Wednesday, June 15, 2005

The war in Iraq and public health: further discussion

In response to my latest post about the war in Iraq, two readers, Narmer and Rant Wraith take me to task. This blog is, among other things, a forum for discussion and critical thinking. Both of these criticisms are thoughtful and challenging and require some response from me in kind. I won't be able to solve the puzzles they present in one shot, but maybe together I, they and others out there can make some progress.

Let me begin with this from Rant Wraith:
"I enjoy your site and find it informative when the posts are about public health issues. But when you stray into lame criticisms of the war in Iraq or the War or Terror you lose your focus and dilute your core mission. Stick with health issues and leave the weak bitching to [Jon] Stewart."
This is a reasonable comment and likely mirrors the thinking of others. I have thought about this issue a great deal already and wondered whether, as a merely pragmatic matter, I should forego comment on the war (or middle east issues, another sensitive topic) in the interests of not alienating a core audience primarily interested in public health. I decided not to do this, because speaking out against this war and the use of coercive force as a policy of advancing national and commercial interests goes to the heart of what I am about. My outbursts on these issues are not calculated, they are in a sense involuntary. My allegiance to the anti-war movement has been a constant of my entire adult life. I cannot change it. It is also connected in a strong, although difficult to define way, to my "purely" professional activities in public health. They both spring from the same source. I would be hard put to name it so I won't even try (it is not what I would call religious or spiritual, but everyone can interpret it as they please).

But saying this doesn't excuse me from making reasoned arguments in support of my positions, so Narmer's comments are much to the point. Let me see what I can do in reply. Narmer first takes me to task for my statement that "history and experience teach us that violence always begets more violence. There are no exceptions."
Well, Revere, here we disagree. I don't think there was any other way to stop Hitler other than a brutal and awful war. Same with Milosevic. Same with Pol-Pot. Similar reasoning goes for some violent criminals. Without violent force to keep them locked up, they'd be rampaging through our communities unchecked.

So, sometimes violence CAN end violence, and sometimes it only makes things worse. History is full of exceptions to most rules, including the one you just cited.
I thought hard about how to reply to this. Should I point out that Milosevic was taken down by non-violent action? That Hitler was defeated by nations acting in self-defense? That Pol-Pot could only come to power as the result of the US attack on Cambodia? I could (and just did), but freely admit these aren't very persuasive counter-arguments unless you are already disposed to my view of things. Instead, without conceding the point, let me not to enter into a fruitless argument about the particular examples and ask about the general question, which also seems to be the point of Narmer's remark and subsequent comments that "stopping rape, genocide and slavery unfortunately often requires, force, violence and killing." What do you do when great wrongs are committed against a people by its own nation?

Let me stop a moment here to connect this up to a public health problem much discussed on this site, bird flu. This may seem like a strange juxtaposition, but I'll try to make it anyway as there is a natural connection in my mind. One can draw a parallel between irresponsible actions of states who do not act to protect their own people, who lie to the international community about what is happening within their borders even when it endangers others, and who place commercial and economic concerns ahead of humanitarian ones and states that criminally abuse their own peoples. Commenters on this and other sites are often quick to demand that WHO move to inspect or require responsible public health actions on the part of UN member states, forgetting that WHO has no power, authority or ability to do so. National sovereignty still trumps international public health and has done so since the acceptance of this principle in the mid seventeenth century at the Peace of Westphalia. But it doesn't seem at all strange or utopian to these same commenters to demand that in a tightly interdependent world this old and outmoded principle of sovereignty be dispensed with and replaced by a structure of cooperation, not confrontation. Exactly how this would work is not said, but few of us think it couldn't be done, and WHO has taken some halting steps in this direction at the recently concluded World Health Assembly.

Jonathan Schell has suggested (in his book Unconquerable World) that a similar principle be applied to the questions that bedevil Narmer (and me). Any state that commits crimes against one of its constituent peoples has lost its claim to sovereignty. My own view (expressed above and to which Narmer strenuously dissented) is that this cannot be enforced by coercive violence. But then how? Suitable international structures and procedures would have to be defined and elaborated, but the basic idea is that such states have violated an international social contract and abrogated their right to participate in the comity of nations. Their leaders would be subject to detention, prosecution and fair trial in the International Criminal Court once they travel outside their own borders, international treaty, trade and commercial agreements would default to humanitarian minima and in general they would be treated as pariah states until responsible and ethical leadership had been restored.

Yes, it is true, as Narmer says that
". . . in almost EVERY CASE (Iraq, Rawanda, Zimbabwe, Sudan,Bosnia....) [e]very nation's petty interests (oil-rights here, strategic ties there, arms contracts everywhere) get in the way."
But this is not just an argument against my position, it is an even more forceful argument against violent intervention. It is a widely held belief that the US war on Iraq was not based on humanitarian concerns or moral outrage (where were these concerns prior to 1991 when Iraq was our friend?), but on just the issues ("oil-rights here, strategic ties there, arms contracts everywhere") Narmer correctly identifies but which are now being served by violent means. In such a circumstance the outcome is distressingly predictable, although many people had a hard time predicting it. Moreover the equally predictable violent resistance has indeed come close to bankrupting us and made it impossible (not that it ever was likely) to take any action in Darfur or Ivory Coast or even off our own shores in Haiti.

Maybe, as Rant Wraith suggests, it would be better in the long run to keep silent about these issues here. It just isn't possible for me. I hope those of you who strongly disagree will take a deep breath and wait for the kind of posts that interest you. Or better, engage me on this matter, convince me or be convinced, work together to come up with another position that moves things forward, if only by a little.