Medical Consequences of War in Iraq
On October 21, 2006, PSR-LA hosted a national conference on the effects of the Iraq war on both Iraqi citizens and their families and American troops and their families. Hundreds of people attended this important event held in the Grand Salon at UCLA’s Kerckoff Hall.
Conference Topics and Speaker Presentations
- The Iraq War: Mortality Data
David Rush, MD
- The New Iraq: A Humanitarian Disaster
Dahlia Wasfi, MD
- Where Birth Forecasts Death: The Medical Situation for the Afghan People
Nafisa Abdullah-Huf, MD
- Doctors & Interrogators: Medical Ethics, Human Rights, & the Laws of War
M. Gregg Bloche, MD
- Challenging the Threats of Nuclear Proliferation and War with Iran
Stephen Zunes, PhD
- Hidden and Horrific Costs of War
Gene Bolles, PhD
- Polytrauma and Hidden Head Injury, the Signature Injuries of the Global War on Terror:
Harriet Zeiner, PhD
- Working with OIF/OEF Veterans and Their Families
Helena Young, PhD
- Physician Ethics and War
John Pastore, PhD
- Healing America’s Soldiers in the Coming Decades
Congressman Bob Filner
- Challenging the Threats of Nuclear Proliferation and War with Iran
Stephen Zunes, PhD
The War in Iraq: Mortality Data – David Rush M.D.
A recent article in The Lancet reported an estimate of 655,000 excess Iraqi deaths since the 2003 U.S. invasion. This finding has been dismissed by some, notably President Bush and his administration, but defended by others. We examined the logic, execution and findings of this study, deal with its strengths and weaknesses, and mentioned some of the criticisms that have been raised in print. See Dr. Rush’s presentation.
Dr. David Rush is Professor of Nutrition, Community Health & Pediatrics (emeritus) at Tufts University. He is a graduate of Harvard College and Harvard Medical School, and is an epidemiologist who is also Board Certified in Pediatrics. Before coming to Tufts, he held academic appointments at the University of Rochester, Columbia University and the Albert Einstein College of Medicine.
During the 1980’s, Dr. Rush was Principal Investigator of the National Evaluation of the Special Supplemental Food Program for Women, Infants and Children (WIC). His current central scientific concern is the possible deleterious effects of nutritional supplementation programs on pregnant women in the third world. He is past president of the Society of Epidemiologic Research, a Fellow of the American Academy of Epidemiology, and a member of the American Epidemiologic Society and the International Epidemiological Association.
Dr. Rush has been active in Physicians for Social Responsibility for 30 years, and chaired its Physicians Task Force on Health Effects of Nuclear Weapons Production. He is one of three epidemiologists to sit on the U.S. Department of Energy’s Scientific Advisory Group to joint U.S.-Russian studies on the health effects of radiation exposure at nuclear weapons production sites in Russia, and has written extensively about this problem in Medicine & Global Survival. He is co-author with H. Jack Geiger, M.D., of Dead Reckoning: A Critical Review of the Department of Energy’s Epidemiologic Research, published in 1992 by PSR.
Iraq’s healthcare system—once known as the “jewel” of the Arab World—was devastated with the country’s infrastructure during the 42 days of the 1991 Gulf War. Significant deterioration of the public’s health was evident in the following years, due in large part to economic sanctions and our military’s use of depleted uranium. Since 2003, hospital conditions have gone from bad to worse, with supplies more scarce than before the invasion and our military’s continuous violations of the Geneva Conventions. These desperate circumstances, in addition to kidnappings and assassinations of Iraqi doctors and intellectuals, have fostered a humanitarian crisis in the cradle of civilization.
Born in the United States to an American Jewish mother and an Iraqi Muslim father, Dr. Wasfi spent the early part of her childhood in Sadam Hussein’s Iraq while her father taught at Basrah University. She returned to the U.S. at age 5 and spent her formative years in New York. She graduated from Swarthmore College with a biology degree, and went on to earn a medical degree from the University of Pennsylvania in 1997.
Dr. Wasfi has made two trips to Iraq since the 2003 “Shock and Awe” invasion to visit her extended family. She returned from a three month stay in Basrah in March, 2006. On April 27 of this year, she testified at a Congressional Forum to provide her eyewitness account of life in Iraq. Based on her experiences, Dr. Wasfi is spoke out on the negative impact of the U.S. invasion and the need to end the occupation.
Dr. Nafisa Huf shared her personal observations of civilian health and the current state of Afghanistan’s health care infrastructure based on her trips to Kabul over the past few years. In addition, she explored the social role of the physician as it relates to social justice, environmental issues, human rights, policy and education. See Dr. Huf’s presentation.
Nafisa Abdullah-Huf, M.D. is the first Afghan woman to study medicine in the U.S., practices Obstetrics and Gynecology at the West Los Angeles Kaiser Permanente Medical Center. She was born and raised in Kabul, Afghanistan where she eventually earned her medical degree from Kabul University before immigrating to the United States over 37 years ago.
In 2003, after the U.S. invasion of Afghanistan, Dr. Abdullah-Huf used her four-week vacation time to return to her war-torn homeland to witness first-hand the state of civilian health in Kabul. She worked with female doctors in Obstetrics and Gynecology departments of the Rabia Balkhi Hospital. In a tiny corner of this hospital, which lacked adequate supplies, medicines and beds, she helped with 55 to 80 deliveries per day. Her last visit was in May of this year.
Dr. Abdullah-Huff is an executive member of the Afghan Medical Association of America and serves as a board member of the Afghan Women’s Association of Southern California.
This presentation reviewed findings concerning involvement of physicians and other health professionals in post-9/11 interrogation. Dr. Bloche also addressed ethical and legal issues that this involvement presents. See Dr. Bloche’s presentation.
Gregg Bloche, M.D., J.D. is a Visiting Fellow at The Brookings Institution, Professor of Law at Georgetown University, and Adjunct Professor at Johns Hopkins University’s Bloomberg School of Public Health. Dr. Bloche teaches and writes on U.S. and international health law and policy. His recent work has appeared in numerous academic and professional publications, including the California and Stanford Law Reviews, New England Journal of Medicine, Journal of the American Medical Association, and Health Affairs. He has also done commentaries for the New York Times, Washington Post, Los Angeles Times, NPR’s Morning Edition, and other media outlets.
Bloche received a Robert Wood Johnson Foundation Investigator Award in Health Policy Research for his 1997-2001 work on the legal and regulatory governance of managed care. He has served on the Institute of Medicine’s Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, the Committee on Scientific Freedom and Responsibility of the American Association for the Advancement of Science, and the board of directors of Physicians for Human Rights. He has been a consultant to South Africa’s Truth and Reconciliation Commission (on human rights in the health sector), the Federal Judicial Center, the National Institutes of Health, the World Health Organization, several House and Senate committees, and other private and public bodies.
Dr. Bloche graduated with a B.A. from Columbia University and received his M.D. and J.D. from Yale University. Before joining Georgetown’s faculty in 1989, he completed his residency in psychiatry at the Columbia Presbyterian Medical Center. He received several awards for research and scholarship as a resident physician and law student, and was an editor of the Yale Law Journal.
Dr. Bolles presented some thoughts and experiences from over two years (Nov. 2001 through Feb. 2004) in working at Landstuhl Regional Medical Center, the largest hospital outside the U.S. for troops stationed in Europe and the Middle East.
Gene Bolles, M.D. is currently Assistant Professor of Neurosurgery at the University of Colorado, Denver. In the wake of 9/11, after the US attacked Afghanistan, Dr. Bolles, a veteran of the Vietnam War, accepted a contract from the Department of Defense to work as a civilian and serve as Chief of Neurosurgery at the Landstuhl Regional Medical Center – the largest hospital outside the U.S. for troops stationed in Europe and the Middle East. He spent two years (2001-2003) treating injured soldiers transferred to the base from military zones around the world, including Afghanistan and Iraq.
Stunned not just by the horrific injuries of but the volume of patients, he created a questionnaire and interviewed 1,000 American soldiers to find out how they felt about the war; what they witnessed; and what they did when in Iraq. Since his return home to the U.S., Dr. Bolles has participated in numerous conferences and media interviews about his experience treating war victims, including a documentary film about Iraq War veterans which had cinema release in the U.S. in September, 2006, called “The Ground Truth.”
In addition to working in a private practice for 32 years, Dr. Bolles, who holds a medical degree from the University of Colorado at Boulder, has participated in medical humanitarian missions for Doctors Without Borders in Belize, Mexico, Albania, and Indonesia. This year, the American Association of Neurological Surgeons honored Dr. Bolles by granting him the Humanitarian Award.
Polytrauma and the Hidden Head Injury, the Signatures Injuries of the Global War on Terrorism: The Impact of Head Injury on Military Personnel and their Families – Harriet Katz Zeiner, Ph.D.
The Iraq and Afghanistan war has produced new weaponry and defensive body armor for American military personnel. This has resulted in a change in the weapon of choice for enemy combatants, the improvised explosive device (IED). Two classes of injuries result from IEDs: 1. Moderate to severely wounded victims have “polytrauma”- multiple systems of the body contain trauma wounds, in addition to brain injury. 2. Hidden mild traumatic brain injury (TBI) resulting from repeated exposure to IED blasts. “Mild” refers to the length of loss of consciousness, NOT to effects on life. Mild TBI can result in significant impairment effects on ability to engage in competitive employment and the ability to maintain emotionally satisfying relationships.
Wounded military personnel are not in isolation—their roles in society and in their families are affected. The impact of head injury on the lives of the obviously wounded as well as hidden, undiagnosed head injuries are a major health care problem for American society, both now and in the years to come. A description of the symptoms of head injury was discussed as was the impact of recruitment video games, such as America’s Army, have on young people both before and after injury. See Dr. Zeiner’s presentation.
Harriet Katz Zeiner, Ph.D. For 17 years, Dr. Zeiner has been a clinical neuropsychologist with the Palo Alto VA, one of four leading national sites treating active duty personnel injured in Afghanistan and Iraq. She has been the lead neuropsychologist on Palo Alto VA’s inpatient polytrauma unit for the past several years. “Polytrauma” is a term designating multiple systems trauma including brain injury; it is the signature wound category from improvised explosive devices (IED) found in current combat theaters.
With her extensive experience in the continuum of care required for adults with brain injury, Dr. Zeiner has established outpatient centers for brain injury treatment in both the U.S. and Denmark.
She is a highly visible spokesperson for service personnel returning home with “hidden head trauma” and has appeared on NPR, California Connected, and the McNeil-Lehrer report. Her work has also been covered in Rolling Stone, the New York Sunday Times, National Geographic and the Ladies Home Journal. Dr. Zeiner is a graduate of USC with a doctorate from UC Berkeley and is one of the authors of the Veterans Health Initiative on Traumatic Brain Injury, an online CME course for physicians.
Working With Operation Iraqi Freedom (OIF)/Operation Enduring Freedom (OEF) Veterans and their Families: Key Issues and Clinical Dilemmas – Helena Young, Ph.D.
This presentation considered the challenges faced by VA clinicians in addressing stress-related problems experienced by Iraq returnees in homecoming and redeployment. Topics discussed included client presentation, the effect on the family, administrative and clinical issues of concern to the redeploying veteran (e.g., are treatment decisions driven by whether the client is active duty vs. separated from service?), and gender issues. DoD and VA are collaborating in the evolution of treatment for the different forms and expressions of trauma in veterans of OEF/OIF. The DoD Risk and Resiliency Model, with a focus on the experience of war as transformative, will be introduced. Some focus for discussion of this new cohort of veterans might be finding a shared lexicon for the therapeutic encounter (i.e., how do we address issues of meaning related to spiritual trauma and grief in our work with young veterans?) In addition, we examined how to create a context of care that addresses issues of stigma (i.e., making the treatment environment acceptable by identifying and managing PTSD in the primary care setting; normalizing symptoms; using new technologies, such as virtual reality or telemedicine, to inspire veterans to treatment and to maintain them there). See Dr. Young’s presentation.
Dr. Helena Young is a clinical psychologist with the National Center for PTSD, and is the Clinical Program Manager for the Center’s outpatient PTSD program in the VA’s Palo Alto Healthcare System. She serves as a consultant to numerous VA-based PTSD programs throughout the country to help develop and administer state-of-the-art combat stress and PTSD units. Dr. Young also acts as liaison with the family assistance centers for fighting force units deployed out of Moffett Field Airbase, educating veterans and their families on issues related to war-zone stress and PTSD.
Dr. Young’s doctoral dissertation, on selective neurobiological processing of trauma cues in Vietnam combat veterans, was awarded an Association for Women in Science Educational Foundation Citation of Merit. As a post-doctoral fellow at the National Center for PTSD, she was a key research collaborator in a recent comprehensive evaluation of the FEMA disaster crisis counseling program.
Key among Dr. Young’s current clinical and research interests are the ethnocultural and spiritual aspects of post-traumatic stress disorder. She is a frequent presenter at the International Society for Traumatic Stress Studies on related issues in addition to serving on the Advisory Committee for Therapist Outreach to Military Service People and Families, The Trauma Center, Los Angeles Institute and Society for Psychoanalytic Studies.
The physician is faced with several dilemmas of an ethical nature when it comes to war. Through the ages, physicians have struggled with the imperative to do no harm, which in many (if not all) cases means resisting and refusing to participate in war, while also being driven by their oath to care for the injured. However, modern warfare has come more and more to mean a preponderance of non-combatant casualties, raising the question whether or not the major imperative for the physician is to bring to public consciousness not only the futility but also the immorality of war. Travels to such “axis of evil” countries as North Korea highlight the fact that there are simply too many civilians at ground zero to allow for the legitimacy of preemptive war under any conceivable circumstances. When such wars are undertaken, therefore, the moral high ground cannot be ceded to the perpetrators. See Dr. Pastore’s presentation.
After Dr. Pastore earned his medical degree from Yale in 1967, he served as a U.S. Public Health Service officer and research internist at the Atomic Bomb Casualty Commission in Hiroshima and Nagasaki, Japan. He returned to Yale in 1972 and was appointed Chief Resident in Medicine.
With a keen interest in the medical impact of war, Dr. Pastore joined the International Physicians for the Prevention of Nuclear War (IPPNW). In 1985, when Dr. Pastore held the position of Executive Secretary, IPPNW was awarded the Nobel Prize for Peace. In 1990, Dr. Pastore was among the first group of physicians invited by the Iraqi Medical Association to assess the medical conditions in Iraq since the embargo was imposed in August of that year. He also made a trip to North Korea for a similar assessment.
Dr. Pastore is a former President of national PSR. He continues to stay active in the cause of peace by serving on the PSR Board and sharing his experience through dialogue about physician ethics and the medical impact of war.
Congressman Bob Filner is one of only a tiny handful of Members of Congress with a scientific degree and one of only 18 members in the House holding a Ph.D. In his twenty year tenure as a Professor of History at San Diego State University, Bob taught his students that ideas don’t mean anything unless they are put into action to help people and make the world a better place. It’s a lesson he strives to demonstrate in the U.S. Congress.
In 1987, Bob Filner was elected to the San Diego City Council. In 1991, he was re-elected with more than 70 percent of the vote. He was subsequently elected by the Council to serve as Deputy Mayor.
In 1992, Bob Filner was elected to the United States House of Representatives by a two-to-one margin. The 51st Congressional District is one of the most diverse areas in the nation. Encompassing the southern half of the City of San Diego, the South Bay cities of Chula Vista and National City, and all of Imperial County, the district’s population is 55 % Latino, 18 % Anglo, 15 % Filipino and 12 % African-American. Bob has been re-elected by overwhelming margins in the subsequent five elections.
Shortly after arriving in Washington, Bob was appointed a seat on the Committee on Veterans’ Affairs. In that capacity, he has been a tireless fighter for veterans and was successful in getting better pay for VA dentists as well as increasing small business pportunities for veterans. His continuous work to ensure that GI benefits keep up with inflation and to secure more mental health care for veterans has won him high accolades from national veterans’ organizations and the praise of thousands of individual VAs.
The threat that Iran may develop nuclear weapons is very real, but the consequences of U.S. military action against Iran – particularly if the U.S. employed the nuclear option itself – would likely be even worse. In addition to the serious humanitarian end environmental consequences, such an attack would further isolate the United States in the international community, lead Iranians to rally behind their government and invite Iranian retaliation. Furthermore, it is highly unlikely that Iran’s nuclear program could be completely destroyed, prompting an Iranian withdrawal from the Non-Proliferation Treaty and a greatly intensified effort to develop nuclear weapons capability as a deterrent to future attacks. Since Iran is at least 8-10 years away from developing nuclear weapons, however, there is time for a diplomatic solution. In return for a verifiable Iranian pledge to rule out such ambitions, the United States should be willing to formally rule out the use of force. In addition, rather than singling out Iran, the U.S. should end its opposition to the establishment of a nuclear weapons-free zone in that volatile region. Furthermore, the United States and other industrialized countries need to finally get serious about fulfilling their own obligations under the NPT and work toward comprehensive nuclear disarmament.
Dr. Stephen Zunes is a Professor of Politics at the University of San Francisco and Middle East editor for Foreign Policy in Focus, a think tank for research, analysis, and action to make the United States a more responsible global partner. Previously, he taught at Ithaca College, Whitman College and the University of Puget Sound in addition to serving as founding director of the Institute for a New Middle East Policy. In 2002, he won recognition from the Peace and Justice Studies Association as Peace Scholar of the Year.
Dr. Zunes is the author of scores of articles for scholarly and general readership on Middle Eastern politics, U.S. foreign policy, nuclear proliferation, international terrorism, social movements, and human rights. He is the principal editor of Nonviolent Social Movements (Blackwell Publishers, 1999) and the author of the highly-acclaimed Tinderbox: U.S. Middle East Policy and the Roots of Terrorism (Common Courage Press, 2003). Western Sahara: Nationalism and Conflict in Northwest Africa is his forthcoming work to be published by Syracuse University Press.
Dr. Zunes has made frequent visits to the Middle East and other regions in conflict, where he has met with top government officials, academics, journalists and opposition leaders, informing his work as a foreign affairs columnist for the National Catholic Reporter and a regular contributor to the Common Dreams website and Tikkun magazine.
His op-ed columns have appeared in major daily newspapers throughout the United States, Canada, and Europe and he has been a frequent guest on National Public Radio, Pacifica Radio, PBS, BBC, MSNBC and other media outlets for analysis on breaking world events.
- Oath Betrayed: Torture, Medical Complicity, and the War on Terror by Steven H. Miles. Random House, 2006.
- Imperial Life in the Emerald City: Inside Iraq’s Green Zone by Rajiv Chandrasekaran. Knopf, 2006.
- Inside Afghanistan after the Taliban by Sarah Chayes. Penguin Press, 2006.
- Veterans of War, Veterans of Peace by Maxine Hong Kingston. Koa Books, 2006.
- The Human Cost of the War in Iraq: A Mortality Study, 2002-2006
Gilbert Burnham, et al. Bloomberg School of Public Health Johns Hopkins University, School of Medicine Al Mustansiriya University.
- PSR-LA Fact Sheet on US Military Casualities in Iraq
- Neuropsychological Outcomes of Army Personnel Following Deployment to the Iraq War
Jennifer J. Vasterling, et al. JAMA. 2006; 296:519-529.
- Mental Health Problems, Use of Mental Health Services, and Attrition From Military Service After Returning From Deployment to Iraq or Afghanistan Charles W. Hoge, et al. JAMA. 2006;295:1023-1032.
- Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care
Charles W. Hoge, et al. N Engl J Med, Volume 2004;351:13-22
- Iraq Health Update: Conflict fuels Iraqi Health Crisis
Kingston Reif, Medact.
- Casualties of War — Military Care for the Wounded from Iraq and Afghanistan
Atul Gawande, M.D., M.P.H., N Engl J Med, Volume 2004;351:2471-2475.
- The Economic Costs of the Iraq War
Joseph Stiglitz, Linda Bilmes, NBER Working Paper 12054, February 2006
- Posttraumatic Stress Disorder and Depression in Battle-Injured Soldiers
Thomas A. Grieger, M.D., et al. Am J of Psychiatry 163:1777-1783, Oct 2006
- National Center for Post Traumatic Stress Disorder contains detailed information about PTSD, including treatment modalities, general resource information, publications, research and contact information.
- The Iraq Index is a statistical compilation of economic, public opinion, and security data compiled by the Brookings Institute.
- American Psychological Association (APA) Resolution against Torture, adopted August 9, 2006.
- World Health Organization: Afghanistan
- World Health Organization: Iraq