Health Consequences of War and Militarism Martin Donohoe, MD, FACP.

Health Consequences of War and Militarism Martin Donohoe, MD, FACP

Outline The history and epidemiology of war The history and epidemiology of war Nuclear weapons Nuclear weapons Chemical weapons Chemical weapons Biological weapons Biological weapons

Outline Economic and environmental consequences of militarism and war Economic and environmental consequences of militarism and war Health consequences of militarism and war Health consequences of militarism and war Contemporary conflicts Contemporary conflicts Afghanistan, “War on terror”, Middle East Afghanistan, “War on terror”, Middle East Solutions Solutions

History of War Violent conflict ubiquitous in the animal kingdom: Violent conflict ubiquitous in the animal kingdom: Interspecies conflict – food, territory Interspecies conflict – food, territory Intraspecies conflict – food, territory, mates (usually not directly fatal) Intraspecies conflict – food, territory, mates (usually not directly fatal) Violence among non-human primates Violence among non-human primates Gorilla infanticide Gorilla infanticide Chimpanzee killing bands Chimpanzee killing bands

History of war 10,000 yrs ago – agriculture 10,000 yrs ago – agriculture Stable populations, division of labor, warrior class Stable populations, division of labor, warrior class 3500 yrs ago – bronze weapons and armor 3500 yrs ago – bronze weapons and armor 2200 yrs ago – iron 2200 yrs ago – iron 1900 yrs ago - horses 1900 yrs ago - horses

History of war Ninth Century China - bombs developed Ninth Century China - bombs developed Thirteenth Century China – rockets Thirteenth Century China – rockets Forgotten until the 19 th Century Forgotten until the 19 th Century 1783 – Balloon 1783 – Balloon Montgolfier brothers Montgolfier brothers Prussian general JCG Heyne – used for bombing Prussian general JCG Heyne – used for bombing

History of War 1903 – Wright brothers/Kitty Hawk – airplane 1903 – Wright brothers/Kitty Hawk – airplane 20 th Century – nuclear submarines, predator drones, weaponization of space 20 th Century – nuclear submarines, predator drones, weaponization of space

History of War Belief that each new invention would eliminate warfare Belief that each new invention would eliminate warfare Instead, increased casualties, killing at a distance Instead, increased casualties, killing at a distance

Epidemiology of Warfare Deaths in war: Deaths in war: 17 th Century = 19/million population 17 th Century = 19/million population 18 th Century = 19/million population 18 th Century = 19/million population 19 th Century = 11/million population 19 th Century = 11/million population 20 th Century = 183/million population 20 th Century = 183/million population Increasing casualties to civilians Increasing casualties to civilians 85-90% in 20 th Century (vs. 10% late 19 th Century) 85-90% in 20 th Century (vs. 10% late 19 th Century)

Legacies of Colonial Exploitation Christopher Columbus’ log entry upon meeting the Arawaks of the Bahamas: Christopher Columbus’ log entry upon meeting the Arawaks of the Bahamas: “They…brought us…many…things…They willingly traded everything they owned…They do not bear arms…They would make fine servants…With fifty men we could subjugate them all and make them do whatever we want.”

Legacies of Colonial Exploitation Winston Churchill (speaking in favor of RAF’s “experimental” bombing of Iraqis in 1920s, which killed 9,000 people with 97 tons of bombs): Winston Churchill (speaking in favor of RAF’s “experimental” bombing of Iraqis in 1920s, which killed 9,000 people with 97 tons of bombs): “I am strongly in favor of using poisoned gas against uncivilized tribes to spread a lively terror…against recalcitrant Arabs as an experiment”

Legacies of Colonial Exploitation Cecil Rhodes (Rhodesia, Rhodes Scholarship, DeBeers Mining Company): Cecil Rhodes (Rhodesia, Rhodes Scholarship, DeBeers Mining Company): “We must find new lands from which we can easily obtain raw materials and at the same time exploit the cheap slave labour that is available from the natives of the colonies. The colonies would also provide a dumping ground for the surplus goods produced in our factories.”

Contemporary Wars 250 wars in the 20 th Century 250 wars in the 20 th Century Incidence of war rising since 1950 Incidence of war rising since 1950 Most conflicts within poor states Most conflicts within poor states 25 separate civil wars currently underway 25 separate civil wars currently underway

Contemporary Wars 72 million lives lost in 20 th Century wars, another 52 million through genocides 72 million lives lost in 20 th Century wars, another 52 million through genocides US dropped the equivalent of one 500 lb. bomb on every person in Vietnam US dropped the equivalent of one 500 lb. bomb on every person in Vietnam Vietnam War: 11.5 to 3 million Vietnamese casualties; 58,000 American Vietnam War: 11.5 to 3 million Vietnamese casualties; 58,000 American More US soldiers died of suicide after Vietnam than died in combat during the war. More US soldiers died of suicide after Vietnam than died in combat during the war.

Contemporary Wars Gulf War I: US planted one land mine for every Iraqi citizen Gulf War I: US planted one land mine for every Iraqi citizen 310,000 direct war-related deaths in 2000 (0.5% of worldwide mortality); indirect deaths much larger 310,000 direct war-related deaths in 2000 (0.5% of worldwide mortality); indirect deaths much larger

Consequences of War Deaths, injuries, psychological sequelae Deaths, injuries, psychological sequelae Collapse of health care system affecting those with acute and chronic illnesses Collapse of health care system affecting those with acute and chronic illnesses Famine Famine Environmental degradation Environmental degradation Increasing poverty and debt Increasing poverty and debt All lead to recurrent cycles of violence All lead to recurrent cycles of violence

Consequences of War Contributes, along with persecution, poverty, and environmental degradation, to the 240 million people “on the move” Contributes, along with persecution, poverty, and environmental degradation, to the 240 million people “on the move” International migrants – 168 million International migrants – 168 million Refugees, including Palestinians – 16 million Refugees, including Palestinians – 16 million Internally displaced due to conflict or persecution (25 million) or natural disasters and other causes (30 million) Internally displaced due to conflict or persecution (25 million) or natural disasters and other causes (30 million) Asylum seekers – 940,000 Asylum seekers – 940,000

Atomic Weapons - History Hiroshima, August 6, 1945 Hiroshima, August 6, 1945 “The day that humanity started taking its final exam” – Buckminster Fuller “The day that humanity started taking its final exam” – Buckminster Fuller 15 kiloton bomb, 140,000 deaths 15 kiloton bomb, 140,000 deaths Nagasaki, August 9, 1945 Nagasaki, August 9, 1945 22 kiloton bomb, 70,000 casualties 22 kiloton bomb, 70,000 casualties

The Hiroshima Bomb

Atomic Explosion

Atomic Weapons – Other Victims Hundreds of thousands of hibakusha – atomic bomb survivors Hundreds of thousands of hibakusha – atomic bomb survivors 80,000 cancers (15,000 fatal) in US citizens as a result of fallout from atmospheric testing 80,000 cancers (15,000 fatal) in US citizens as a result of fallout from atmospheric testing NCI/CDC NCI/CDC

Atomic Weapons – Other Victims Thousands of illnesses and deaths, higher CA risk in 600,000 former employees Thousands of illnesses and deaths, higher CA risk in 600,000 former employees - DOE Bush administration trying to limit payments mandated by Congress in 2001 ($150,000 plus lifetime medical benefits) Bush administration trying to limit payments mandated by Congress in 2001 ($150,000 plus lifetime medical benefits)

Atomic Weapons Today 20,000 nuclear weapons 20,000 nuclear weapons Several thousand megatons (100,000 Hiroshimas) Several thousand megatons (100,000 Hiroshimas) GW Bush - Nuclear Posture Review GW Bush - Nuclear Posture Review Possible targets: Russia, China, Iran, Iraq, Libya, North Korea, and Syria Possible targets: Russia, China, Iran, Iraq, Libya, North Korea, and Syria First strike First strike

Atomic Weapons Today US and Russia have 13,000 actively deployed warheads US and Russia have 13,000 actively deployed warheads 2500 (US) and 2000 (Russia) on high alert 2500 (US) and 2000 (Russia) on high alert Fired within 15 minutes, reach targets in 30 minutes Fired within 15 minutes, reach targets in 30 minutes Vastly redundant arsenal Vastly redundant arsenal 150-200 weapons adequate to destroy all major urban centers in Russia 150-200 weapons adequate to destroy all major urban centers in Russia

Atomic Weapons Today Accidental intermediate-sized launch of weapons from a single Russian submarine would immediately kill 6.8 million Americans in 8 cities

Nuclear Weapons – Oops! Pentagon: 32 nuclear weapons accidents since 1950 Pentagon: 32 nuclear weapons accidents since 1950 GAO: 233 GAO: 233 Since 1950, 10 nuclear weapons lost and never recovered Since 1950, 10 nuclear weapons lost and never recovered All laying on seabed, potentially leaking radioactivity All laying on seabed, potentially leaking radioactivity

Effects of a Nuclear Explosion Immediate: Immediate: Vaporized by thermal radiation Vaporized by thermal radiation Crushed by blast wave Crushed by blast wave Burned and suffocated by firestorm Burned and suffocated by firestorm

Effects of a Nuclear Explosion Intermediate: Intermediate: Suffering, painful deaths Suffering, painful deaths Health care personnel/resources overwhelmed Health care personnel/resources overwhelmed Famine Famine Refugees Refugees Devastated transportation infrastructure Devastated transportation infrastructure

Effects of a Nuclear Explosion Late effects: Late effects: Cancer Cancer Psychological trauma (PTSD, anxiety, depression) Psychological trauma (PTSD, anxiety, depression) nuclear winter (mass starvation due to disruption of agricultural, transportation, industrial and health care systems) nuclear winter (mass starvation due to disruption of agricultural, transportation, industrial and health care systems)

Effects of a 20 megaton nuclear explosion Ground zero - 2 miles: Ground zero - 2 miles: Within 1/100 second fireball hotter than sun; everything vaporized Within 1/100 second fireball hotter than sun; everything vaporized 2 - 4 miles: 2 - 4 miles: 25 psi pressures; 650 mph winds 25 psi pressures; 650 mph winds Buildings ripped apart and leveled Buildings ripped apart and leveled

Effects of a 20 megaton nuclear explosion 4 - 10 miles: 4 - 10 miles: 7 – 10 psi; 200 mph winds 7 – 10 psi; 200 mph winds Sheet metal melts; concrete buildings heavily damaged (all others leveled) Sheet metal melts; concrete buildings heavily damaged (all others leveled) 16 miles: 16 miles: 100 mph winds, firestorm, T = 1400° C 100 mph winds, firestorm, T = 1400° C 100% mortality 100% mortality

Effects of a 20 megaton nuclear explosion 21 miles: 21 miles: 2 psi; 100 mph winds 2 psi; 100 mph winds Shattered glass, flying debri Shattered glass, flying debri 29 miles: 29 miles: 3° burns over all exposed skin 3° burns over all exposed skin 40 miles: 40 miles: Retinal burns blind all who witness explosion Retinal burns blind all who witness explosion

Effects of a 20 megaton nuclear explosion over Boston Death toll: Death toll: 1,000,000 within minutes 1,000,000 within minutes 1,800,000 survivors: 1,800,000 survivors: 1,100,000 fatally injured 1,100,000 fatally injured 500,000 with major injuries 500,000 with major injuries 200,000 without injuries 200,000 without injuries

Types of Injuries Burns Burns Blindings Blindings Deafenings Deafenings PTX PTX Fxs Fxs Shrapnel wounds Shrapnel wounds

Radiation Sickness Very high dose: cerebral edema, N/V/D, speech and gait difficulties, convulsions, coma, death within 1-2 days Very high dose: cerebral edema, N/V/D, speech and gait difficulties, convulsions, coma, death within 1-2 days Medium doses: N/V/D → resolves → recurrent hematemesis, bloody D → majority die Medium doses: N/V/D → resolves → recurrent hematemesis, bloody D → majority die Low doses: BM failure, infections, bleeding, sores, ± death Low doses: BM failure, infections, bleeding, sores, ± death

Effects on health professionals 70% killed or fatally wounded 70% killed or fatally wounded 15% injured 15% injured < 1000 survive < 1000 survive

Effects on health care system Most major hospitals destroyed Most major hospitals destroyed EMS system debilitated EMS system debilitated No X-ray machines, electricity, water, antibiotics or other meds, blood/plasma, bandages No X-ray machines, electricity, water, antibiotics or other meds, blood/plasma, bandages 2000 burn unit beds in US (100 per major city) – essentially destroyed 2000 burn unit beds in US (100 per major city) – essentially destroyed

Effects on Health Care System 1500 patients/doctor 1500 patients/doctor 10 min/pt 10 min/pt 4 hours sleep/noc 4 hours sleep/noc 2 weeks to see all injured 2 weeks to see all injured

Ultimate Outcomes Boston (pop. 2.8 million in 1998) Boston (pop. 2.8 million in 1998) > 2.5 million dead after one month > 2.5 million dead after one month More than 6x as many Americans as died in WW II More than 6x as many Americans as died in WW II

Health hazards of the Nuclear Cycle Ecosystem degradation: e.g., Bikini Island Ecosystem degradation: e.g., Bikini Island Uranium mining: 5-fold increase in lung cancer Uranium mining: 5-fold increase in lung cancer Depleted uranium: Depleted uranium: increased stillbirths, birth defects, childhood leukemias, other cancers in Southern Iraq increased stillbirths, birth defects, childhood leukemias, other cancers in Southern Iraq Possible increase in lung CA in U.S. soldiers (data sparse) Possible increase in lung CA in U.S. soldiers (data sparse)

Nuclear Waste Disposal On-site storage: On-site storage: 118 commercial reactors 118 commercial reactors 10 weapons plants 10 weapons plants 37 research reactors 37 research reactors

Nuclear Waste Disposal Skull Valley, Goshute Indian Reservation, Utah Skull Valley, Goshute Indian Reservation, Utah Private fuel storage consortium Private fuel storage consortium Temporary storage of 44,000 tons of high- level nuclear waste Temporary storage of 44,000 tons of high- level nuclear waste Bribes to tribes; environmental injustice Bribes to tribes; environmental injustice Waste Isolation Pilot Plant, New Mexico Waste Isolation Pilot Plant, New Mexico Defense Dept. waste Defense Dept. waste

Nuclear Waste Disposal – Yucca Mountain On DOE land claimed by Western Shoshone Nation under the Ruby Valley Treaty of 1863 On DOE land claimed by Western Shoshone Nation under the Ruby Valley Treaty of 1863 100 miles from Las Vegas 100 miles from Las Vegas Near aquifer and earthquake fault Near aquifer and earthquake fault

Nuclear Waste Disposal – Yucca Mountain Est. 100,000 shipments of 70,000 – 120,000 tons of waste over 25 yrs Est. 100,000 shipments of 70,000 – 120,000 tons of waste over 25 yrs Coming within ½ mile of 50 million Americans Coming within ½ mile of 50 million Americans Est. 200-350 accidents Est. 200-350 accidents Nuclear roulette Nuclear roulette

Nuclear Power Plants 103 plants in US 103 plants in US Aging, equipment failures (8 from 3/00- 4/01 → shutdowns) Aging, equipment failures (8 from 3/00- 4/01 → shutdowns) 440 plants worldwide (generate 16% of planet’s electricity) 440 plants worldwide (generate 16% of planet’s electricity) 60 plants in Russia 60 plants in Russia ? Condition, safety ? Condition, safety

Nuclear Power Supply of uranium for fission to run out by 2050 Supply of uranium for fission to run out by 2050 Alternate sources: Alternate sources: MOX (mixed oxide) fuel (reprocessed spent fuel – plutonium and uranium) MOX (mixed oxide) fuel (reprocessed spent fuel – plutonium and uranium) Breeder reactors – make more fuel (plutonium) than they consume Breeder reactors – make more fuel (plutonium) than they consume Fission – currently impractical Fission – currently impractical

Nuclear Power Plants For every US plant that has its license renewed, 12 additional cancer deaths (NRC) For every US plant that has its license renewed, 12 additional cancer deaths (NRC) Plus any deaths from accidents, non-routine releases, high level waste and spent fuel Plus any deaths from accidents, non-routine releases, high level waste and spent fuel Chernobyl: Chernobyl: 50 deaths (among highly exposed emergency workers) 50 deaths (among highly exposed emergency workers) 4000 thyroid cancers (most have survived) 4000 thyroid cancers (most have survived) Expected 3940 deaths from radiation-induced cancers Expected 3940 deaths from radiation-induced cancers Greatest problem anxiety Greatest problem anxiety

Nuclear Power Plants Nuclear power industry receives $10 billion/yr in taxpayer subsidies Nuclear power industry receives $10 billion/yr in taxpayer subsidies Precautionary principle Precautionary principle

Nuclear Power Plants

Nuclear Terrorism Attack on nuclear power plant or other nuclear installation Attack on nuclear power plant or other nuclear installation 47% of nuclear plants failed to repel mock terrorist attacks conducted by the NRC in the 1990s 47% of nuclear plants failed to repel mock terrorist attacks conducted by the NRC in the 1990s Dirty bomb Dirty bomb Potential tens to hundreds of thousands of deaths, billions of dollars of damage, chaos Potential tens to hundreds of thousands of deaths, billions of dollars of damage, chaos Numerous radiation sources left over from Cold War in post-Soviet countries Numerous radiation sources left over from Cold War in post-Soviet countries

Nuclear Terrorism Collapse of Soviet Union –15,000 nuclear warheads and enough highly-enriched uranium and plutonium to make 60,000 more Collapse of Soviet Union –15,000 nuclear warheads and enough highly-enriched uranium and plutonium to make 60,000 more More than 90% of Russia’s fissile materials are located in 171 buildings, only 11 of which have been fully secured More than 90% of Russia’s fissile materials are located in 171 buildings, only 11 of which have been fully secured 175 cases of nuclear trafficking from 1993 – 2001 (NRC) 175 cases of nuclear trafficking from 1993 – 2001 (NRC)

Nuclear Terrorism Reports of weapons missing from Soviet arsenal Reports of weapons missing from Soviet arsenal Non-proliferation efforts, including the DOE’s Nuclear Cities Initiative, get a fraction of 1% of the defense budget, further cuts planned Non-proliferation efforts, including the DOE’s Nuclear Cities Initiative, get a fraction of 1% of the defense budget, further cuts planned The Nth Country experiment (1964): 3 science post-docs with no nuclear know-how designed a working atom bomb The Nth Country experiment (1964): 3 science post-docs with no nuclear know-how designed a working atom bomb

Chemical Weapons 428 BC – Athenians and Spartans burned wax, pitch and sulfur 428 BC – Athenians and Spartans burned wax, pitch and sulfur Davinci – arsenic and sulfur shells Davinci – arsenic and sulfur shells WW I WW I Italians vs. Ethiopians Italians vs. Ethiopians Japanese vs. Chinese Japanese vs. Chinese Germans vs. Allies Germans vs. Allies Franz Haber – chlorine gas Franz Haber – chlorine gas 91,000 deaths and 1.3 million injuries 91,000 deaths and 1.3 million injuries

Chemical Weapons Egypt vs. South Yemen (1963-7) Egypt vs. South Yemen (1963-7) Iran/Iraq War (1980s) Iran/Iraq War (1980s) Gulf War (versus Kurds, ? Others) Gulf War (versus Kurds, ? Others) 1995 Tokyo subway attack by Aum Shrinko cult using sarin 1995 Tokyo subway attack by Aum Shrinko cult using sarin 12 dead, 5000 injured or incapacitated 12 dead, 5000 injured or incapacitated

Types of Chemical Weapons Nerve gasses / paralytics Nerve gasses / paralytics E.g., sarin, VX E.g., sarin, VX S/S: paralysis (incl. resp. muscles), headache, dizziness, N/V S/S: paralysis (incl. resp. muscles), headache, dizziness, N/V Rx: ± gas masks, pretreatment with pyridostigmine, decontamination, antidotes (atropine, pralidoxime, diazepam, tropicamide) Rx: ± gas masks, pretreatment with pyridostigmine, decontamination, antidotes (atropine, pralidoxime, diazepam, tropicamide)

Types of Chemical Weapons Blistering agents: Blistering agents: E.g., sulphur mustard E.g., sulphur mustard S/S: burns, blindness, pulmonary toxicity, BM suppression, N/V/D S/S: burns, blindness, pulmonary toxicity, BM suppression, N/V/D Rx: decontamination, analgesia, pulmonary and eye care Rx: decontamination, analgesia, pulmonary and eye care

Types of Chemical Weapons Pulmonary toxicants Pulmonary toxicants E.g., chlorine, phosgene E.g., chlorine, phosgene S/S: pneumonitis, laryngeal spasm, pulmonary edema, ARDS S/S: pneumonitis, laryngeal spasm, pulmonary edema, ARDS Rx: O2, bronchodilators, corticosteroids, ?ibuprofen, ?acetylcysteine Rx: O2, bronchodilators, corticosteroids, ?ibuprofen, ?acetylcysteine

Chemical Weapons: Vietnam and Napalm

Chemical Weapons 1972 Biological and Toxic Weapons Convention prohibits development, production, and stockpiling 1972 Biological and Toxic Weapons Convention prohibits development, production, and stockpiling 1989 stockpiles: 1989 stockpiles: US – 36,000 tons US – 36,000 tons Russia – 270,000 tons (1/2 = nerve gas) Russia – 270,000 tons (1/2 = nerve gas)

Other Chemical Weapons: Tear gas Use in civil and political unrest Use in civil and political unrest Causes eye, skin and pulmonary toxicity, N/V, photophobia and headache, trauma due to blast Causes eye, skin and pulmonary toxicity, N/V, photophobia and headache, trauma due to blast Rx: wash skin, flush eyes, IVF, humidified O2, bronchodilators prn, ±prophylactic antibiotics Rx: wash skin, flush eyes, IVF, humidified O2, bronchodilators prn, ±prophylactic antibiotics

Other Chemical Weapons: Pepper Spray Derived from cayenne peppers (contains 10-15% oleoresin capsicum) Derived from cayenne peppers (contains 10-15% oleoresin capsicum) 1.5-2 million Scoville unit heat rating 1.5-2 million Scoville unit heat rating Jalapeño pepper = 2500-5000 Scoville units Jalapeño pepper = 2500-5000 Scoville units Habañero pepper (world’s hottest) = 300,000 Scoville units Habañero pepper (world’s hottest) = 300,000 Scoville units Use in civil and political unrest Use in civil and political unrest

Other Chemical Weapons Calmatives: mind-altering or sleep- inducing weapons (benzo-, SSRI-, and anesthetic derivatives) Calmatives: mind-altering or sleep- inducing weapons (benzo-, SSRI-, and anesthetic derivatives) Cramp-inducing agents Cramp-inducing agents Stink bombs (“?Race specific?”) Stink bombs (“?Race specific?”) Colored smoke as an obscurant Colored smoke as an obscurant Crowd control vs use in warfare Crowd control vs use in warfare US pilot amphetamine use US pilot amphetamine use

Biological Weapons - History Sixth Century BC: Assyrians poison wells with rye ergot Sixth Century BC: Assyrians poison wells with rye ergot 300 BC: Greeks pollute wells 300 BC: Greeks pollute wells Later: Romans and Persians, Classical, Medieval and Renaissance periods, US Civil War (General Johnson at Vicksburg) Later: Romans and Persians, Classical, Medieval and Renaissance periods, US Civil War (General Johnson at Vicksburg) 14 th Century: Tatars catapulting plague- infested corpses 14 th Century: Tatars catapulting plague- infested corpses

Biological Weapons - History Koch’s postulates: anthrax – first linkage of a specific disease with a specific pathogen Koch’s postulates: anthrax – first linkage of a specific disease with a specific pathogen Louis Pasteur: anthrax and cholera vaccines Louis Pasteur: anthrax and cholera vaccines

Biological Weapons - History Sir Jeffrey Amherst (French and Indian Wars - smallpox): “You would do well to try to inoculate the Indians, by means of blankets, … to extirpate this execrable race” Sir Jeffrey Amherst (French and Indian Wars - smallpox): “You would do well to try to inoculate the Indians, by means of blankets, … to extirpate this execrable race” WW I: Cholera, plague, glanders, anthrax WW I: Cholera, plague, glanders, anthrax

Biological Weapons – WW II Unit 731, Manchuria, Shiro Ishii Unit 731, Manchuria, Shiro Ishii British “Operation Vegetarian” (anthrax cakes / Germany) British “Operation Vegetarian” (anthrax cakes / Germany) US military personnel received typhoid, smallpox, yellow fever and tetanus vaccines US military personnel received typhoid, smallpox, yellow fever and tetanus vaccines Those who refused subject to court martial Those who refused subject to court martial c.f., Gulf War – pyridostigmine, botulism vaccine c.f., Gulf War – pyridostigmine, botulism vaccine

Biological Weapons – WW II Unlicensed yellow fever vaccine contaminated with hepatitis B Unlicensed yellow fever vaccine contaminated with hepatitis B 330,000 infections 330,000 infections 51,000 cases of symptomatic hep B 51,000 cases of symptomatic hep B Long term outcomes good Long term outcomes good

Biological Weapons Post WWII Swerdlosk Swerdlosk Zimbabwe Zimbabwe False alarms False alarms

Biological Weapons Today 17 countries possess (+ Al Qaeda?) 17 countries possess (+ Al Qaeda?) US role in supplying other nations: US role in supplying other nations: e.g., 1985-1989: US companies sold to Iraq: e.g., 1985-1989: US companies sold to Iraq: Bacillus anthracis, Clostridium botulinum, Histoplasma capsulatum, Brucella melitensis, Clostsridium perfringens, Clostridium tetani, and E. coli Bacillus anthracis, Clostridium botulinum, Histoplasma capsulatum, Brucella melitensis, Clostsridium perfringens, Clostridium tetani, and E. coli Despite evidence of use of chemical weapons against Kurds Despite evidence of use of chemical weapons against Kurds

Biological Weapons Today 1972 Biological Weapons Protocol: signed by 158 nations 1972 Biological Weapons Protocol: signed by 158 nations Lacks adequate enforcement mechanisms Lacks adequate enforcement mechanisms US has rejected enforcement (wary of foreign inspectors discovering military secrets and/or trade secrets of biotechnology and pharmaceutical companies) US has rejected enforcement (wary of foreign inspectors discovering military secrets and/or trade secrets of biotechnology and pharmaceutical companies)

Biological Weapons - Agents AnthraxBrucellosisCholera GlandersPneumonic plague TularemiaQ FeverSmallpox Venezuelan Equine Encephalitis Viral Hemorrhagic Fevers (e.g., Ebola) BotulismStaph enterotoxin B RicinMycxotoxins

Biological Weapons Today Genetic weapons – targeted at specific ethnic groups Genetic weapons – targeted at specific ethnic groups 1999: FBI – “at least once a day a politician, school, abortion clinic, or other controversial person or institution receives an envelope from a dissident containing a powder and a note announcing a lethal dose of anthrax” 1999: FBI – “at least once a day a politician, school, abortion clinic, or other controversial person or institution receives an envelope from a dissident containing a powder and a note announcing a lethal dose of anthrax”

Biological Weapons Today Use, along with chemical weapons, in “The Drug War”: Use, along with chemical weapons, in “The Drug War”: Fusarium oxysporum fungus to eradicate coca pants in Columbia; Fusarium oxysporum and Pleaspora papaveracea fungus to eradicate opium poppies in Central Asia Fusarium oxysporum fungus to eradicate coca pants in Columbia; Fusarium oxysporum and Pleaspora papaveracea fungus to eradicate opium poppies in Central Asia ? Marijuana ? Marijuana Food crops also destroyed Food crops also destroyed US, UN Drug Control Program, others US, UN Drug Control Program, others

Biological Weapons Today Quarantine Issues: Quarantine Issues: Quarantine versus Isolation Quarantine versus Isolation National versus foreign outbreaks / border control National versus foreign outbreaks / border control Adverse consequences – increased risk of disease transmission in quarantined population, violence, mistrust of government, ethnic bias Adverse consequences – increased risk of disease transmission in quarantined population, violence, mistrust of government, ethnic bias

Smallpox DNA virus; decimated native American populations; eradicated by WHO vaccination campaign in 1972; genome sequenced DNA virus; decimated native American populations; eradicated by WHO vaccination campaign in 1972; genome sequenced ?Only remaining viral stocks at CDCP and in Siberia? ?Only remaining viral stocks at CDCP and in Siberia? WHO Executive Board recommended retaining stores WHO Executive Board recommended retaining stores

Smallpox Incubation period 7-17 days (avg. = 12) Incubation period 7-17 days (avg. = 12) Spread by droplet infection; highly contagious Spread by droplet infection; highly contagious Symptoms: abrupt onset of F/HA/myalgias → non-specific erythematous rash (most prominent on face and extremities, simultaneous; varicella – most prominent on trunk, successive waves) → MSOF → death Symptoms: abrupt onset of F/HA/myalgias → non-specific erythematous rash (most prominent on face and extremities, simultaneous; varicella – most prominent on trunk, successive waves) → MSOF → death

Smallpox Dx: clinical, EM of vesicular fluid Dx: clinical, EM of vesicular fluid Rx: isolation, post-exposure vaccination, supportive care, ?antivirals Rx: isolation, post-exposure vaccination, supportive care, ?antivirals 30 % fatality rate 30 % fatality rate

Smallpox

Smallpox Vaccination Vaccinia Vaccinia US ended in 1972 US ended in 1972 Waning (?negligible) immunity Waning (?negligible) immunity Effects: local reaction. Lymphadenopathy Effects: local reaction. Lymphadenopathy Side effects: postvaccinial encephalitis (1/300,000), progressive vaccinia; eczema vaccinatum, generalized vaccinia Side effects: postvaccinial encephalitis (1/300,000), progressive vaccinia; eczema vaccinatum, generalized vaccinia Vaccinia immune globulin may modulate Vaccinia immune globulin may modulate

Smallpox Vaccination Acambis and subcontractor Baxter Int’l. - $428 million contract to produce 155 million doses of smallpox vaccine by the end of 2002 Acambis and subcontractor Baxter Int’l. - $428 million contract to produce 155 million doses of smallpox vaccine by the end of 2002 Would bring total to 286 million (enough for every American) Would bring total to 286 million (enough for every American) Fed govt has ordered 209 million doses from a British company Fed govt has ordered 209 million doses from a British company

Smallpox Vaccination Current recommendation: isolation and vaccination / VIG for close contacts Current recommendation: isolation and vaccination / VIG for close contacts Vaccination of all US citizens not feasible: Vaccination of all US citizens not feasible: Inadequate supplies Inadequate supplies Several hundred deaths Several hundred deaths ? Diversion of resources from usual childhood vaccines ? Diversion of resources from usual childhood vaccines ? vaccinate health professionals, public servants ? vaccinate health professionals, public servants Infectivity, disability, workman’s comp issues Infectivity, disability, workman’s comp issues

Anthrax Bacillus anthracis, aerobic, G+, spore- forming rod Bacillus anthracis, aerobic, G+, spore- forming rod Zoonosis Zoonosis Invisible and odorless when aerosolized Invisible and odorless when aerosolized

Anthrax 1979 accidental release at Swerdlosk (USSR): 250 cases, 100 deaths, town abandoned due to contamination 1979 accidental release at Swerdlosk (USSR): 250 cases, 100 deaths, town abandoned due to contamination Aum Shrinko cult attempted aerosol dispersal – unsuccessful Aum Shrinko cult attempted aerosol dispersal – unsuccessful

Anthrax Est. 50kg release over urban center of 5 million people would sicken 250K and kill 100K Est. 50kg release over urban center of 5 million people would sicken 250K and kill 100K 100 kg release would have the same # of casualties as a hydrogen bomb explosion 100 kg release would have the same # of casualties as a hydrogen bomb explosion

Cutaneous Anthrax 2000 cases/yr worldwide 2000 cases/yr worldwide Due to exposure to infected animals / animal products Due to exposure to infected animals / animal products Epidemic in Zimbabwe, 1989-1995: 10,000 cases Epidemic in Zimbabwe, 1989-1995: 10,000 cases

Cutaneous Anthrax Incubation period 1-10 days (avg. = 5) Incubation period 1-10 days (avg. = 5) Pruritic macule or papule day 1 Pruritic macule or papule day 1 Round ulcer day 2 Round ulcer day 2 Black eschar follows; resolves over 1-2 weeks Black eschar follows; resolves over 1-2 weeks Painful lymphadenopathy Painful lymphadenopathy

Cutaneous Anthrax Antibiotic Rx (doxy, cipro, pcn) decreases likelihood of systemic disease Antibiotic Rx (doxy, cipro, pcn) decreases likelihood of systemic disease Fatality rate 20% without antibiotics; rare with antibiotics Fatality rate 20% without antibiotics; rare with antibiotics Following 9/11: 11 cases Following 9/11: 11 cases

Cutaneous Anthrax - Ulcer

Cutaneous Anthrax - Eschar

Gastrointestinal Anthrax From ingestion of poorly cooked, infected meat From ingestion of poorly cooked, infected meat Oropharyngeal ulcers – LAN – edema – sepsis Oropharyngeal ulcers – LAN – edema – sepsis Terminal ileal / cecal lesion - N/V/bloody D/acute abdomen/ascites/sepsis Terminal ileal / cecal lesion - N/V/bloody D/acute abdomen/ascites/sepsis Rx: Abx (doxy, cipro, pcn), supportive care Rx: Abx (doxy, cipro, pcn), supportive care

Inhalational Anthrax Stage I: Stage I: begins 2-43 days post-exposure begins 2-43 days post-exposure F/dyspnea/cough/HA/V/Ch/weakness/AP/CP F/dyspnea/cough/HA/V/Ch/weakness/AP/CP Lasts a few hours to a few days Lasts a few hours to a few days

Inhalational Anthrax Stage II: Stage II: F/dyspnea/diaphoresis/shock F/dyspnea/diaphoresis/shock CXR with widened mediastinum due to lymphadenopathy CXR with widened mediastinum due to lymphadenopathy ±pleural effusions ±pleural effusions 50% develop hemorrhagic meningitis – meningismus, delirium and obtundation 50% develop hemorrhagic meningitis – meningismus, delirium and obtundation Rapid progression to cyanosis, hypotension and death Rapid progression to cyanosis, hypotension and death

Inhalational Anthrax Widened Mediastinum

Inhalational Anthrax

Dx: blood cultures, XR/CT, post-mortem; serology not helpful Dx: blood cultures, XR/CT, post-mortem; serology not helpful Case fatality rate approx. 50% Case fatality rate approx. 50% Rx: Rx: post-exposure antibiotics (doxycycline, ciprofloxacin, penicillin) post-exposure antibiotics (doxycycline, ciprofloxacin, penicillin) Supportive care Supportive care

Anthrax Vaccine 6 dose series 6 dose series US armed service members – approx 450K vaccinated to date US armed service members – approx 450K vaccinated to date Side effects: HA 0.4%, local rxn 3.6%, mild systemic SEs in 1% Side effects: HA 0.4%, local rxn 3.6%, mild systemic SEs in 1% Manufacturer = Bioport Manufacturer = Bioport Contract to produce 4.6 million doses for the DOD Contract to produce 4.6 million doses for the DOD

Anthrax Vaccine Pre/post exposure vaccination Pre/post exposure vaccination Improved vaccine under development Improved vaccine under development ?Groups to vaccinate? ?Groups to vaccinate?

Anthrax – The Band

Non-lethal weapons High-power microwaves (crammed into cruise missiles, discharge a huge energy pulse to damage electronics) High-power microwaves (crammed into cruise missiles, discharge a huge energy pulse to damage electronics) Soft bombs Soft bombs E.g., carbon fiber showers to short circuit electrical power grids (used in former Yugoslavia and in Gulf War I) E.g., carbon fiber showers to short circuit electrical power grids (used in former Yugoslavia and in Gulf War I)

“Non-lethal” Weapons Proposed and Under Development Acoustic Acoustic Acoustic bullets Acoustic bullets Curdler unit – shrieks, clangs Curdler unit – shrieks, clangs Infrasound – penetrates most buildings and vehicles, causes nausea, diarrhea, disorientation, internal organ damage and even death Infrasound – penetrates most buildings and vehicles, causes nausea, diarrhea, disorientation, internal organ damage and even death “Squawk box” – intolerable ultrasound pulses “Squawk box” – intolerable ultrasound pulses

“Non-lethal” Weapons Proposed and Under Development Acoustic and optical weapons Acoustic and optical weapons Photic driver – ultrasound plus stroboscopic infrared flasher to penetrate closed eyelids and cause seizures Photic driver – ultrasound plus stroboscopic infrared flasher to penetrate closed eyelids and cause seizures Psycho-correction devices – send subliminal visual and aural messages Psycho-correction devices – send subliminal visual and aural messages

“Non-lethal” Weapons Proposed and Under Development Barrier Weapons: Barrier Weapons: Slick coatings – slippery like ice Slick coatings – slippery like ice Sticky foam (used by US in Somalia) Sticky foam (used by US in Somalia) Obscurants: Obscurants: Colored smoke – felt to cause more psychological panic than white smoke Colored smoke – felt to cause more psychological panic than white smoke Markers: Markers: Fluorescent powder visible under UV light Fluorescent powder visible under UV light Sponge grenades impregnated with infrared dye Sponge grenades impregnated with infrared dye To mark targets To mark targets

“Non-lethal” Weapons Proposed and Under Development Riot Control Riot Control Invisible tear gas Invisible tear gas Electrical: Electrical: Police or soldier’s jacket which jolts anyone who touches it Police or soldier’s jacket which jolts anyone who touches it Cattle prods (malicious and accidental use by civilians) Cattle prods (malicious and accidental use by civilians)

“Non-lethal” Weapons Proposed and Under Development Biotechnical: Biotechnical: Biodegrading microbes (to destroy fuel) Biodegrading microbes (to destroy fuel) Genetic code alterations (to create less-than-lethal but long-term disablements, perhaps for generations, thereby creating a societal burden) Genetic code alterations (to create less-than-lethal but long-term disablements, perhaps for generations, thereby creating a societal burden) Neuro-implants for behavior modification Neuro-implants for behavior modification Project Agile (1996) – race-specific stink bombs Project Agile (1996) – race-specific stink bombs Pheromones (to impair human and animal reproduction; mark individuals for assaults by killer bees, other animals or pests) Pheromones (to impair human and animal reproduction; mark individuals for assaults by killer bees, other animals or pests)

“Non-lethal” Weapons Proposed and Under Development Holograms: Holograms: God/gods/other religious figures or symbols God/gods/other religious figures or symbols Soldier forces Soldier forces Death, dead comrades Death, dead comrades Others Others

Health Care System Preparedness for Weapons of Mass Destruction ¾ of US ERs not fully prepared for treating mass casualties ¾ of US ERs not fully prepared for treating mass casualties Only 12% of US hospitals have bioterrorism response measures developed and in place Only 12% of US hospitals have bioterrorism response measures developed and in place

Health Care System Preparedness for Weapons of Mass Destruction US public health / emergency care system already in disarray US public health / emergency care system already in disarray 80% of states facing budget cuts or holdbacks 80% of states facing budget cuts or holdbacks Medicaid over budget in 23 states Medicaid over budget in 23 states

Costs of Militarization US: ½ of discretionary tax dollars spent on the military US: ½ of discretionary tax dollars spent on the military US military budget represents 34% of total world military budget ($1.035 trillion in 2004) US military budget represents 34% of total world military budget ($1.035 trillion in 2004) Expected $400 billion defense budget for 2003 (excluding costs of war in Iraq) Expected $400 billion defense budget for 2003 (excluding costs of war in Iraq) 4.6% increase in spending on nuclear weapons 4.6% increase in spending on nuclear weapons 11.5% decrease in spending to prevent the spread of chemical, biological, and nuclear weapons ($773 million) 11.5% decrease in spending to prevent the spread of chemical, biological, and nuclear weapons ($773 million)

Missile Defense Shield The Militarization of Space Star Wars program proceeding, despite: Star Wars program proceeding, despite: Astronomical cost – est. $100 billion Astronomical cost – est. $100 billion Strong opposition by scientific community Strong opposition by scientific community Spectacular failures in 2/4 tests, despite highly structured conditions Spectacular failures in 2/4 tests, despite highly structured conditions Abandonment of ABM Treaty by Bush administration Abandonment of ABM Treaty by Bush administration

Missile Defense Shield The Militarization of Space “Shield” or very porous umbrella “Shield” or very porous umbrella Easily overwhelmed and fooled by inexpensive decoys Easily overwhelmed and fooled by inexpensive decoys No protection against internal accidents or terrorists bringing weapon onto US soil or “dirty bomb” No protection against internal accidents or terrorists bringing weapon onto US soil or “dirty bomb” Proposed use of moon for spy observatories and weapons Proposed use of moon for spy observatories and weapons

Dwight Eisenhower “The problem in defense spending is to figure out how far you should go without destroying from within that which you are trying to protect from without”

Meanwhile... Social Injustices Abound 46 million Americans lack health insurance 46 million Americans lack health insurance 20-25% of US children live in poverty 20-25% of US children live in poverty Homelessness, public educational system a shambles, increasing jail populations, etc. Homelessness, public educational system a shambles, increasing jail populations, etc. 2.5 billion people worldwide live in abject poverty (earn less than $500 per year, lack access to clean drinking water) 2.5 billion people worldwide live in abject poverty (earn less than $500 per year, lack access to clean drinking water)

Meanwhile... Social Injustices Abound Worldwide Worldwide poverty increasing poverty increasing maldistribution of wealth maldistribution of wealth corporatization corporatization global debt crisis global debt crisis environmental destruction and global warming environmental destruction and global warming AIDS epidemic in sub-Saharan Africa AIDS epidemic in sub-Saharan Africa

Environmental Consequences of Militarization World’s single largest polluter World’s single largest polluter 8% of global air pollution 8% of global air pollution 2-11% of raw material use 2-11% of raw material use Almost all high and low level radioactive waste Almost all high and low level radioactive waste

The US Military Owns an amount of land equal to North Korea or Kentucky (25 million acres) Owns an amount of land equal to North Korea or Kentucky (25 million acres) Much of it polluted Much of it polluted Cleanup cost estimates in the hundreds of billions Cleanup cost estimates in the hundreds of billions 2000 abandoned firing ranges 2000 abandoned firing ranges E.g., Kahoolawe E.g., Kahoolawe 60 people killed by unexploded ordnance since WWII 60 people killed by unexploded ordnance since WWII

Societal Costs of Militarization An 8.5% cut in the Pentagon’s 2003 budget could: An 8.5% cut in the Pentagon’s 2003 budget could: rebuild America’s public schools over the next 10 years - $12 billion rebuild America’s public schools over the next 10 years - $12 billion Feed and provide basic health care to all the world’s poor - $12 billion Feed and provide basic health care to all the world’s poor - $12 billion Buy health insurance for every uninsured American child - $6 billion Buy health insurance for every uninsured American child - $6 billion Military experts agree that a cut double this size would not affect our war-making powers

Health Costs of Militarization 3 hours of world arms spending = annual WHO budget 3 hours of world arms spending = annual WHO budget ½ day of world arms spending = immunization for all the world’s children ½ day of world arms spending = immunization for all the world’s children 3 days of US arms spending = amount spent on health, education and welfare programs for US children in one year 3 days of US arms spending = amount spent on health, education and welfare programs for US children in one year

Health Costs of Militarization 3 weeks of world arms spending = primary health care for all in poor countries, including safe drinking water and full immunizations 3 weeks of world arms spending = primary health care for all in poor countries, including safe drinking water and full immunizations Brain drain: 2/3 of US scientists work in military-industrial complex Brain drain: 2/3 of US scientists work in military-industrial complex

Skewed Priorities The world spends $780 billion/year on military goods and services The world spends $780 billion/year on military goods and services For 30% of this, we could: For 30% of this, we could: Eliminate starvation and malnutrition Eliminate starvation and malnutrition Provide shelter for all Provide shelter for all Eliminate illiteracy Eliminate illiteracy Provide clean and safe water Provide clean and safe water Prevent soil erosion Prevent soil erosion

Skewed Priorities Prevent global warming Prevent global warming Stop deforestation Stop deforestation Aid all refugees Aid all refugees Retire developing nations’ debt Retire developing nations’ debt Provide clean, safe energy (through efficiency and renewables) Provide clean, safe energy (through efficiency and renewables)

Skewed Priorities Prevent acid rain Prevent acid rain Fix the ozone hole Fix the ozone hole Stabilize world population Stabilize world population Provide basic universal health care and AIDS control Provide basic universal health care and AIDS control Eliminate nuclear weapons and land mines Eliminate nuclear weapons and land mines

Dwight Eisenhower “Every gun that is made, every rocket fired, signifies in the final sense a theft from those who hunger and are not fed, those who are cold and not clothed”

Dwight Eisenhower “This world is not spending money alone. It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children. This is not a way of life at all, in any true sense. Under the cloud of threatening war, it is humanity hanging from a cross of iron.”

Martin Luther King “A nation that continues year after year to spend more money on military defense than on programs of social uplift is approaching spiritual death.”

US Foreign Aid US ranks 21 st in the world in foreign aid as a percentage of GDP (0.7%, versus UN recommended 0.15%) US ranks 21 st in the world in foreign aid as a percentage of GDP (0.7%, versus UN recommended 0.15%) Foreign Aid: Foreign Aid: 1/3 military 1/3 military 1/3 economic 1/3 economic 1/3 food and development 1/3 food and development US world’s second largest arms exporter US world’s second largest arms exporter

Top Pentagon Prime Contractors Fiscal Year 2001 General Dynamics General Dynamics United Technologies United Technologies TRW TRW SAIC SAIC General Electric General Electric Owns NBC; Westinghouse used to own CBS Owns NBC; Westinghouse used to own CBS Effect on news reporting? Effect on news reporting?

Top Pentagon Prime Contractors Fiscal Year 2001 Lockeed Lockeed Boeing Boeing Newport News Shipbuilding Newport News Shipbuilding Raytheon Raytheon Northrup Gruman Northrup Gruman

September 11, 2001

World Trade Center Bombing 3300 fatalities - foreign nationals outnumbered Americans 3300 fatalities - foreign nationals outnumbered Americans Environmental health consequences unknown: Environmental health consequences unknown: 300-400 tons asbestos 300-400 tons asbestos 130,000 gallons of transformer oil contaminated with PCBS 130,000 gallons of transformer oil contaminated with PCBS Lead, sulfuric acid, silicon Lead, sulfuric acid, silicon Fine dust particles Fine dust particles

September 11, 2001 Pentagon: 286 casualties Pentagon: 286 casualties Pennsylvania: approximately 100 casualties Pennsylvania: approximately 100 casualties

The War on Terror (The War on Afghanistan, Iraq, and ?) “May last 50 or more years” – CheneyAfghanistan: Ruled by repressive Ruled by repressive human-(women’s-)rights abusingTaliban Potential transit route for oil and gas pipeline from Central Asia Potential transit route for oil and gas pipeline from Central Asia Strategic importance in Middle East Strategic importance in Middle East

Afghanistan Population = 27 million Population = 27 million Life expectancy = 46 years Life expectancy = 46 years Literacy rate = 32% Literacy rate = 32% Avg. annual income = $280 Avg. annual income = $280

Afghanistan Negligible infrastructure secondary to decades of civil war Negligible infrastructure secondary to decades of civil war 1 of every 230 persons is a land mine amputee 1 of every 230 persons is a land mine amputee Infant mortality = 146/1000 Infant mortality = 146/1000 50% of children malnourished; 33% are orphans 50% of children malnourished; 33% are orphans

The War in Afghanistan Estimated 6000 civilians killed Estimated 6000 civilians killed Up to 5 million refugees in border states, many more internal refugees Up to 5 million refugees in border states, many more internal refugees 9000 US troops remain 9000 US troops remain Bin Laden not caught Bin Laden not caught US abandoning commitment to rebuilding US abandoning commitment to rebuilding Bush: war “yes”, nation building “no” Bush: war “yes”, nation building “no”

Afghanistan/Iraq Parallels 10 years of sanctions, bombings resulting in 500,000 to 1,000,000 deaths (per UN) 10 years of sanctions, bombings resulting in 500,000 to 1,000,000 deaths (per UN) UN Devt. Index 126/174 UN Devt. Index 126/174 Infant mortality rates jumped from 65/1000 (pre-Gulf War I) to 103/1000 (2003) Infant mortality rates jumped from 65/1000 (pre-Gulf War I) to 103/1000 (2003) Life expectancy decreased from 62 to 56 Life expectancy decreased from 62 to 56

Afghanistan/Iraq Parallels Literacy decreased from 89% to 57% Literacy decreased from 89% to 57% Infrastructure devastated, Environment degraded Infrastructure devastated, Environment degraded Rebuilding post-war? Rebuilding post-war? Bush’s 2003 budget does not even request the money the US promised Afghanistan for rebuilding Bush’s 2003 budget does not even request the money the US promised Afghanistan for rebuilding

What goes around comes around 1980s: CIA arms Afghan rebels with hundreds of Stinger missiles 1980s: CIA arms Afghan rebels with hundreds of Stinger missiles Late 2002: Terrorists using a similar Russian- made version of Stinger almost bring down Israeli passenger airline over Kenya Late 2002: Terrorists using a similar Russian- made version of Stinger almost bring down Israeli passenger airline over Kenya CIA trying to buy back, but most unaccounted for CIA trying to buy back, but most unaccounted for Can shoot down a plane at up 6000-8000 feet Can shoot down a plane at up 6000-8000 feet 24 diverted to Iran 24 diverted to Iran

Before Gulf War I US sells weapons to Iraq/Hussein US sells weapons to Iraq/Hussein Including components to produce WMDs Including components to produce WMDs Rumsfeld visits Baghdad to promote US weapons sales Rumsfeld visits Baghdad to promote US weapons sales US minimally perturbed when Hussein gasses 4000 Kurds, torpedoes US naval vessel US minimally perturbed when Hussein gasses 4000 Kurds, torpedoes US naval vessel

Gulf War I 105,000 military and 110,000 civilian deaths (almost all Iraqis) 105,000 military and 110,000 civilian deaths (almost all Iraqis) 2/3 of US casualties from “friendly fire” 2/3 of US casualties from “friendly fire” Cost $61 billion ($82 billion in 2003 dollars) Cost $61 billion ($82 billion in 2003 dollars) US pays only 10% of costs (most from Saudi Arabia, Kuwait, Germany and Japan) US pays only 10% of costs (most from Saudi Arabia, Kuwait, Germany and Japan) Environmental devastation Environmental devastation $48 billion in claims to UN $48 billion in claims to UN

Kuwaiti Oil Fires

Gulf War II 48,000 – 260,000 deaths predicted during conflict 48,000 – 260,000 deaths predicted during conflict 20,000 deaths from potential resultant civil war 20,000 deaths from potential resultant civil war Up to 200,000 post-war deaths Up to 200,000 post-war deaths Est. 900,000 refugees Est. 900,000 refugees Massive humanitarian crisis Massive humanitarian crisis

Gulf War II Financial cost of war: $100 billion - $200 billion Financial cost of war: $100 billion - $200 billion $810 million to $16.2 billion to Oregon $810 million to $16.2 billion to Oregon US likely to bear majority of costs US likely to bear majority of costs Cost of rebuilding: $50 billion Cost of rebuilding: $50 billion Global travel industry expected to lose $460 billion Global travel industry expected to lose $460 billion Distraction from North Korea, other threats Distraction from North Korea, other threats Shock and awe battle plan: targeting infrastructure explicitly prohibited by the Geneva Conventions Shock and awe battle plan: targeting infrastructure explicitly prohibited by the Geneva Conventions

George W Bush’s Military Record February, 1968: States desire to be pilot; scores in 25 th percentile in pilot aptitude section of Air Force officers test. February, 1968: States desire to be pilot; scores in 25 th percentile in pilot aptitude section of Air Force officers test. May, 1968: Enlists in Texas Air National Guard; jumps list with assistance of Texas House Speaker; pledges two years of active duty and four years of reserve duty May, 1968: Enlists in Texas Air National Guard; jumps list with assistance of Texas House Speaker; pledges two years of active duty and four years of reserve duty

George W Bush’s Military Record June, 1968: Student deferment expires June, 1968: Student deferment expires September, 1968: Pulls inactive duty to serve on Florida Senator’s re-election campaign September, 1968: Pulls inactive duty to serve on Florida Senator’s re-election campaign November, 1968: Re-activated November, 1968: Re-activated

George W Bush’s Military Record November, 1970: Promoted to First Lieutenant, rejected by UT Law School November, 1970: Promoted to First Lieutenant, rejected by UT Law School Spring, 1970: Hired by Texas agricultural importer to shuttle plants to/from Florida Spring, 1970: Hired by Texas agricultural importer to shuttle plants to/from Florida June, 1970: Joins Guard’s “Champagne Unit,” flying with sons of Texas’ elite June, 1970: Joins Guard’s “Champagne Unit,” flying with sons of Texas’ elite

George W Bush’s Military Record May, 1972: Transfers to Alabama Guard unit so he can work on Senator Blount’s re-election campaign May, 1972: Transfers to Alabama Guard unit so he can work on Senator Blount’s re-election campaign His commanding officer states he never showed up for duty Grounded for missing a mandatory physical Grounded for missing a mandatory physical

George W Bush’s Military Record Returns to Houston but never reports for Guard duty Returns to Houston but never reports for Guard duty December, 1972: DUI arrest December, 1972: DUI arrest October, 1973: Air National Guard relieves him from commitment 8 months early, allowing him to attend Harvard Business School October, 1973: Air National Guard relieves him from commitment 8 months early, allowing him to attend Harvard Business School

New US Nuclear Weapons Policies Under GW Bush Nuclear Posture Review – expands scope of use of nuclear weapons, including first-strike against non-nuclear states Nuclear Posture Review – expands scope of use of nuclear weapons, including first-strike against non-nuclear states Withdrawal from ABM Treaty Withdrawal from ABM Treaty Boycotted Comprehensive Nuclear Test Ban Treaty Conference Boycotted Comprehensive Nuclear Test Ban Treaty Conference Budgeted money to resume nuclear testing and development Budgeted money to resume nuclear testing and development Possible use of nuclear-powered predator drones Possible use of nuclear-powered predator drones

Phillip Berrigan “Nuclear weapons are the scourge of the earth; to mine for them, manufacture them, deploy them, use them, is a curse against God, the human family, and the earth itself.”

Disturbing Trends: The “Patriot Bill” Passed with minimal debate, most Congresspersons acknowledge not reading Passed with minimal debate, most Congresspersons acknowledge not reading Increased governmental and corporate secrecy – polluters subject to decreased public scrutiny Increased governmental and corporate secrecy – polluters subject to decreased public scrutiny Erosion of civil liberties – deportations, accused held without charge/access to legal counsel Erosion of civil liberties – deportations, accused held without charge/access to legal counsel 70,000 individuals on government’s list of suspected terrorists 70,000 individuals on government’s list of suspected terrorists

Disturbing Trends: The Homeland Security Agency The HSA absorbs two dozen agencies, 170,000 employees, $38 billion budget The HSA absorbs two dozen agencies, 170,000 employees, $38 billion budget TIPS program (citizen spying program) TIPS program (citizen spying program) Total Information Awareness System (Poindexter) Total Information Awareness System (Poindexter) Paranoia: alert levels, duct tape and plastic sheeting Paranoia: alert levels, duct tape and plastic sheeting

Special Interest Provisions in the Homeland Security Law Vaccine liability protection (incl. existing thimersol lawsuits) – Eli Lilly Vaccine liability protection (incl. existing thimersol lawsuits) – Eli Lilly US corporations setting up offshore business fronts to avoid paying taxes allowed to contract with HSD US corporations setting up offshore business fronts to avoid paying taxes allowed to contract with HSD US government prohibited from publicly releasing information related to “vulnerabilities” – incl. safety of nuclear reactors, environmental toxins, etc US government prohibited from publicly releasing information related to “vulnerabilities” – incl. safety of nuclear reactors, environmental toxins, etc

Special Interest Provisions in the Homeland Security Law Immunity from liability for manufacturers of anti-terrorism products and technologies Immunity from liability for manufacturers of anti-terrorism products and technologies Army investigations show 60-90% of soldiers’ CBW protective gear malfunctions Army investigations show 60-90% of soldiers’ CBW protective gear malfunctions Liability protection for airport screening companies Liability protection for airport screening companies Secret advisory meetings with industry permitted, even if meeting not related to national security Secret advisory meetings with industry permitted, even if meeting not related to national security C.f. Cheney’s Energy Commission C.f. Cheney’s Energy Commission

Disturbing Trends: Censorship and Propaganda US blacks out names of corporations which sold weapons to Iraq on UN inspectors’ reports US blacks out names of corporations which sold weapons to Iraq on UN inspectors’ reports Covering of Picasso’s Guernica for news conferences outside UN Security Council Covering of Picasso’s Guernica for news conferences outside UN Security Council Armed Services Edition books for soldiers: Armed Services Edition books for soldiers: WW II – the Classics to popular fiction WW II – the Classics to popular fiction Gulf War II – Henry V, Art of War, War Letters, Profiles of American Military Heroes Gulf War II – Henry V, Art of War, War Letters, Profiles of American Military Heroes

Disturbing Trends: Censorship and Propaganda “No Child Left Behind” Education Act contains amendment requiring that all public schools allow recruiters in their buildings and provide military with contact numbers and addresses for all students “No Child Left Behind” Education Act contains amendment requiring that all public schools allow recruiters in their buildings and provide military with contact numbers and addresses for all students 21st Century McCarthyism 21st Century McCarthyism

Disturbing Trends Hate crimes, intolerance Hate crimes, intolerance Media jingoism: Media jingoism: New shows planned: “Profiles From the Front Line,” “Military Diaries,” “AFP: American Fighter Pilot” New shows planned: “Profiles From the Front Line,” “Military Diaries,” “AFP: American Fighter Pilot” Army to ignore FDA safety standards in experiments on soldiers (legacy of 20 th Century crimes) Army to ignore FDA safety standards in experiments on soldiers (legacy of 20 th Century crimes)

Disturbing Trends 2000: budget surplus = $5.6 trillion 2000: budget surplus = $5.6 trillion 2003: Budget deficit = $2.1 trillion 2003: Budget deficit = $2.1 trillion Cities and states facing $68 billion budget shortfall Cities and states facing $68 billion budget shortfall Bush: “States are on their own.” Bush: “States are on their own.” Patriot II… Patriot II…

George W. Bush August 5, 2004 “Our enemies are innovative and resourceful, and so are we. They never stop thinking about new ways to harm our country and our people, and neither do we." “Our enemies are innovative and resourceful, and so are we. They never stop thinking about new ways to harm our country and our people, and neither do we."

James Madison “The fetters imposed on liberty at home have ever been forged out of the weapons provided for defense against real, pretended, or imaginary dangers from abroad.”

Samuel Johnson “Patriotism is the last refuge of a scoundrel”

Responses to Terror: Just War Theory The cause must be just The cause must be just A lawful authority must decide to resort to force A lawful authority must decide to resort to force The intention of the war must be in accord with international law The intention of the war must be in accord with international law The use of force must be a last resort The use of force must be a last resort

Responses to Terror: Just War Theory The probability of success should be high The probability of success should be high The cost-benefit ratio must be high The cost-benefit ratio must be high The means used must conform with international humanitarian law The means used must conform with international humanitarian law

How to Win Without War in Iraq Border monitoring in Jordan, Syria and Turkey Border monitoring in Jordan, Syria and Turkey Advanced X-ray scanning technology and an electronic pass system at borders Advanced X-ray scanning technology and an electronic pass system at borders Sanctions assistance missions to enforce military sanctions Sanctions assistance missions to enforce military sanctions Political assurances and economic incentives to neighboring states Political assurances and economic incentives to neighboring states

How to Win Without War in Iraq Improve cargo monitoring at port of Azqaba, Jordan (high-volume port for sea- going cargo to Iraq) Improve cargo monitoring at port of Azqaba, Jordan (high-volume port for sea- going cargo to Iraq) Create a green list of approved oil companies to purchase Iraqi oil – i.e., those not providing kickbacks to Hussein Create a green list of approved oil companies to purchase Iraqi oil – i.e., those not providing kickbacks to Hussein Require audited financial reports from oil purchasers to enforce above Require audited financial reports from oil purchasers to enforce above

How to Win Without War in Iraq Control or shut down the Syria-Iraq pipeline Control or shut down the Syria-Iraq pipeline Expose and penalize arms embargo violations Expose and penalize arms embargo violations Justice in Palestine Justice in Palestine Israel = most UN Security Council Violations Israel = most UN Security Council Violations Economic and humanitarian assistance to poor Muslim countries – build alliances, good will Economic and humanitarian assistance to poor Muslim countries – build alliances, good will Middle Eastern Marshall Plan Middle Eastern Marshall Plan Truth and Reconciliation Commissions (c.f. South Africa, El Salvador) Truth and Reconciliation Commissions (c.f. South Africa, El Salvador)

The US: Rogue Nation History: Native Americans, slavery, current excesses, disparities and injustices History: Native Americans, slavery, current excesses, disparities and injustices Co-opting Nazi and Japanese WWII scientists Co-opting Nazi and Japanese WWII scientists Minimum 277 troop deployments by the US in its 225+ year history Minimum 277 troop deployments by the US in its 225+ year history

The US: Rogue Nation Since the end of WWII, the US has bombed: Since the end of WWII, the US has bombed: China, Korea, Indonesia, Cuba, Guatemala, Congo, Peru, Vietnam, Laos, Cambodia, Nicaragua, El Salvador, Grenada, Libya, Panama, Afghanistan, Sudan, Yugoslavia, and Iraq China, Korea, Indonesia, Cuba, Guatemala, Congo, Peru, Vietnam, Laos, Cambodia, Nicaragua, El Salvador, Grenada, Libya, Panama, Afghanistan, Sudan, Yugoslavia, and Iraq

The US: Rogue Nation Conservative estimate = 8 million killed Conservative estimate = 8 million killed US invasions/bombings often largely at behest of corporate interests US invasions/bombings often largely at behest of corporate interests

The US: Rogue Nation In 2002, the US spent about $1,211 per US citizen on defense In 2002, the US spent about $1,211 per US citizen on defense vs. $2.27 per citizen on international peacekeeping efforts vs. $2.27 per citizen on international peacekeeping efforts The US maintains military bases in 69 “sovereign” nations around the world The US maintains military bases in 69 “sovereign” nations around the world

The US: Rogue Nation Continued funding of the Western Hemisphere Institute for Security Cooperation Continued funding of the Western Hemisphere Institute for Security Cooperation Formerly the School of the Americas Formerly the School of the Americas Over 60,000 graduates, including many of the worst human rights abusers in Latin America (e.g., Manuel Noriega, Omar Torrijos, and the assassins of Archbishop Oscar Romero) Over 60,000 graduates, including many of the worst human rights abusers in Latin America (e.g., Manuel Noriega, Omar Torrijos, and the assassins of Archbishop Oscar Romero) School of the Americas Watch, arrests School of the Americas Watch, arrests

International Non- Cooperation/Isolationism Failure to sign or approve: Failure to sign or approve: Kyoto Protocol on Climate Change Kyoto Protocol on Climate Change Convention on the Prohibition of Anti- Personnel Land Mines Convention on the Prohibition of Anti- Personnel Land Mines Comprehensive Nuclear Test Ban Treaty Comprehensive Nuclear Test Ban Treaty

International Non- Cooperation/Isolationism Failure to sign or approve: Failure to sign or approve: Convention on the Rights of the Child Convention on the Rights of the Child Convention on the Elimination of Discrimination Against Women Convention on Economic, Social and Cultural Rights Convention on the Elimination of Discrimination Against Women Convention on Economic, Social and Cultural Rights Convention for the Suppression of Traffic in Persons Convention for the Suppression of Traffic in Persons

International Non- Cooperation/Isolationism Failure to sign or approve: Failure to sign or approve: Protocol 1, Article 55 of the Geneva Conventions, which bans methods or means of warfare which are intended, or may be expected, to cause widespread, long-term and severe damage to the natural environment Protocol 1, Article 55 of the Geneva Conventions, which bans methods or means of warfare which are intended, or may be expected, to cause widespread, long-term and severe damage to the natural environment The Basel Convention on the Control of Transboundary Movements of Hazardous Wastes (designed to control dumping of hazardous wastes from the industrialized world in developing countries) The Basel Convention on the Control of Transboundary Movements of Hazardous Wastes (designed to control dumping of hazardous wastes from the industrialized world in developing countries)

The US: Rogue Nation Death Penalty: Death Penalty: US executes more of its citizens than any other country US executes more of its citizens than any other country Until recently, the US was the only country to execute both juveniles and the mentally ill Until recently, the US was the only country to execute both juveniles and the mentally ill Failure to follow World Court Decisions Failure to follow World Court Decisions Largest debtor to the UN (only 40% of dues paid) Largest debtor to the UN (only 40% of dues paid)

Solutions Physician activism (PSR, IPPNW, etc.) Physician activism (PSR, IPPNW, etc.) Increased education: public, medical and public health students Increased education: public, medical and public health students Tolerance and appreciation of diversity Tolerance and appreciation of diversity Conservation measures Conservation measures Assist victims of war (PHR, MSF, etc.) Assist victims of war (PHR, MSF, etc.)

Thomas Jefferson “Nothing can keep (government) right but (the people’s) vigilant and distrustful superintendence”

Harvey Cushing “A physician is obligated to consider more than a diseased organ, more even than the whole man. He must view the man in his world.”

Rudolph Virchow “Doctors are natural attorneys for the poor … If medicine is to really accomplish its great task, it must intervene in political and social life…”

The role of the doctor in society World Health Organization: World Health Organization: “The role of the physician … in the preservation and promotion of peace is the most significant factor for the attainment of health for all.” “The role of the physician … in the preservation and promotion of peace is the most significant factor for the attainment of health for all.”

Pastor Niemoller “First they came for the Jews, and I did not speak up, for I was not a Jew. Then they came for the communists, and I did not speak up, for I was not a communist. Then they came for the trade unionists, and I did not speak up, for I was not a trade unionist. Then they came for me, and there was no one left to speak up for me.”

Contact Information Public Health and Social Justice Website http://www.phsj.org martindonohoe@phsj.org

Health Consequences of War and Militarism Martin Donohoe, MD, FACP.

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