
worked for about fifty days straight during the war. They continued to care for patients even while the Ba’athists and
Fedeyeen had taken over the basement of the hospital and were firing at Coalition aircraft from the hospital grounds.
When we went to the Maternity Hospital on Friday (their holy day) we ended up sitting and talking with about 15 of
the junior residents. We spoke about many issues including the atrocities carried out against physicians in the
past. They were eager to hear about the States and looked forward to learning about the latest medical advances.
We had the opportunity to interview four Iraqis who had their right ear cut during the mutilation program in 1994.
Their stories echoed the ones we had heard in Basra, except that two victims told of having a bulky dressing on their
chest after the operation and when the bandage fell off two days later and they saw that it contained the remnant of
their ear. The two other victims relayed that after their ear was cut they found some gauze in their pocket and when
they took it out, it contained their ear. I plan to see if any of the organizations that work with people with disabilities
have any ideas for helping these men with reintegration into society. For years they were banned from holding jobs
and were discriminated against. The psychiatrist we met said that he had ten of these patients in his practice who
saw on a fairly regular basis. The other issue, though much further down the line is to approach the plastic
surgeons. There are probably anywhere from one to two hundred of these guys around the country. With time it
may be beneficial to set up some program to teach the local surgeons how to do reconstructive surgery for these
guys.
On a different note, for you history buffs, Nasiriya is located near to Ur of the Challides, which for those of you who
don’t remember your Old Testament is the town that Abraham came from. The Ziggurat (stepped pyramid) is
located near the airbase and we saw it briefly on the way out of town.
The plan for the moment is for me the stay in Kuwait City for a few days and then head back to Nasiriya by Friday or
Saturday. We have put together a survey of human rights violations and abuses and the plan is to do a study of all
the doctors in the Nasiriya area. I feel we can probably get about 100+ respondents or roughly 80% or more of the
docs in the city
By conducting the survey we can more accurately describe how vast the problem really was. Saying that there were
a lot of abuses is not a strong as having all the documented abuses for all the doctors in a major city. Hopefully I’ll
be able to get most of it done by the middle of next week.
What may not come as a surprise for many is the fact that while I feel that we are doing a good thing here, my
surgeon side is eager to be able to do something with a more immediate impact. I think there is a real need to
accurately survey and document the human rights violations which occurred, for use in future trials, to help people
understand the past and also try to put in safeguards so that such things will not happen again in the future. But,
some clinical stuff would be nice too.
As it turns out, IMC has an Emergency Medicine doc who works at Cook County in Chicago. He’s been doing
assessments of the hospitals and is planning to set up a training program for people working in the ERs. I agreed to
help out and we are going to put together a series of lectures on issues relating to Trauma. We’ll try to do blunt and
penetrating and start with abdominal and see if we have time for more. I’ve also been invited to scrub on some
cases so I may also try to sneak in to the OR at some point.
Anyway, that’s all for now, I’ll keep you posted.
Iraq Update #3
One quick note, please feel free to forward these updates, however, since I am part of a Physicians for Human
Rights team, everything must be considered to be “off the record.”
Since the last update I’ve done a fair amount of moving around. I initially spent two days in Kuwait City. We took
one day to just relax and catch up on emails and such. Then it was a quick trip to Basra. We hitched a ride with
“Save the Children” an international aid organization. I guess in some respect my maturity level allowed me to
qualify for the ride.
I only spent one night in Basra. During that time I spoke on the phone with one of the surgeons we met on my
previous visit. He was overjoyed to hear my voice. The rest of the time was spent arranging for a trip for a forensic
medicine and mass grave specialist. The guy who is coming out works full time with PHR and has led investigations
in Kosovo, Bosnia , and about 10 other countries. Sasha, a guy from Human Rights Watch (another human rights
group also concerned about mass graves) met Sidney and me in Basra. The plan was for the two of them to
continue looking at mass graves, set up meetings for the following week and then to head north to Baghdad. I went
back to Kuwait, hitching a ride courtesy of the United Nations (WFP-World Food Program to be specific).
It was interesting to note that while I was only in Basra a short time, it seems as if the security conditions have
deteriorated slightly. This was confirmed by others as well. The night before we arrived, the night after UN
sanctions were lifted, we heard that there was a massive amount of gunfire, tracers and automatic weapons. Some
people said it was in celebration, however, in speaking to others it probably started with armed looting and a shoot
out and then developed into a “celebration” of sorts. Turns out the British troops reportedly returned fire as well.
On an even less pleasant note, while talking with another aid worker, he mentioned that his translator told him that
the word on the street is that former Ba’athists on one end and Shiite clerics on the other are beginning to say that
people should target aid workers or those working with them. Now, obviously this is concerning and I did pass it
along to the military guys in the Humanitarian Operations Center and the UN security team, although they had not
heard of these threats before. Needless to say, looting still continues in Basra and there is still a significant heavy
armor presence on the streets.
Nasiriya on the other hand doesn’t have the same feel. In fact, when I got back to my hotel one evening and saw a
column of Humvees my first instinct was to wonder what the trouble was. It turns out that the troops were parked
there in order to partake of the ice cream served at a small shop right next to the hotel. It was good to see that the
troops were getting a little treat besides the MREs.
Back in Kuwait City, I was able to print out a finalized copy of our survey and make copies. I then arranged a ride
again with the UN to Basra and from there hired a taxi to Nasiriya. It was about a 2 hour drive. The highway was
wide and modern, but at times visibility was cut to almost nothing because of blowing sand.
While I was in Basra waiting for my ride I had time to reflect on my situation and had one of those “What the hell am I
doing here?” moments. Here I was, traveling by myself in Iraq, looking to hire a taxi to go up north, to do a survey of
doctors’ participation in torture and abuses. It really didn’t make too much sense, but then again I’ve been in this
type of situation so many times that I’ve actually grown accustom to such thoughts and I’ve discovered that it usually
means I’m on the right track. Usually.
Unfortunately this was one of the times when things did not work out perfectly. On my first full day in Nasiriya I
stopped by the General Hospital. The plan was to meet up with some of the staff and pilot test the surveys to see if
there were any problems. Well, I showed the survey to a young radiologist and an older internist and orthopaedic
surgeon and it was not pretty. While people had previously stated that they would be willing to partake in a survey
of human rights violations, when they actually saw the questions, regarding torture, falsifying death certificates and
complicity with the regime and also questions about their families, they were very upset. So much so that they
began accusing me of wanting intelligence information and hinting that I was with the CIA. It got pretty ugly for a little
while. Luckily the Director of Health came by and he understands the needs and benefits of such a study. He took
a quick look at it and while he said that some questions should be eliminated or changed, he felt that it could and
should be administered in the future. He agreed to look it over and show it to other physicians and we agreed to
meet up again in about a month.
Needless to say, it was pretty disappointing, but given the current situation, part of me was not really surprised.
Since I had already committed to giving a lecture on abdominal trauma to the medical staff I decided to stay in town
for a few more days.
The lecture, “Update on Abdominal Trauma” went very well. More than 50 doctors, both surgeons and internist, and
residents attended. The questions at the end certainly underscored the high level of training that they guys have. I
made sure, however, that I stressed that the information I was providing was the latest from the States and that it
should not be taken as definitive nor was it all appropriate for implementation in Iraq. The truth is, they are probably
more experienced in high velocity weapon injuries and blast and landmine injuries than just about any surgeon in
the states. However, they also don’t really have a reliable CT scanner, ultrasound or any angiography. I apologize
to the non-surgeons, but…They seemed hesitant to try non-operative management of splenic and liver injuries (with
god reason) and were skeptical about primary repairs for colon injuries and in trying damage control surgery. We
had a good discussion after my talk, and I think, with the proper supplies and equipment and some evidence in the
form of journal articles with studies, they may, just may be convinced.
Before my talk I also had a lengthy discussion with some of the surgeons. We spoke about the state of surgery both
in the States and in Iraq and new advances including laparoscopy. Supposedly there is laparoscopic equipment in
the hospital, but no one knows how to use it. I didn’t even both to look at the equipment and stressed that at this
juncture there were many other priorities other than laparoscopic surgery. But we did agree than it would happen
someday.
After the lecture I left for Basra and then hitched a ride with UNICEF back to Kuwait. The ride between Nasiriya and
Basra was pretty uneventful; driving past bombed out tanks and trucks along the highway, passing through a dusty
and bleak desert, listening to Shania Twain on the radio. Ah, the simple joys of travel.
Some of the most lasting impressions that I had in the cities were of the dusty brown color of everything mixed with
the heat. Many of the major streets are wide and there are multiple traffic circles with monuments or statues of
famous Iraqis. In some places the traffic lights are working, but no one pays attention to them. It’s a good indicator
of how the electricity is functioning but clearly demonstrates the lack of any system of law and order. There is a lack
of upkeep in the buildings and sometimes one is unsure whether a building was bombed or just neglected. Debris is
strewn on many of the side streets and in vacant lots. One is constantly amazed by the women, despite the heat,
shrouded from head to toe in black. The shops are small and sell fresh fruit or warm bottles of water or Pepsi.
Slowly more places to eat were opening up, in some ways life was normalizing.
The children are ubiquitous, with almost everyone saying “hello mista” and “what iz your name?” wherever you pass
by. They frequently wave to passing NGO vehicles. In the South along the Kuwaiti border it was reported that young
boys were throwing rocks and had broken some car windows. I never experienced this problem. The people
generally were all very friendly. The doctors I met were great as were the people in the hotels and restaurants,
many asked if I would return. When I said I might, it was almost always responded to with “Enshallah,” god willing. It
was both touching and amusing that people tended to say “hello” when meeting some one and when saying
goodbye. I can still vividly recall the highly accented “hallo, hallo” as I walked away from many meetings.
For those of you that have been in a post-war or humanitarian crisis setting, one major difference is the lack of white
four wheel drive vehicles. As white vehicles were used by many Saddam supporters to attack Coalition Forces, the
UN adopted royal blue with orange lettering as their color scheme. Many of the NGOs have been using dark colored
vehicles, but ICRC, MSF and MDM still use white.
Another interesting thing of note that was discussed at a military briefing in Nasiriya was the payment scheme for
civil servants, including teachers, doctors and managers. The plan was to give them all at once, their April, May and
June salaries in Iraqi Dinars (starting at 100,000 ID per person – 1,000 ID = 1 US $) and a one time US$ 50 bonus.
Now maybe I’m wrong, but I thought I learned in my high school economics class that when too many dollars or in
this case dinars are chasing too few goods, the result is inflation. Now I know people haven’t been getting paid,
but…I’m just not so sure of the results of this plan. Hopefully things will work out.
Another problem related to the currency is that the only notes in circulation are the 250 dinar. Luckily most meals
(my main expense in local currency) have been in the US$3-5 range, but imagine having only paper bills worth 25
cents. I cashed a US$20 for a stack of 80, 250 dinar notes.
Anyway, I’m now back in Kuwait City and am beginning to make plans to head to the States. The tentative itinerary
will be to leave on June 3rd, spend a few days in Germany and then be back in NYC by the middle of June. After
that, well…
Regards to all,
For those of you that didn't see this, here is the op-ed from Sunday's Washington Post.
Doctors With 'Dirty Hands'
By Maryam Elahi and Adam Kushner
Sunday, June 8, 2003; Page B07
For most people, it's unimaginable to think of physicians assuming the role of torturers and executioners. Yet under
Saddam Hussein this is what took place. Whether the complicity was forced or voluntary, physicians participated for
years in the state's apparatus of cruelty and terror. As researchers for Physicians for Human Rights in Iraq, we
spoke to many doctors who reported on complicity in these heinous acts. The state wanted them to have "dirty
hands," said one senior surgeon, who told us that they acted on a government mandate ordering all surgeons to
participate in cutting off the ears and branding the foreheads of army deserters. In one hospital, all surgeons --
general, orthopedic, plastic, cardiac and neurosurgeons -- were reportedly required to perform the mutilation.
This was an extreme example of dual loyalty, whereby doctors were called on to subordinate their core ethical
responsibility to the interests of the state. According to a 1994 decree, surgeons who refused to engage in state-
sponsored torture would have their own ears cut and be branded, and if they sought plastic surgery, the plastic
surgeon would be executed. In one hospital we visited, virtually all senior surgeons complied. We spoke to one
surgeon who had hidden in a closet for an entire day to avoid the act. He knew of many others who had been
haunted by the practice and suffered greatly. Many, deeply traumatized, quit their medical practices.
We also spoke to those who had been tortured and mutilated. One young man told us that in an operating room, the
anesthesiologist said to him, "You shouldn't have left the army. If I could let you leave the hospital now, I would, but it
is surrounded so you cannot run away. I am sorry about this." When he came to, he was cuffed to the bed with his
arms spread wide apart. Someone told him his ear was gone. That night when he took the gauze off his head and
looked in the mirror, he said, he felt "very sad, angry and destroyed." Then he found a piece of gauze in his pocket.
When he took it out and unwrapped it, he found his ear.
Throughout Iraq, in all professional settings, there were informants. In some cases doctors reported on medical
professionals and students in their midst and accused them of disloyalty to the regime. We were given a copy of a
letter written in 1999 by a physician who reported three medical students to the authorities. He stated that the
students had notified him that they intended to kill a member of the Baath Party. The three students were
subsequently arrested and executed.
Physicians revealed to us that the Baath Party practice of creating terror and intimidation extended to hospitals,
where physicians and hospital staff suspected of "disloyalty" to the regime were publicly executed at the workplace.
Staff were then ordered not to bury the corpses for three days -- to let them serve as a warning to others.
We are only beginning to put together pieces of a gruesome picture that may take years to fully reveal. The stories
of torture and arbitrary killings -- most recently graphically verified through the discovery of the mass graves of
thousands -- are evidence of the extent to which the state inflicted horrific injury on its own people.
The extent to which Iraqi surgeons participated in mutilation in Iraq appears to be unprecedented, but this is hardly
the first instance of complicity, forced or voluntary, by physicians in human rights violations. In South Africa,
hearings held by the Truth and Reconciliation Commission showed how deeply the profession's leadership was
implicated in the perversion of medical values under apartheid. The response of some institutions in South Africa,
however, demonstrates one route forward -- a thorough review and accounting of the role of members of the
profession in human rights violations and a commitment to human rights through new institutional structures and
policies. Now the Iraqis must decide on an accountability mechanism that fosters reconciliation and stability, and the
United States and its allies in Iraq should create a safe environment for this process to begin.
Maryam Elahi, a lawyer, and Adam Kushner, a physician, are research consultants for Physicians for Human Rights.
© 2003 The Washington Post Company
Iraq
Human Rights Assessment Mission
Physicians for Human Rights
April - June 2003
Human Rights Assessment Mission
Physicians for Human Rights
April - June 2003
| Doctors With 'Dirty Hands' June 8, 2003 |
