estratto da
http://www.tomdispatch.com/index.mhtml?pid=186766
Calling Names by Their Things in Iraq
Among the stranger aspects of the war is this: At least three foundational pieces of the American occupation of Iraq have essentially gone nameless. Yet, without them, the last years can make little sense. Amid the endless interviews, news conferences, press briefings, radio addresses, speeches, and talk radio and television interviews that come out of this administration in weekly, if not daily, surges -- the tens upon tens of thousands of words that pour from Washington and the Green Zone of Baghdad -- these three subjects remain largely unmentioned, largely uncovered in a media that has relied so heavily on the administration's framing of the issues. Where there is no language, of course, things exist in consciousness in, at best, the most shadowy of forms, leaving Americans tongue-tied on matters of genuine import.
Here they are in brief order:
Air Power: Consider a recent exchange between a reporter and Secretary of Defense Gates
"Q Can you talk a little bit about the bombing today in Iraq?
"SEC. GATES: I don't know much more about it than you all do."
Even if you know nothing about the actual subject of this question, you should automatically know one thing: It wasn't about American air power. In fact, the reporter was bringing up the recent suicide bombing inside a cafeteria in the Iraqi parliament building. But in both Iraq and Afghanistan, there's a simple rule of these last years: They bomb, we don't. If you Google the words "bombing" and "Iraq," you'll see what I mean.
Air power has long been the American way of war. In fact, the use of air power with all its indiscriminate terror has, in the last year, ratcheted up strikingly in Afghanistan and may now be in the process of doing the same in Iraq. (It's hard to tell without the necessary reporting.) Journalists in Baghdad evidently do not look up -- and military press briefers don't point to the skies. We have, in fact, been bombing and missiling in heavily populated urban areas of Iraq throughout the occupation years. But no descriptive language has been developed that would capture in any significant way the loosing of the U.S. Air Force on either country; and so, in a sense, the regular (if, in Iraq, still limited) use of air power has next to no reality for Americans, even though Iraq's skies are filled with attack helicopters, jets, and drones.
Permanent Bases: Every now and then some political figure mentions the possibility of, at some future moment, withdrawing American troops into the vast, multi-billion-dollar permanent bases that have been (and are still being) constructed in Iraq. Some of these are large enough to be small American towns (with their own multiple bus routes). Balad Air Base, for example, along with its 20,000 troops and its contractors, has air traffic that rivals Chicago's O'Hare Airport. At least four such mega-bases were planned before the invasion began. Early on, they were called "enduring camps" by the Pentagon, which had charm as well as a certain rudimentary accuracy. But over these years, the bases have rarely been mentioned by the administration and seldom attended to by the media. They remain a major fact-on-the-ground in Iraq -- and in Bush administration plans for that country -- but we have next to no real language for taking in their massive reality, so they remain a non-issue, nearly nonexistent in American debate about Iraq.
Most "withdrawal" plans now being offered by our Congressional representatives, for instance, only account for the withdrawal of "combat brigades," not troops guarding the bases, which means, of course, that after most imagined "withdrawals," these vast bases are to remain well staffed. Little wonder Iraqis of just about every stripe are suspicious of us and our intentions in their country. And what descriptive language is there for what Washington Post on-line columnist William Arkin calls "a Pentagon-like military headquarters in the Green Zone" or the "largest Embassy in the universe," also being built in that massively fortified citadel in the heart of the Iraqi capital. When an embassy is to have a "staff" of many thousands, along with its own water and electricity systems, and its own anti-missile defenses, the very word "embassy" no longer has much meaning. We have no word for such a symbol of (attempted) permanent domination of a country and so, most of the time, nothing much is said.
Mercenaries: When the mainstream media speaks of the approximately 170,000 troops that will be in Iraq after the surge or "plus-up" is theoretically complete, they are perpetrating a fiction. As a start, just about no one counts the support troops in Kuwait, on ships off the coast, or in the region generally, which would certainly bring the figure up closer to 250,000. And it's rare to see anyone discussing the hordes of mercenaries, known politely as "private contractors," on the ground in Iraq working for rent-a-cop corporations. These range in numbers from the Pentagon's division-sized estimate of 20,000 up to 100,000, depending on how (and who) you decide to count. As part of the privatizing of the American military, they are undertaking various military and semi-military duties and have, as a group, recently been classified, according to Jeremy Scahill, as "an official part of the U.S. war machine."
They are a force (or a rabble) beyond control, beyond the law. (Not a single hired gun has yet been brought up on charges for any of their lawless acts in Iraq.) Their numbers, like their casualties, are essentially unknown; their tasks, largely unexplored; and, as "private contractor" indicates, there is no suitable descriptive language for them either. As a result, there is little way for Americans to grasp the essential lawlessness of the American occupation of Iraq, the real numbers involved in the wars in Iraq and Afghanistan, or just how far our former citizen military has gone down the path to becoming a mercenary military.
With these key aspects of the invasion, occupation, and destruction of Iraq -- for which language has failed us so badly -- missing in action, much in the situation remains hidden, mysterious, even incomprehensible to us, though not necessarily to the Iraqis or, in many cases, to readers and viewers elsewhere on the planet.
Visualizzazione post con etichetta Iraq. Mostra tutti i post
Visualizzazione post con etichetta Iraq. Mostra tutti i post
venerdì 20 aprile 2007
giovedì 19 aprile 2007
President George W. Bush reportedly referred to bombing Arab broadcaster Al-Jazeera
from www.heraldtribune.com
Article published Apr 18, 2007
Former government spokesman David Keogh leaves the Old Bailey, London, during a lunch break at the start of his trial on charges of leaking details of a memo in which U.S. President George W. Bush reportedly referred to bombing Arab broadcaster Al-Jazeera, Wednesday April 18, 2007. Keogh, 49, and former parliamentary researcher Leo O'Connor, 42, are accused of violating Britain's Official Secrets Act. (AP Photo/Alastair Grant)
Al-Jazeera Memo Trial Starts in London
BY DAVID STRINGER
ASSOCIATED PRESS WRITER
A British government official and a former political researcher went on trial Wednesday for allegedly leaking a classified memo in which President Bush reportedly referred to bombing the Arab television station Al-Jazeera.
David Keogh, 50, a cipher expert, and Leo O'Connor, 44, a lawmaker's aide, are accused of violating secrecy laws by disclosing a document relating to 2004 talks between Bush and Prime Minister Tony Blair. Both defendants deny violating the Official Secrets Act.
Prosecutors allege Keogh passed the memo to O'Connor in May 2004, who in turn placed it in a file he handed to his boss, Tony Clarke, then a legislator who had voted against Britain's decision to join the U.S.-led invasion of Iraq in 2003.
The Daily Mirror newspaper previously reported that the memo noted Blair had argued against Bush's suggestion of bombing Al-Jazeera's headquarters in Doha, Qatar. The Daily Mirror said its sources disagreed on whether Bush's suggestion was serious.
Blair said he had no information about any proposed U.S. action against Al-Jazeera, and the White House called the claims "outlandish and inconceivable."
In his opening remarks, prosecutor David Perry did not mention the memo's contents, but said jurors would see the document during parts of the trial that would be closed to the public because of the sensitivity of the contents.
The document, marked "Secret-Personal," was intended to be restricted to senior officials and was written by a Blair adviser, he said.
Keogh and O'Connor put the lives of troops in Iraq at risk because the memo contained defense data, Perry said.
Bush and Blair met in Washington on April 16, 2004, while the Coalition Provisional Authority was acting as administrator in postwar Iraq against what Perry said was "the background of the insurgency."
"We live in a democratic society, not the Wild West," the prosecutor told the court. "It is not for people to decide they are going to be the sheriff in town."
Keogh worked at a government communications bunker handling sensitive documents and intelligence, Perry said. The unit relayed information to diplomats overseas via encrypted or secure methods.
Perry said Keogh received a faxed copy of the memo to send on to an official, but duplicated it unlawfully before doing so and later passed the document to O'Connor.
Clarke, who is no longer a lawmaker, alerted authorities when he discovered the memo among the paperwork from O'Connor.
Britain's Foreign Office said Keogh is suspended pending the outcome of the case.
Prosecutors said the trial would likely last two to three weeks.
Article published Apr 18, 2007
Former government spokesman David Keogh leaves the Old Bailey, London, during a lunch break at the start of his trial on charges of leaking details of a memo in which U.S. President George W. Bush reportedly referred to bombing Arab broadcaster Al-Jazeera, Wednesday April 18, 2007. Keogh, 49, and former parliamentary researcher Leo O'Connor, 42, are accused of violating Britain's Official Secrets Act. (AP Photo/Alastair Grant)
Al-Jazeera Memo Trial Starts in London
BY DAVID STRINGER
ASSOCIATED PRESS WRITER
A British government official and a former political researcher went on trial Wednesday for allegedly leaking a classified memo in which President Bush reportedly referred to bombing the Arab television station Al-Jazeera.
David Keogh, 50, a cipher expert, and Leo O'Connor, 44, a lawmaker's aide, are accused of violating secrecy laws by disclosing a document relating to 2004 talks between Bush and Prime Minister Tony Blair. Both defendants deny violating the Official Secrets Act.
Prosecutors allege Keogh passed the memo to O'Connor in May 2004, who in turn placed it in a file he handed to his boss, Tony Clarke, then a legislator who had voted against Britain's decision to join the U.S.-led invasion of Iraq in 2003.
The Daily Mirror newspaper previously reported that the memo noted Blair had argued against Bush's suggestion of bombing Al-Jazeera's headquarters in Doha, Qatar. The Daily Mirror said its sources disagreed on whether Bush's suggestion was serious.
Blair said he had no information about any proposed U.S. action against Al-Jazeera, and the White House called the claims "outlandish and inconceivable."
In his opening remarks, prosecutor David Perry did not mention the memo's contents, but said jurors would see the document during parts of the trial that would be closed to the public because of the sensitivity of the contents.
The document, marked "Secret-Personal," was intended to be restricted to senior officials and was written by a Blair adviser, he said.
Keogh and O'Connor put the lives of troops in Iraq at risk because the memo contained defense data, Perry said.
Bush and Blair met in Washington on April 16, 2004, while the Coalition Provisional Authority was acting as administrator in postwar Iraq against what Perry said was "the background of the insurgency."
"We live in a democratic society, not the Wild West," the prosecutor told the court. "It is not for people to decide they are going to be the sheriff in town."
Keogh worked at a government communications bunker handling sensitive documents and intelligence, Perry said. The unit relayed information to diplomats overseas via encrypted or secure methods.
Perry said Keogh received a faxed copy of the memo to send on to an official, but duplicated it unlawfully before doing so and later passed the document to O'Connor.
Clarke, who is no longer a lawmaker, alerted authorities when he discovered the memo among the paperwork from O'Connor.
Britain's Foreign Office said Keogh is suspended pending the outcome of the case.
Prosecutors said the trial would likely last two to three weeks.
sabato 7 aprile 2007
A Shock Wave of Brain Injuries
http://www.washingtonpost.com/wp-dyn/content/article/2007/04/06/AR2007040601821_pf.html
A Shock Wave of Brain Injuries
By Ronald Glasser
Sunday, April 8, 2007; B01
"We can save you. But you might not be what you were."
Neurosurgeon, Combat Support Hospital, Balad, Iraq
This is the new physics of war. Three 155mm shells, linked together and combined with 100 pounds of Semtex plastic explosive, covered by canisters of butane or barrels of gasoline, can upend a 70-ton tank, destroy a Humvee or blow an engine block through the hood of a truck. Those deadly ingredients form the signature weapon of the war in Iraq: improvised explosive devices, known by anybody who watches the news as IEDs.
Some of the impact of these roadside bombs is brutally clear: Troops are maimed by projectiles, poisoned by clouds of bacteria-laced debris and burned by post-blast flames. But the IEDs have added a new dimension to battlefield injuries: wounds and even deaths among troops who have no external signs of trauma but whose brains have been severely damaged. Iraq has brought back one of the worst afflictions of World War I trench warfare: shell shock. The brain of a soldier exposed to a roadside bomb is shocked, truly.
About 1,800 U.S. troops, according to the Department of Veterans Affairs, are now suffering from traumatic brain injuries (TBIs) caused by penetrating wounds. But neurologists worry that hundreds of thousands more -- at least 30 percent of the troops who've engaged in active combat for four months or longer in Iraq and Afghanistan -- are at risk of potentially disabling neurological disorders from the blast waves of IEDs and mortars, all without suffering a scratch.
For the first time, the U.S. military is treating more head injuries than chest or abdominal wounds, and it is ill-equipped to do so. According to a July 2005 estimate from Walter Reed Army Medical Center, two-thirds of all soldiers wounded in Iraq who don't immediately return to duty have traumatic brain injuries.
Here's why IEDS carry such hidden danger. The detonation of any powerful explosive generates a blast wave of high pressure that spreads out at 1,600 feet per second from the point of explosion and travels hundreds of yards. The lethal blast wave is a two-part assault that rattles the brain against the skull. The initial shock wave of very high pressure is followed closely by the "secondary wind": a huge volume of displaced air flooding back into the area, again under high pressure. No helmet or armor can defend against such a massive wave front.
It is these sudden and extreme differences in pressures -- routinely 1,000 times greater than atmospheric pressure -- that lead to significant neurological injury. Blast waves cause severe concussions, resulting in loss of consciousness and obvious neurological deficits such as blindness, deafness and mental retardation. Blast waves causing TBIs can leave a 19-year-old private who could easily run a six-minute mile unable to stand or even to think.
Another problem is that these blast-related brain injuries differ from other severe head traumas, and the complexity of treating returning troops with "closed-head" injuries is taxing an already overburdened military health-care system. There is not a neurosurgeon who works in a trauma unit anywhere in the United States who doesn't know what to do when an ambulance brings in a biker who has suffered a severe head injury in a highway accident. The standard care involves using calcium channel blockers to protect damaged nerve cells against further injury, intravenous diuretics to control brain swelling and, if the swelling becomes too great, removal of the top of the skull to allow the brain to swell without increasing neurological damage. This is what surgeons did in the case of ABC News anchor Bob Woodruff, who suffered severe brain injuries from an IED blast in Baghdad last year.
All this works with the common types of severe head injuries, but it does not work with brains damaged by shock waves. Despite the usual interventions and treatments, the majority of blast-injury patients who have neurological damage do not fully recover. There is a growing understanding within the neurosurgical community that blast injuries are different from those caused by penetrating or skull-fracture trauma. It is thought that shock waves damage the brain at a microscopic, sub-cellular level. That's why surgeons who are quite capable of reconstructing the skull of a motorcycle crash victim -- something for which they have been well trained -- struggle to come up with treatment and rehabilitation techniques for the explosion-damaged brains of troops.
"TBIs from Iraq are different," said P. Steven Macedo, a neurologist and former doctor at the Veterans Administration. Concussions from motorcycle accidents injure the brain by stretching or tearing it, he noted. But in Iraq, something else is going on. "When the sound wave moves through the brain, it seems to cause little gas bubbles to form," he said. "When they pop, it leaves a cavity. So you are littering people's brains with these little holes."
Almost as daunting as treating TBI is the volume of such injuries coming out of Iraq. Macedo cited the estimates, gleaned at seminars with VA doctors, that as many as one-third of all combat forces are at risk of TBI. Military physicians have learned that significant neurological injuries should be suspected in any troops exposed to a blast, even if they were far from the explosion. Indeed, soldiers walking away from IED blasts have discovered that they often suffer from memory loss, short attention spans, muddled reasoning, headaches, confusion, anxiety, depression and irritability.
What's baffling is the Pentagon's failure to work with Congress to provide a steady stream of funding for research on TBIs. Meanwhile, the high-profile firings of top commanders at Walter Reed have shed light on the woefully inadequate treatment for troops. In these circumstances, soldiers face a struggle to get the long-term rehabilitation necessary for a TBI. At Walter Reed, Macedo said, doctors have chosen to medicate most TBI patients, even though cognitive rehabilitation, including brain teasers and memory exercises, seems to hold the most promise for dealing with the disorder.
Oddly enough, having more military patients than can be adequately treated is, in terms of warfare, a gruesome kind of success. These are the war injured who once would have been the war dead. And it is the unexpected number of casualties who in a previous medical era would have been fatalities that has sunk the outpatient clinics at Walter Reed and left those in the VA system lost and adrift.
In Iraq and Afghanistan, the ratio of wounded service members to fatalities is 16 to 1, if the definition of "wounded" is anyone evacuated from a combat zone. During the Vietnam War, according to the VA, the ratio was 2.6 to 1. U.S. troops no longer die from the kind of injuries that killed many thousands in Vietnam. The majority of combat deaths there occurred right where the soldier was hit. If you were going to die, you were dead before there was any need of a medevac chopper. If you'd had an arm or leg blown off, the chances were that you had also suffered a penetrating chest or abdominal wound and would bleed to death waiting to be taken to the nearest surgical hospital.
But if the bleeding could be staunched and you were still breathing when the medics got to you, the odds on survival were in your favor. The military medicine practiced in Vietnam wasn't so different from what World War II medics practiced: Stop the bleeding and hope for the best until the helicopter shows up.
It wasn't until October 1993, when a U.S. combat assault team rappelled down from a helicopter into a 72-hour gunfight in the streets of Mogadishu, Somalia, that the notion of military medicine changed from basic life support to intensive care. In that siege situation, medics had no choice but to care for a growing number of wounded on their own, because evacuation was impossible. But without clear intensive-care procedures, they ran out of medications and fluids to treat the most severely injured.
In the civilian world, trauma medicine had progressed throughout the 1970s and '80s, well past the simple expedients of tourniquet, plasma and keeping an airway open. Mogadishu forced the military to abandon the last of its medical practices from Vietnam. It was time to teach the medics a new trade.
Pentagon officials increased the training period for a 91W, or combat medic, from 10 to 16 weeks. Medics now trained on patient simulators that would "bleed to death" if blood loss was not stopped or "suffocate" if chest tubes weren't correctly placed or a tracheotomy wasn't performed within three minutes. Medics learned the new intensive-care theory of "hypotensive resuscitation," in which intravenous fluids are given only in minimal amounts solely to keep the heart pumping, as opposed to the old Vietnam method of keeping blood pressure elevated, which only added to blood loss. Medics today use better-designed tourniquets and hemostatic bandages -- dressings that act to stop bleeding for better hemorrhage control. They administer the latest non-opiate painkillers, which, unlike morphine and Demerol, do not slow breathing. This is the first war in which troops are very unlikely to die if they're still alive when a medic arrives.
Another large part of the 16-to-1 wounded-to-fatality ratio has to do with advances in body armor. Today's body armor is dramatically effective in preventing fatal wounds of the chest and upper abdomen. There is not an orthopedic or general surgeon in Iraq or Afghanistan who hasn't been astonished the first time a trooper with two missing limbs and a traumatic brain injury is carried off in a chopper and the surgeon removing the armor cannot find a scratch from the chin to the groin.
But the unseen damage can be long-lasting. Most of the families of our wounded that I have interviewed months, if not years, after the injury say the same thing: "Someone should have told us that with these closed-head injuries, things would not really get all that much better."
Now in its fifth year, the Iraq conflict is not a war of death for U.S. troops nearly so much as it is a war of disabilities. The symbol of this battle is not the cemetery but the orthopedic ward and the neurosurgical unit. The men and women inside those units have come home alive but missing arms and legs, many unable to see or hear or remember who they were before being hit by a roadside bomb. Survival clearly represents as much of a revolution in military medicine as does the dominance of the suicide bomber and the roadside bomb in the age of "shock and awe." But now both the medical profession and the country are left to play a terrible game of catch-up.r
Ronald Glasser is a pediatric nephrologist and the author of " Wounded: Vietnam to Iraq," published last year. From 1968 to 1970, he was deployed at the U.S. Army Hospital at Camp Zama, Japan, treating U.S. soldiers wounded in Vietnam.
A Shock Wave of Brain Injuries
By Ronald Glasser
Sunday, April 8, 2007; B01
"We can save you. But you might not be what you were."
Neurosurgeon, Combat Support Hospital, Balad, Iraq
This is the new physics of war. Three 155mm shells, linked together and combined with 100 pounds of Semtex plastic explosive, covered by canisters of butane or barrels of gasoline, can upend a 70-ton tank, destroy a Humvee or blow an engine block through the hood of a truck. Those deadly ingredients form the signature weapon of the war in Iraq: improvised explosive devices, known by anybody who watches the news as IEDs.
Some of the impact of these roadside bombs is brutally clear: Troops are maimed by projectiles, poisoned by clouds of bacteria-laced debris and burned by post-blast flames. But the IEDs have added a new dimension to battlefield injuries: wounds and even deaths among troops who have no external signs of trauma but whose brains have been severely damaged. Iraq has brought back one of the worst afflictions of World War I trench warfare: shell shock. The brain of a soldier exposed to a roadside bomb is shocked, truly.
About 1,800 U.S. troops, according to the Department of Veterans Affairs, are now suffering from traumatic brain injuries (TBIs) caused by penetrating wounds. But neurologists worry that hundreds of thousands more -- at least 30 percent of the troops who've engaged in active combat for four months or longer in Iraq and Afghanistan -- are at risk of potentially disabling neurological disorders from the blast waves of IEDs and mortars, all without suffering a scratch.
For the first time, the U.S. military is treating more head injuries than chest or abdominal wounds, and it is ill-equipped to do so. According to a July 2005 estimate from Walter Reed Army Medical Center, two-thirds of all soldiers wounded in Iraq who don't immediately return to duty have traumatic brain injuries.
Here's why IEDS carry such hidden danger. The detonation of any powerful explosive generates a blast wave of high pressure that spreads out at 1,600 feet per second from the point of explosion and travels hundreds of yards. The lethal blast wave is a two-part assault that rattles the brain against the skull. The initial shock wave of very high pressure is followed closely by the "secondary wind": a huge volume of displaced air flooding back into the area, again under high pressure. No helmet or armor can defend against such a massive wave front.
It is these sudden and extreme differences in pressures -- routinely 1,000 times greater than atmospheric pressure -- that lead to significant neurological injury. Blast waves cause severe concussions, resulting in loss of consciousness and obvious neurological deficits such as blindness, deafness and mental retardation. Blast waves causing TBIs can leave a 19-year-old private who could easily run a six-minute mile unable to stand or even to think.
Another problem is that these blast-related brain injuries differ from other severe head traumas, and the complexity of treating returning troops with "closed-head" injuries is taxing an already overburdened military health-care system. There is not a neurosurgeon who works in a trauma unit anywhere in the United States who doesn't know what to do when an ambulance brings in a biker who has suffered a severe head injury in a highway accident. The standard care involves using calcium channel blockers to protect damaged nerve cells against further injury, intravenous diuretics to control brain swelling and, if the swelling becomes too great, removal of the top of the skull to allow the brain to swell without increasing neurological damage. This is what surgeons did in the case of ABC News anchor Bob Woodruff, who suffered severe brain injuries from an IED blast in Baghdad last year.
All this works with the common types of severe head injuries, but it does not work with brains damaged by shock waves. Despite the usual interventions and treatments, the majority of blast-injury patients who have neurological damage do not fully recover. There is a growing understanding within the neurosurgical community that blast injuries are different from those caused by penetrating or skull-fracture trauma. It is thought that shock waves damage the brain at a microscopic, sub-cellular level. That's why surgeons who are quite capable of reconstructing the skull of a motorcycle crash victim -- something for which they have been well trained -- struggle to come up with treatment and rehabilitation techniques for the explosion-damaged brains of troops.
"TBIs from Iraq are different," said P. Steven Macedo, a neurologist and former doctor at the Veterans Administration. Concussions from motorcycle accidents injure the brain by stretching or tearing it, he noted. But in Iraq, something else is going on. "When the sound wave moves through the brain, it seems to cause little gas bubbles to form," he said. "When they pop, it leaves a cavity. So you are littering people's brains with these little holes."
Almost as daunting as treating TBI is the volume of such injuries coming out of Iraq. Macedo cited the estimates, gleaned at seminars with VA doctors, that as many as one-third of all combat forces are at risk of TBI. Military physicians have learned that significant neurological injuries should be suspected in any troops exposed to a blast, even if they were far from the explosion. Indeed, soldiers walking away from IED blasts have discovered that they often suffer from memory loss, short attention spans, muddled reasoning, headaches, confusion, anxiety, depression and irritability.
What's baffling is the Pentagon's failure to work with Congress to provide a steady stream of funding for research on TBIs. Meanwhile, the high-profile firings of top commanders at Walter Reed have shed light on the woefully inadequate treatment for troops. In these circumstances, soldiers face a struggle to get the long-term rehabilitation necessary for a TBI. At Walter Reed, Macedo said, doctors have chosen to medicate most TBI patients, even though cognitive rehabilitation, including brain teasers and memory exercises, seems to hold the most promise for dealing with the disorder.
Oddly enough, having more military patients than can be adequately treated is, in terms of warfare, a gruesome kind of success. These are the war injured who once would have been the war dead. And it is the unexpected number of casualties who in a previous medical era would have been fatalities that has sunk the outpatient clinics at Walter Reed and left those in the VA system lost and adrift.
In Iraq and Afghanistan, the ratio of wounded service members to fatalities is 16 to 1, if the definition of "wounded" is anyone evacuated from a combat zone. During the Vietnam War, according to the VA, the ratio was 2.6 to 1. U.S. troops no longer die from the kind of injuries that killed many thousands in Vietnam. The majority of combat deaths there occurred right where the soldier was hit. If you were going to die, you were dead before there was any need of a medevac chopper. If you'd had an arm or leg blown off, the chances were that you had also suffered a penetrating chest or abdominal wound and would bleed to death waiting to be taken to the nearest surgical hospital.
But if the bleeding could be staunched and you were still breathing when the medics got to you, the odds on survival were in your favor. The military medicine practiced in Vietnam wasn't so different from what World War II medics practiced: Stop the bleeding and hope for the best until the helicopter shows up.
It wasn't until October 1993, when a U.S. combat assault team rappelled down from a helicopter into a 72-hour gunfight in the streets of Mogadishu, Somalia, that the notion of military medicine changed from basic life support to intensive care. In that siege situation, medics had no choice but to care for a growing number of wounded on their own, because evacuation was impossible. But without clear intensive-care procedures, they ran out of medications and fluids to treat the most severely injured.
In the civilian world, trauma medicine had progressed throughout the 1970s and '80s, well past the simple expedients of tourniquet, plasma and keeping an airway open. Mogadishu forced the military to abandon the last of its medical practices from Vietnam. It was time to teach the medics a new trade.
Pentagon officials increased the training period for a 91W, or combat medic, from 10 to 16 weeks. Medics now trained on patient simulators that would "bleed to death" if blood loss was not stopped or "suffocate" if chest tubes weren't correctly placed or a tracheotomy wasn't performed within three minutes. Medics learned the new intensive-care theory of "hypotensive resuscitation," in which intravenous fluids are given only in minimal amounts solely to keep the heart pumping, as opposed to the old Vietnam method of keeping blood pressure elevated, which only added to blood loss. Medics today use better-designed tourniquets and hemostatic bandages -- dressings that act to stop bleeding for better hemorrhage control. They administer the latest non-opiate painkillers, which, unlike morphine and Demerol, do not slow breathing. This is the first war in which troops are very unlikely to die if they're still alive when a medic arrives.
Another large part of the 16-to-1 wounded-to-fatality ratio has to do with advances in body armor. Today's body armor is dramatically effective in preventing fatal wounds of the chest and upper abdomen. There is not an orthopedic or general surgeon in Iraq or Afghanistan who hasn't been astonished the first time a trooper with two missing limbs and a traumatic brain injury is carried off in a chopper and the surgeon removing the armor cannot find a scratch from the chin to the groin.
But the unseen damage can be long-lasting. Most of the families of our wounded that I have interviewed months, if not years, after the injury say the same thing: "Someone should have told us that with these closed-head injuries, things would not really get all that much better."
Now in its fifth year, the Iraq conflict is not a war of death for U.S. troops nearly so much as it is a war of disabilities. The symbol of this battle is not the cemetery but the orthopedic ward and the neurosurgical unit. The men and women inside those units have come home alive but missing arms and legs, many unable to see or hear or remember who they were before being hit by a roadside bomb. Survival clearly represents as much of a revolution in military medicine as does the dominance of the suicide bomber and the roadside bomb in the age of "shock and awe." But now both the medical profession and the country are left to play a terrible game of catch-up.r
Ronald Glasser is a pediatric nephrologist and the author of " Wounded: Vietnam to Iraq," published last year. From 1968 to 1970, he was deployed at the U.S. Army Hospital at Camp Zama, Japan, treating U.S. soldiers wounded in Vietnam.
venerdì 6 aprile 2007
America's Learning Disability in Iraq
America's Learning Disability in Iraq
Moisés Naím
Washington, DC
The United States government is suffering from a curious learning disability when it comes to Iraq. As it begins the painful process of disengaging from Iraq, the U.S. is at risk of repeating the mistakes it made going into the war.
This is particularly curious because such a strong consensus has developed about the mistakes made going in. Liberals and conservatives, Republicans and Democrats, defenders and critics of the decision to go to war have all settled on the same list of errors: Not sending enough troops; not anticipating correctly the training and armor that the troops would need; dismantling the Iraqi army; failing to prevent the looting; purging Baath Party members from government jobs, thus leaving thousands of Iraqi families without income and important agencies bereft of critical personnel; misreading the nature of the enemy; underestimating the Sunni-Shiite conflict; misjudging the influence of Iran, Syria and foreign jihadists; squandering reconstruction funds and the catastrophic attempt to micromanage Iraq right after the invasion.
Obviously the United States can't recommit all of those specific mistakes, but amazingly, the assumptions that led to them are still intact, and still inform the proposals and debates about what should be the next steps in Iraq. Consider:
Overestimating the capabilities of the Iraqi government
Assuming that Saddam Hussein’s government was militarily robust and that Iraq had an effective public sector were central tenets in the planning for the war and its aftermath. Assuming that the current Iraqi government can do far more than it is presently doing underpins current plans aimed at decreasing U.S. involvement there. Both assumptions are wrong.
Four years ago the U.S. government thought that Iraq had weapons of mass destruction, that its armed forces were more capable than they turned out to be, that the country's institutions were more functional and reliable than they really were, that its economy, oil industry and overall national infrastructure were in relatively good shape. In March of 2003 then Deputy Defense Secretary Paul Wolfowitz told Congress, "We're dealing with a country that can really finance its own reconstruction, and relatively soon." His boss Donald Rumsfeld added a month later, "I don't know that there is much reconstruction to do."
They were of course wrong. The combination of a ruthless, corrupt dictatorship and a long international embargo had crippled the country and especially its public sector. Moreover, as the cases of Nigeria and Venezuela exemplify, underdeveloped, oil-rich countries tend to have inefficient public sectors, weak institutions, rotten infrastructure and a bankrupt non-oil economy – even without the damage of international sanctions and a regime like Saddam Hussein’s.
Yet, assuming that the Iraqi government is more capable than it has shown itself to be remains an implicit assumption in current proposals for U.S. policy in Iraq. Many of the proposals rely on the hope that the "Iraqi army will stand up as U.S. troops stand down," that the Iraqis will "pull up their socks," "get their act together," "muster the political will" and so on. It has become common to assume that the Iraqi government has the means and the institutions to carry out enormously complex political, financial and military tasks – the sorts of things that most underdeveloped countries can hardly do.
We've learned in four years that Iraq had far fewer institutional capabilities than most expected – that behind Saddam's gilded palaces and military parades lay a state in shambles. Of course it has been further devastated in the last four years. Demands for government action in Iraq often ignore the fact that they are directed at what is in effect an almost empty shell.
Overestimating the capabilities of the U.S. government
Similar caution is in order regarding the U.S. government. We seem permanently deluded that the government has access to unfathomable amounts of money, the most advanced technologies, and is run by a well-staffed bureaucracy educated by the world's best university system. Obviously, these advantages were not enough to run the Iraq operation effectively – or the response to Hurricane Katrina, for that matter.
So in Iraq, a Pentagon funded by a budget that exceeds the combined defense spending of the world's 15 top military-spending nations has been unable to contain ragged Iraqi militias that rely on improvised explosive devices. Recently, General David Petraeus, the U.S. commander in Iraq, famously admitted that "There is no military solution to a problem like that in Iraq, to the insurgency of Iraq."
Unfortunately, the U.S. government has not performed very well in delivering non-military solutions either. The avalanche of books that catalog the blunders made by American civilians in Iraq should give us pause when leaders propose new strategies whose success would depend on the nation-building, democracy-promoting prowess of the U.S. government.
Disdaining diplomacy
Working with others is never easy. Working with others that are foreign governments is often infuriatingly difficult. Others are not just different; they also have different interests. Foreign governments rarely have the same interests Americans have.
Perhaps this truth lay behind the Bush administration's preference for unilateral action, including its decision to invade Iraq. The existence of a British contingent and a handful of troops from 47 other countries in Iraq did not alter the fact that this was an American war. Partly as a result, America finds itself essentially alone in dealing with Iraq today – militarily, politically and financially. At this point even the Bush White House would like to have more actively engaged foreign allies to help in Iraq. The sort of coalition George H. W. Bush built for the first Gulf War in 1991 must look awfully attractive to this President Bush today, but it's far too late to create such an alliance now.
To its credit, the Bush administration has lately shown more interest in diplomacy to deal with problems like Iran and North Korea. But its decisions and overall strategy in Iraq continue to have a strong unilateral and military bias. The latest tack, "the surge," the only new idea of significance in months, is essentially a military decision (send more troops). This time even the British are moving in the opposite direction. The surge has no foreign support at all.
An approach based less on purely military calculation, one that combined new tactics on the ground with bold international initiatives, might have brought some goodwill and assistance to the U.S. at a time when the country desperately needs international solidarity. True, at this point the idea of a diplomatic solution in Iraq may be as unrealistic and naive as a military one. The political costs to foreign leaders of appearing too close to President Bush have become substantial. But isn't it revealing that even after three years of persuasive demonstration that the military is not the solution to Iraq's quagmire, the US is relying almost exclusively on the deployment of more soldiers to stabilize the situation?
Perhaps there is a certain logic to relying on an agency whose annual budget is close to $600 billion – the Pentagon – rather than on one whose budget is a paltry $10 billion – the U.S. State Department. Moreover diplomacy can be unsavory and often involves painful compromises with hard-to-trust foreigners.
There's that learning disability again. We've had four years of war, massive casualties and $500 billion in costs, and to what end? Today, not even the generals seem to think that the military is the main tool for solving the Iraq problem. Yet the administration, the Congress, and a great many commentators all seem to ignore the obvious, powerful lesson.
The conditions set by House and Senate Democrats in exchange for their approval of additional funds for the Iraq war are all about setting complex goals – "benchmarks" – and tight deadlines for the Iraqi government. The House Democrats declare that "Iraq will take responsibility for security in all provinces" and "spend 10 billion in job creating projects." No explanation is given as to how these goals might actually be achieved, and none of the bills clearly articulates how to incentivize other countries to help. The Democrats seem to have learned little themselves from years of unilateral, Pentagon-dominated actions in Iraq.
According to the National Center for Learning Disabilities, "A learning disability is a neurological disorder that affects the brain's ability to receive, process, store and respond to information." This definition naturally refers to learning disabilities in individuals. Its causes are diverse and not yet completely understood. In the case of governments and political systems that are learning disabled, it seems plausible to suspect that the disability is closely related not to neurological disorders but to election cycles. Too much political power without sufficient countervailing checks and balances also breeds arrogance among leaders. This surely contributes to their inability to acknowledge and learn from their mistakes. But what is interesting here is that erstwhile all-powerful leaders don’t seem to be alone in their failure to learn from the recent past. Their opponents also share similar blind spots.
In individuals, one clear symptom of a learning disability is "a distinct gap between the level of achievement that is expected and what is actually being achieved." Alas, this perfectly applies to the American performance in Iraq.
Moises Naim is editor in chief of Foreign Policy magazine
http://newsweek.washingtonpost.com/postglobal/moises_naim/2007/04/americas_learning_disability.html
Moisés Naím
Washington, DC
The United States government is suffering from a curious learning disability when it comes to Iraq. As it begins the painful process of disengaging from Iraq, the U.S. is at risk of repeating the mistakes it made going into the war.
This is particularly curious because such a strong consensus has developed about the mistakes made going in. Liberals and conservatives, Republicans and Democrats, defenders and critics of the decision to go to war have all settled on the same list of errors: Not sending enough troops; not anticipating correctly the training and armor that the troops would need; dismantling the Iraqi army; failing to prevent the looting; purging Baath Party members from government jobs, thus leaving thousands of Iraqi families without income and important agencies bereft of critical personnel; misreading the nature of the enemy; underestimating the Sunni-Shiite conflict; misjudging the influence of Iran, Syria and foreign jihadists; squandering reconstruction funds and the catastrophic attempt to micromanage Iraq right after the invasion.
Obviously the United States can't recommit all of those specific mistakes, but amazingly, the assumptions that led to them are still intact, and still inform the proposals and debates about what should be the next steps in Iraq. Consider:
Overestimating the capabilities of the Iraqi government
Assuming that Saddam Hussein’s government was militarily robust and that Iraq had an effective public sector were central tenets in the planning for the war and its aftermath. Assuming that the current Iraqi government can do far more than it is presently doing underpins current plans aimed at decreasing U.S. involvement there. Both assumptions are wrong.
Four years ago the U.S. government thought that Iraq had weapons of mass destruction, that its armed forces were more capable than they turned out to be, that the country's institutions were more functional and reliable than they really were, that its economy, oil industry and overall national infrastructure were in relatively good shape. In March of 2003 then Deputy Defense Secretary Paul Wolfowitz told Congress, "We're dealing with a country that can really finance its own reconstruction, and relatively soon." His boss Donald Rumsfeld added a month later, "I don't know that there is much reconstruction to do."
They were of course wrong. The combination of a ruthless, corrupt dictatorship and a long international embargo had crippled the country and especially its public sector. Moreover, as the cases of Nigeria and Venezuela exemplify, underdeveloped, oil-rich countries tend to have inefficient public sectors, weak institutions, rotten infrastructure and a bankrupt non-oil economy – even without the damage of international sanctions and a regime like Saddam Hussein’s.
Yet, assuming that the Iraqi government is more capable than it has shown itself to be remains an implicit assumption in current proposals for U.S. policy in Iraq. Many of the proposals rely on the hope that the "Iraqi army will stand up as U.S. troops stand down," that the Iraqis will "pull up their socks," "get their act together," "muster the political will" and so on. It has become common to assume that the Iraqi government has the means and the institutions to carry out enormously complex political, financial and military tasks – the sorts of things that most underdeveloped countries can hardly do.
We've learned in four years that Iraq had far fewer institutional capabilities than most expected – that behind Saddam's gilded palaces and military parades lay a state in shambles. Of course it has been further devastated in the last four years. Demands for government action in Iraq often ignore the fact that they are directed at what is in effect an almost empty shell.
Overestimating the capabilities of the U.S. government
Similar caution is in order regarding the U.S. government. We seem permanently deluded that the government has access to unfathomable amounts of money, the most advanced technologies, and is run by a well-staffed bureaucracy educated by the world's best university system. Obviously, these advantages were not enough to run the Iraq operation effectively – or the response to Hurricane Katrina, for that matter.
So in Iraq, a Pentagon funded by a budget that exceeds the combined defense spending of the world's 15 top military-spending nations has been unable to contain ragged Iraqi militias that rely on improvised explosive devices. Recently, General David Petraeus, the U.S. commander in Iraq, famously admitted that "There is no military solution to a problem like that in Iraq, to the insurgency of Iraq."
Unfortunately, the U.S. government has not performed very well in delivering non-military solutions either. The avalanche of books that catalog the blunders made by American civilians in Iraq should give us pause when leaders propose new strategies whose success would depend on the nation-building, democracy-promoting prowess of the U.S. government.
Disdaining diplomacy
Working with others is never easy. Working with others that are foreign governments is often infuriatingly difficult. Others are not just different; they also have different interests. Foreign governments rarely have the same interests Americans have.
Perhaps this truth lay behind the Bush administration's preference for unilateral action, including its decision to invade Iraq. The existence of a British contingent and a handful of troops from 47 other countries in Iraq did not alter the fact that this was an American war. Partly as a result, America finds itself essentially alone in dealing with Iraq today – militarily, politically and financially. At this point even the Bush White House would like to have more actively engaged foreign allies to help in Iraq. The sort of coalition George H. W. Bush built for the first Gulf War in 1991 must look awfully attractive to this President Bush today, but it's far too late to create such an alliance now.
To its credit, the Bush administration has lately shown more interest in diplomacy to deal with problems like Iran and North Korea. But its decisions and overall strategy in Iraq continue to have a strong unilateral and military bias. The latest tack, "the surge," the only new idea of significance in months, is essentially a military decision (send more troops). This time even the British are moving in the opposite direction. The surge has no foreign support at all.
An approach based less on purely military calculation, one that combined new tactics on the ground with bold international initiatives, might have brought some goodwill and assistance to the U.S. at a time when the country desperately needs international solidarity. True, at this point the idea of a diplomatic solution in Iraq may be as unrealistic and naive as a military one. The political costs to foreign leaders of appearing too close to President Bush have become substantial. But isn't it revealing that even after three years of persuasive demonstration that the military is not the solution to Iraq's quagmire, the US is relying almost exclusively on the deployment of more soldiers to stabilize the situation?
Perhaps there is a certain logic to relying on an agency whose annual budget is close to $600 billion – the Pentagon – rather than on one whose budget is a paltry $10 billion – the U.S. State Department. Moreover diplomacy can be unsavory and often involves painful compromises with hard-to-trust foreigners.
There's that learning disability again. We've had four years of war, massive casualties and $500 billion in costs, and to what end? Today, not even the generals seem to think that the military is the main tool for solving the Iraq problem. Yet the administration, the Congress, and a great many commentators all seem to ignore the obvious, powerful lesson.
The conditions set by House and Senate Democrats in exchange for their approval of additional funds for the Iraq war are all about setting complex goals – "benchmarks" – and tight deadlines for the Iraqi government. The House Democrats declare that "Iraq will take responsibility for security in all provinces" and "spend 10 billion in job creating projects." No explanation is given as to how these goals might actually be achieved, and none of the bills clearly articulates how to incentivize other countries to help. The Democrats seem to have learned little themselves from years of unilateral, Pentagon-dominated actions in Iraq.
According to the National Center for Learning Disabilities, "A learning disability is a neurological disorder that affects the brain's ability to receive, process, store and respond to information." This definition naturally refers to learning disabilities in individuals. Its causes are diverse and not yet completely understood. In the case of governments and political systems that are learning disabled, it seems plausible to suspect that the disability is closely related not to neurological disorders but to election cycles. Too much political power without sufficient countervailing checks and balances also breeds arrogance among leaders. This surely contributes to their inability to acknowledge and learn from their mistakes. But what is interesting here is that erstwhile all-powerful leaders don’t seem to be alone in their failure to learn from the recent past. Their opponents also share similar blind spots.
In individuals, one clear symptom of a learning disability is "a distinct gap between the level of achievement that is expected and what is actually being achieved." Alas, this perfectly applies to the American performance in Iraq.
Moises Naim is editor in chief of Foreign Policy magazine
http://newsweek.washingtonpost.com/postglobal/moises_naim/2007/04/americas_learning_disability.html
mercoledì 4 aprile 2007
Beware of State Power by Noam Chomsky
ZNet | Asia
Beware of State Power
by Noam Chomsky and George McLeod; April 03, 2007
Noam Chomsky is the world's leading critic of US power. He has been voted the most important intellectual of the 20th century and has published more than 30 leading political works, many of them bestsellers. In his first ever interview with the Bangkok Post, Professor Chomsky discusses regional and global issues with GEORGE MCLEOD.
Beware of State Power
by Noam Chomsky and George McLeod; April 03, 2007
Noam Chomsky is the world's leading critic of US power. He has been voted the most important intellectual of the 20th century and has published more than 30 leading political works, many of them bestsellers. In his first ever interview with the Bangkok Post, Professor Chomsky discusses regional and global issues with GEORGE MCLEOD.
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