Health Consequences of War and Militarism

1
Health Consequences of War and Militarism

• Martin Donohoe, MD, FACP

2
Outline

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

3
Outline

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

4
History of War

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

5
History of war

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

6
History of war

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

7
History of War

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

8
History of War

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

9
Epidemiology of Warfare

• Deaths in war
• 17th Century 19/million population
• 18th Century 19/million population
• 19th Century 11/million population
• 20th Century 183/million population
• Increasing casualties to civilians
• 85-90 in 20th Century (vs. 10 late 19th Century)

10
War Deaths, 1945-2000
11
Legacies of Colonial Exploitation

• Christopher Columbus log entry upon meeting the
  Arawaks of the Bahamas
• Theybrought usmanythingsThey willingly
  traded everything they ownedThey do not bear
  armsThey would make fine servantsWith fifty men
  we could subjugate them all and make them do
  whatever we want.

12
Legacies of Colonial Exploitation

• Winston Churchill (speaking in favor of RAFs
  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
  terroragainst recalcitrant Arabs as an
  experiment

13
Legacies of Colonial Exploitation

• 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.

14
Contemporary Wars

• 250 wars in the 20th Century
• Incidence of war rising since 1950
• Most conflicts within poor states
• 27 separate civil wars currently underway
• 19 involve U.S.-supplied weapons

15
Contemporary Wars

• 72 million lives lost in 20th Century wars,
  another 52 million through genocides
• WW II first war with more battle deaths than
  deaths from other causes, such as accidents,
  disease, and infections

16
Vietnam War

• 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
• More US soldiers died of suicide after Vietnam
  than died in combat during the war.

17
Contemporary Wars

• 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

18
Consequences of War

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

19
Consequences of War

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

20
Atomic Weapons - History

• Hiroshima, August 6, 1945
• The day that humanity started taking its final
  exam Buckminster Fuller
• 15 kiloton bomb, 140,000 deaths
• Nagasaki, August 9, 1945
• 22 kiloton bomb, 70,000 casualties

21
The Hiroshima Bomb
22
Atomic Explosion
23
Atomic Weapons Other Victims

• Hundreds of thousands of hibakusha atomic bomb
  survivors
• 1054 U.S. nuclear tests since 1940s, 331 in
  atmosphere
• 80,000 cancers (15,000 fatal) in US citizens as a
  result of fallout from atmospheric testing
• NCI/CDC

24
Atomic Weapons Other Victims

• 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)

25
Atomic Weapons Today

• Approximately 14,000 nuclear weapons at 11 sites
  in 14 countries (1/2 active or operationally-deplo
  yed)
• 5,000 active U.S. warheads today (½ on
  hair-trigger alert) 8,000 in Russia
• Several thousand megatons (100,000 Hiroshimas)

26
Atomic Weapons Today

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

27
Atomic Weapons Today

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

28
Nuclear Weapons Oops!

• Pentagon 32 nuclear weapons accidents since 1950
• GAO 233
• Since 1950, 10 nuclear weapons lost and never
  recovered
• All laying on seabed, potentially leaking
  radioactivity

29
Effects of a Nuclear Explosion

• Immediate
• Vaporized by thermal radiation
• Crushed by blast wave
• Burned and suffocated by firestorm

30
Effects of a Nuclear Explosion

• Intermediate
• Suffering, painful deaths
• Health care personnel/resources overwhelmed
• Famine
• Refugees
• Devastated transportation infrastructure

31
Effects of a Nuclear Explosion

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

32
Effects of a 20 megaton nuclear explosion

• Ground zero - 2 miles
• Within 1/100 second fireball hotter than sun
  everything vaporized
• 2 - 4 miles
• 25 psi pressures 650 mph winds
• Buildings ripped apart and leveled

33
Effects of a 20 megaton nuclear explosion

• 4 - 10 miles
• 7 10 psi 200 mph winds
• Sheet metal melts concrete buildings heavily
  damaged (all others leveled)
• 16 miles
• 100 mph winds, firestorm, T 1400 C
• 100 mortality

34
Effects of a 20 megaton nuclear explosion

• 21 miles
• 2 psi 100 mph winds
• Shattered glass, flying debri
• 29 miles
• 3 burns over all exposed skin
• 40 miles
• Retinal burns blind all who witness explosion

35
Effects of a 20 megaton nuclear explosion over
Boston

• Death toll
• 1,000,000 within minutes
• 1,800,000 survivors
• 1,100,000 fatally injured
• 500,000 with major injuries
• 200,000 without injuries

36
Types of Injuries

• Burns
• Blindings
• Deafenings
• PTX
• Fxs
• Shrapnel wounds

37
Radiation Sickness

• 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
• Low doses BM failure, infections, bleeding,
  sores, death

38
Effects on health professionals

• 70 killed or fatally wounded
• 15 injured
• lt 1000 survive

39
Effects on health care system

• Most major hospitals destroyed
• EMS system debilitated
• 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

40
Effects on Health Care System

• 1500 patients/doctor
• 10 min/pt
• 4 hours sleep/noc
• 2 weeks to see all injured

41
Ultimate Outcomes

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

42
Health hazards of the Nuclear Cycle

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

43
Nuclear Waste Disposal

• On-site storage
• 118 commercial reactors
• 10 weapons plants
• 37 research reactors

44
Nuclear Waste Disposal

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

45
Nuclear Waste Disposal Yucca Mountain

• On DOE land claimed by Western Shoshone Nation
  under the Ruby Valley Treaty of 1863
• 100 miles from Las Vegas
• Near aquifer and earthquake fault

46
Nuclear Waste Disposal Yucca Mountain

• Est. 100,000 shipments of 70,000 120,000 tons
  of waste over 25 yrs
• Coming within ½ mile of 50 million Americans
• Est. 200-350 accidents
• Nuclear roulette
• Unlikely to occur other options being considered

47
Nuclear Power Plants

• 104 plants in US
• Aging, equipment failures (8 from 3/00-4/01 ?
  shutdowns)
• 435 plants worldwide (generate 16 of planets
  electricity)
• 60 plants in Russia
• ? Condition, safety

48
Nuclear Power

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

49
Nuclear Power Plant Accidents

• Three Mile Island (1979)
• 50,000 to 100,000 excess deaths
• Chernobyl
• 50 deaths (among highly exposed emergency
  workers)
• 4000 thyroid cancers (most have survived)
• Expected 3940 deaths from radiation-induced
  cancers
• Greatest problem anxiety

50
Nuclear Power Plants

• 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
• Nuclear power industry receives 10 billion/yr in
  taxpayer subsidies
• Precautionary principle

51
Nuclear Power Plants
52
Nuclear Terrorism

• 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
• Dirty bomb
• 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

53
Nuclear Terrorism

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

54
Nuclear Terrorism

• Reports of weapons missing from Soviet arsenal
• Non-proliferation efforts, including the DOEs
  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

55
Chemical Weapons

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

56
Chemical Weapons

• Egypt vs. South Yemen (1963-7)
• Iran/Iraq War (1980s)
• Gulf War (versus Kurds, ? Others)
• Gulf War Syndrome (real per Congressionally-mandat
  ed scientific panel, 2008)
• 1995 Tokyo subway attack by Aum Shrinko cult
  using sarin
• 12 dead, 5000 injured or incapacitated

57
Types of Chemical Weapons

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

58
Types of Chemical Weapons

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

59
Types of Chemical Weapons

• Pulmonary toxicants
• E.g., chlorine, phosgene
• S/S pneumonitis, laryngeal spasm, pulmonary
  edema, ARDS
• Rx O2, bronchodilators, corticosteroids,
  ?ibuprofen, ?acetylcysteine

60
Chemical WeaponsVietnam and Napalm
61
Chemical WeaponsVietnam and Napalm
62
Chemical WeaponsVietnam and Napalm
63
Chemical Weapons

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

64
Other Chemical WeaponsTear gas

• Use in civil and political unrest
• 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

65
Other Chemical WeaponsPepper Spray

• Derived from cayenne peppers (contains 10-15
  oleoresin capsicum)
• 1.5-2 million Scoville unit heat rating
• Jalapeño pepper 2500-5000 Scoville units
• Habañero pepper (worlds hottest) 300,000
  Scoville units
• Use in civil and political unrest

66
Other Chemical Weapons

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

67
Biological Weapons - History

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

68
Biological Weapons - History

• Kochs postulates anthrax first linkage of a
  specific disease with a specific pathogen
• Louis Pasteur anthrax and cholera vaccines

69
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
• WW I Cholera, plague, glanders, anthrax

70
Biological Weapons WW II

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

71
Biological Weapons WW II

• Unlicensed yellow fever vaccine contaminated with
  hepatitis B
• 330,000 infections
• 51,000 cases of symptomatic hep B
• Long term outcomes good

72
Biological Weapons Post WWII

• Swerdlosk
• Zimbabwe
• False alarms

73
Biological Weapons Today

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

74
Biological Weapons Today

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

75
Biological Weapons - Agents

• Anthrax Brucellosis Cholera
• Glanders Pneumonic plague
• Tularemia Q Fever Smallpox
• Venezuelan Equine Encephalitis
• Viral Hemorrhagic Fevers (e.g., Ebola)
• Botulism Staph enterotoxin B
• Ricin Mycxotoxins

76
Biological Weapons Today

• 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

77
Biological Weapons Today

• 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
• ? Marijuana
• Food crops also destroyed
• US, UN Drug Control Program, others

78
Biological Weapons Today

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

79
Smallpox

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

80
Smallpox

• Incubation period 7-17 days (avg. 12)
• 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

81
Smallpox

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

82
Smallpox
83
Smallpox Vaccination

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

84
Smallpox Vaccination

• Acambis and subcontractor Baxter Intl. - 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)
• Fed govt has ordered 209 million doses from a
  British company

85
Smallpox Vaccination

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

86
Anthrax

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

87
Anthrax

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

88
Anthrax

• 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

89
Cutaneous Anthrax

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

90
Cutaneous Anthrax

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

91
Cutaneous Anthrax

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

92
Cutaneous Anthrax - Ulcer
93
Cutaneous Anthrax - Eschar
94
Gastrointestinal Anthrax

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

95
Inhalational Anthrax

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

96
Inhalational Anthrax

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

97
Inhalational AnthraxWidened Mediastinum
98
Inhalational Anthrax
99
Inhalational Anthrax

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

100
Anthrax Vaccine

• 3 or 4 dose series
• US armed service members approx 450K vaccinated
  to date
• Side effects HA 0.4, local rxn 3.6, mild
  systemic SEs in 1
• Manufacturer Bioport
• Contract to produce 4.6 million doses for the DOD

101
Anthrax Vaccine

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

102
Anthrax The Band
103
Non-lethal weapons

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

104
Non-lethal Weapons Proposed and Under
Development

• Acoustic
• Acoustic bullets
• Curdler unit shrieks, clangs
• Infrasound penetrates most buildings and
  vehicles, causes nausea, diarrhea,
  disorientation, internal organ damage and even
  death
• Squawk box intolerable ultrasound pulses

105
Non-lethal Weapons Proposed and Under
Development

• Acoustic and optical weapons
• Photic driver ultrasound plus stroboscopic
  infrared flasher to penetrate closed eyelids and
  cause seizures
• Psycho-correction devices send subliminal
  visual and aural messages

106
Non-lethal Weapons Proposed and Under
Development

• Barrier Weapons
• Slick coatings slippery like ice
• Sticky foam (used by US in Somalia)
• Obscurants
• Colored smoke felt to cause more psychological
  panic than white smoke
• Markers
• Fluorescent powder visible under UV light
• Sponge grenades impregnated with infrared dye
• To mark targets

107
Non-lethal Weapons Proposed and Under
Development

• Riot Control
• Invisible tear gas
• Electrical
• Police or soldiers jacket which jolts anyone who
  touches it
• Cattle prods (malicious and accidental use by
  civilians)

108
Non-lethal Weapons Proposed and Under
Development

• Biotechnical
• 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)
• Neuro-implants for behavior modification
• 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)

109
Non-lethal Weapons Proposed and Under
Development

• Holograms
• God/gods/other religious figures or symbols
• Soldier forces
• Death, dead comrades
• Others

110
Other WMDs

• Small arms
• Land mines
• Cluster bombs

111
Health Care System Preparedness for Weapons of
Mass Destruction

• ¾ of US ERs not fully prepared for treating mass
  casualties
• Only 12 of US hospitals have bioterrorism
  response measures developed and in place
• Congressional panel estimates gt 50 chance of
  terrorist act involving WMDs by 2013

112
Health Care System Preparedness for Weapons of
Mass Destruction

• US public health / emergency care system already
  in disarray
• 80 of states facing budget cuts or holdbacks
• Medicaid over budget in 23 states

113
Costs of Militarization

• US over ½ of discretionary tax dollars spent on
  the military
• US military budget represents 43 of total world
  military budget (1.5 trillion in 2009)
• Increased spending on nuclear weapons
• Inadequate spending to prevent the spread of
  chemical, biological, and nuclear weapons

114
2009 Federal Budget2.65 trillion
115
Missile Defense ShieldThe Militarization of Space

• Star Wars program proceeding, despite
• Astronomical cost est. 100 billion
• Strong opposition by scientific community
• Spectacular failures in 2/4 tests, despite highly
  structured conditions
• Abandonment of ABM Treaty by Bush administration

116
Missile Defense ShieldThe Militarization of Space

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

117
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

118
Meanwhile...Social Injustices Abound

• 51 million Americans lack health insurance
• 25 of US children live in poverty
• 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)

119
Meanwhile...Social Injustices Abound

• Worldwide
• poverty increasing
• maldistribution of wealth
• corporatization
• global debt crisis
• environmental destruction and global warming
• AIDS epidemic in sub-Saharan Africa

120
Environmental Consequences of Militarization

• Worlds single largest polluter
• 8 of global air pollution
• 2-11 of raw material use
• Almost all high and low level radioactive waste

121
The US Military

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

122
Societal Costs of Militarization

• An 8.5 cut in the Pentagons 2003 budget could
• rebuild Americas public schools over the next 10
  years - 12 billion
• Feed and provide basic health care to all the
  worlds poor - 12 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

123
Health Costs of Militarization

• 3 hours of world arms spending annual WHO
  budget
• ½ day of world arms spending immunization for
  all the worlds children
• 3 days of US arms spending amount spent on
  health, education and welfare programs for US
  children in one year

124
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
• Brain drain 2/3 of US scientists work in
  military-industrial complex

125
Skewed Priorities

• The world spends 1.6 trillion/year on military
  goods and services
• For 25 of this, we could
• Eliminate starvation and malnutrition
• Provide shelter for all
• Eliminate illiteracy
• Provide clean and safe water
• Prevent soil erosion

126
Skewed Priorities

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

127
Skewed Priorities

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

128
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

129
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.

130
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.

131
US Foreign Aid

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

132
Military Spending

• US ½ of discretionary tax dollars spent on the
  military
• US military budget represents 34 of total world
  military budget (1.5 trillion in 2009)
• Iraq War costs could reach 2-3 trillion

133
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134
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135
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136
Arms Exports
137
Arms Imports
138
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139
Top Pentagon Prime Contractors Fiscal Year 2009

• Lockheed Martin Corp.
• Northrop Grumman Corp.
• Boeing Corp.
• Raytheon Corp.
• General Dynamics Corp.
• KBR, Inc.

140
September 11, 2001
141
World Trade Center Bombing

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

142
September 11, 2001

• Pentagon 286 casualties
• Pennsylvania approximately 100 casualties

143
The War on Terror(The War on Afghanistan, Iraq,
and ?)

• May last 50 or more years Cheney
• Afghanistan
• Ruled by repressive
• human-(womens-)rights-abusing Taliban, then
  corrupt quasi-democratic kleptocracy
• Potential transit route for oil and gas pipeline
  from Central Asia
• Strategic importance in Middle East

144
Afghanistan

• Population 27 million
• Life expectancy 46 years
• Literacy rate 32
• Avg. annual income 280

145
Afghanistan

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

146
Afghanistan/Iraq Parallels

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

147
Afghanistan/Iraq Parallels

• Literacy decreased from 89 to 57
• Infrastructure devastated, Environment degraded
• Rebuilding post-war?

148
What goes around comes around

• 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
• CIA trying to buy back, but most unaccounted for
• Can shoot down a plane at up 6000-8000 feet
• 24 diverted to Iran

149
Before Gulf War I

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

150
Gulf War I

• 105,000 military and 110,000 civilian deaths
  (almost all Iraqis)
• Over 2.25 million refugees
• 2/3 of US casualties from friendly fire
• Cost 61 billion (82 billion in 2003 dollars)
• US pays only 1/6 of cost (most from Saudi Arabia,
  Kuwait, Germany and Japan)
• Environmental devastation
• 48 billion in claims to UN

151
Kuwaiti Oil Fires
152
Gulf War II

• Approximately 4,500 U.S. military deaths, over
  40,000 injuries (2010)
• Traumatic brain injuries common
• Over 100,000 civilian deaths (Iraq)
• Over 2,400 civilian deaths (Afghanistan, 2009
  alone)
• Massive humanitarian crisis

153
Gulf War II

• Financial cost of war 2-3 trillion (est.)
• Includes fighting, rebuilding, veterans health
  care, economic losses, etc.
• Global travel industry expected to lose over 500
  billion
• Distraction from North Korea, other threats
• Shock and awe battle plan targeting
  infrastructure explicitly prohibited by the
  Geneva Conventions

154
George W Bushs Military Record

• February, 1968 States desire to be pilot scores
  in 25th 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

155
George W Bushs Military Record

• June, 1968 Student deferment expires
• September, 1968 Pulls inactive duty to serve on
  Florida Senators re-election campaign
• November, 1968 Re-activated

156
George W Bushs Military Record

• November, 1970 Promoted to First Lieutenant,
  rejected by UT Law School
• Spring, 1970 Hired by Texas agricultural
  importer to shuttle plants to/from Florida
• June, 1970 Joins Guards Champagne Unit,
  flying with sons of Texas elite

157
George W Bushs Military Record

• May, 1972 Transfers to Alabama Guard unit so he
  can work on Senator Blounts re-election campaign
• His commanding officer states he never showed up
  for duty
• Grounded for missing a mandatory physical

158
George W Bushs Military Record

• Returns to Houston but never reports for Guard
  duty
• December, 1972 DUI arrest
• October, 1973 Air National Guard relieves him
  from commitment 8 months early, allowing him to
  attend Harvard Business School

159
New US Nuclear Weapons PoliciesUnder GW Bush

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

160
U.S. Nuclear Policy Under Obama

• U.S. retains first strike option against nuclear
  states
• START treaty signed by Obama, Putin
• Awaiting Senate approval

161
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.

162
Disturbing TrendsThe Patriot Bill

• Passed with minimal debate, most Congresspersons
  acknowledge not reading
• Increased governmental and corporate secrecy
  polluters subject to decreased public scrutiny
• Erosion of civil liberties deportations,
  accused held without charge/access to legal
  counsel
• 70,000 individuals on governments list of
  suspected terrorists

163
Disturbing TrendsThe Homeland Security Agency

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

164
Special Interest Provisions in the Homeland
Security Law

• 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 government prohibited from publicly releasing
  information related to vulnerabilities incl.
  safety of nuclear reactors, environmental toxins,
  etc

165
Special Interest Provisions in the Homeland
Security Law

• Immunity from liability for manufacturers of
  anti-terrorism products and technologies
• Army investigations show 60-90 of soldiers CBW
  protective gear malfunctions
• Liability protection for airport screening
  companies
• Secret advisory meetings with industry permitted,
  even if meeting not related to national security
• C.f. Cheneys Energy Commission

166
Disturbing TrendsCensorship and Propaganda

• US blacks out names of corporations which sold
  weapons to Iraq on UN inspectors reports
• Covering of Picassos Guernica for news
  conferences outside UN Security Council
• Armed Services Edition books for soldiers
• WW II the Classics to popular fiction
• Gulf War II Henry V, Art of War, War Letters,
  Profiles of American Military Heroes

167
Disturbing TrendsCensorship 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
• 21st Century McCarthyism

168
Disturbing Trends

• Hate crimes, intolerance
• Media jingoism
• TV shows developed/planned Profiles From the
  Front Line, Military Diaries, AFP American
  Fighter Pilot
• Army to ignore FDA safety standards in
  experiments on soldiers (legacy of 20th Century
  crimes)

169
Disturbing Trends

• Budget surplus/deficit
• 2000 surplus 5.6 trillion
• 2003 deficit 2.1 trillion
• 2010 deficit 1.3 trillion
• Cities and states facing huge budget shortfall
• Bush States are on their own.
• Obama Financial meltdown
• Patriot II?

170
George W. BushAugust 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."

171
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.

172
Samuel Johnson

• Patriotism is the last refuge of a scoundrel

173
Responses to TerrorJust War Theory

• The cause must be just
• A lawful authority must decide to resort to force
• The intention of the war must be in accord with
  international law
• The use of force must be a last resort

174
Responses to TerrorJust War Theory

• The probability of success should be high
• The cost-benefit ratio must be high
• The means used must conform with international
  humanitarian law

175
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176
Ignored Alternatives to War in Iraq

• Border monitoring in Jordan, Syria and Turkey
• Advanced X-ray scanning technology and an
  electronic pass system at borders
• Sanctions assistance missions to enforce military
  sanctions
• Political assurances and economic incentives to
  neighboring states

177
Ignored Alternatives to War in 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
• Require audited financial reports from oil
  purchasers to enforce above

178
Ignored Alternatives to War in Iraq

• Control or shut down the Syria-Iraq pipeline
• Expose and penalize arms embargo violations
• Justice in Palestine
• Israel most UN Security Council Violations
• Economic and humanitarian assistance to poor
  Muslim countries build alliances, good will
• Middle Eastern Marshall Plan
• Truth and Reconciliation Commissions (c.f. South
  Africa, El Salvador)

179
The US Rogue Nation

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

180
The US Rogue Nation

• 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

181
The US Rogue Nation

• Conservative estimate 8 million killed
• US invasions/bombings often largely at behest of
  corporate interests

182
The US Rogue Nation

• In 2009, the US spent about 2,210 per US citizen
  on defense
• vs. a few dollars per capita on peacekeeping
  efforts
• The US maintains military bases in 69 sovereign
  nations around the world

183
The US Rogue Nation

• Continued funding of the Western Hemisphere
  Institute for Security Cooperation
• 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)
• School of the Americas Watch, arrests

184
International Non-Cooperation/Isolationism

• Failure to sign or approve
• Kyoto Protocol on Climate Change
• Convention on the Prohibition of Anti-Personnel
  Land Mines
• Comprehensive Nuclear Test Ban Treaty

185
International Non-Cooperation/Isolationism

• Failure to sign or approve
• Convention on the Rights of the Child
• Convention on the Elimination of Discrimination
  Against Women Convention on Economic, Social and
  Cultural Rights
• Convention for the Suppression of Traffic in
  Persons

186
International Non-Cooperation/Isolationism

• 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
• 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)

187
The US Rogue Nation

• Death Penalty
• US executes more of its citizens than any other
  country except China, Iran, and Saudi Arabia
• Until recently, the US was the only country to
  execute both juveniles and the mentally ill
• Failure to follow World Court Decisions
• Largest debtor to the UN (only 40 of dues paid)

188
Solutions

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

189
Thomas Jefferson

• Nothing can keep (government) right but (the
  peoples) vigilant and distrustful
  superintendence

190
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.

191
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

192
The role of the doctor in society

• 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.

193
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.

194
Contact Information

• Public Health and Social Justice Website
• http//www.phsj.org
• martindonohoe_at_phsj.org