Consequences of War and Militarism Martin Donohoe Outline The history and epidemiology of war Nuclear weapons Chemical weapons Biological weapons.
Download ReportTranscript Consequences of War and Militarism Martin Donohoe Outline The history and epidemiology of war Nuclear weapons Chemical weapons Biological weapons.
Consequences of War and Militarism Martin Donohoe Outline The history and epidemiology of war Nuclear weapons Chemical weapons Biological weapons Outline Economic and environmental consequences of militarism and war Health consequences of militarism and war Contemporary conflicts Afghanistan, Iraq, “War on terror” Solutions 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 Chimps vs. Bonobos Origins of War Foragers vs. Agriculturalists Agriculture Hierarchical society Private property Money Subjugation of women Infectious/chronic diseases Origins of War Violence Today Link with poverty, oppression, fueled by desire for wealth/power Familial vs. Societal Gun culture Media Violence Militarism The deliberate extension of military objectives and rationale into shaping the culture, politics and economics of civilian life so that war and the preparation for war is normalized, and the development and maintenance of strong military institutions is prioritized An excessive reliance on military power and the threat of force in pursuing policy goals in international relations Militarism Positively correlated with: Conservatism Nationalism Religiosity Patriotism Authoritarianism Militarism Negatively correlated with: Respect for civil liberties Tolerance of dissent Democratic principles Sympathy and welfare toward the troubled and poor Foreign aid for poorer nations Subverts other societal interests (health, environment, education, social programs) 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 – widespread use of horses 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 History of War 1803-1814 (Napoleonic Wars): English General Henry Shrapnel fills cannonballs with bullets and exploding charges to increase killing capacity 1903 – Wright brothers/Kitty Hawk – airplane 20th Century – nuclear submarines, predator drones, weaponization of Arctic/space History of War Belief that each new invention would eliminate warfare Instead, increased casualties, killing at a distance Epidemiology of Warfare Deaths in war: 17th 18th 19th 20th Century Century Century Century = = = = 19/million population 19/million population 11/million population 183/million population Increasing casualties to civilians 85-90% in 20th Century (vs. 10% late 19th Century) War Deaths, 1945-2010 Contemporary War Deaths Worldwide Violence (2013) 526,000 killed by armed violence/yr 396,000 intentional homicides 55,000 direct conflict deaths 54,000 unintentional homicides 21,000 killed during legal interventions 7.9 violent deaths/100,000 persons/yr Gun Violence U.S. death toll for all wars from the Revolutionary War to Afghanistan: 1.2 million (Congressional Research Service) Number killed by firearms since 1968 (suicides, homicides, and accidental shootings): 1.4 million (CDC) More than from all wars in the nation’s history combined (1.2 million) Legacies of Colonial Exploitation 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): “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): “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 20th Century Incidence of war rising since 1950 Most conflicts within poor states Over 30 separate civil wars currently underway Most involve U.S.-supplied weapons War Deaths Revolutionary War: 25,000 Civil War: 625,000 World War I: 17 million World War II: 60 million Korean War: 2.9 million Vietnam War: 3.8 million War Deaths Iran-Iraq War: 700,000 Soviet War in Afghanistan: 1.5 million Second Congo War: 3.8 million Second Sudanese Civil War: 1.9 million War Deaths (as of 12/1/12) Second Iraq War: 4,485 U.S. soldiers 17,000 Iraqi military Estimates of civilian deaths range from 150,000 violent deaths to 1 million deaths U.S. Afghan War: Over 2,000 U.S. soldiers; 1,200 coalition forces Estimated 20,000 civilians Contemporary Wars 72 million lives lost in 20th Century wars, another 52 million through genocides 190 million deaths in 20th Century directly or indirectly related to war 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 Vietnam War US dropped the equivalent of one 500 lb. bomb on every person in Vietnam Vietnam War: 1.5 to 3 million Vietnamese casualties; 58,000 American More US soldiers died of suicide after Vietnam than died in combat during the war. Gulf War I: U.S. planted one land mine for every Iraqi citizen Child Soldiers Use of child soldiers by 19 countries Despite 2008 Child Soldiers Prevention Act, U.S. still provides aid to some of these Child Soldiers U.S. JROTC: Total enrollment: 560,000 “Youth development program” per Pentagon “One of the best recruiting devices we could have” – Defense Secretary William Cohen, 2000) Costs taxpayers hundreds of millions of dollars Military recruiters have access to students Students, parents must actively opt out Wars Promoted Through Militarism Military buildups Exceptionalism Imperialism Glorification of war Unrealistic expectations Consequences of War Deaths, injuries, physical and psychological sequelae Collapse of health care system affecting those with acute and chronic illnesses Famine Consequences of War 51 million forcibly displaced persons worldwide 16.7 million refugees (50% are children under 18) 33 million internally displaced persons 1.2 million asylum seekers 86% of world’s refugees are hosted by developing countries Consequences of War Environmental degradation Augments global warming, which Pentagon calls an immediate national security threat Increasing poverty and debt All lead to recurrent cycles of violence 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 Hydrogen bomb exploded at Bikini Atoll (1,000 times stronger than Hiroshima weapon) - 1954 The Hiroshima Bomb Atomic Explosion Atomic Weapons – Other Victims Hundreds of thousands of hibakusha – atomic bomb survivors 1054 U.S. nuclear tests since 1940s, 331 in atmosphere Atomic Weapons – Other Victims 80,000 cancers (15,000 fatal) in US citizens as a result of fallout from atmospheric testing NCI/CDC Thousands of illnesses and deaths, higher CA risk in 600,000 former employees - DOE Atomic Weapons Today Approximately 17,300 nuclear weapons in at least 9 countries Down from over 71,000 at height of Cold War 4,300 active U.S./Russian warheads today 1,800 on hair-trigger alert Several thousand megatons (100,000 Hiroshimas) Atomic Weapons Today Vastly redundant arsenal 150-200 weapons adequate to destroy all major urban centers in Russia U.S. planning to spend $250 billion on new nuclear weapons and delivery systems over the next few decades 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 GAO: 233 Since 1950, 10 nuclear weapons lost and never recovered All laying on seabed, potentially leaking radioactivity Effects of a Nuclear Explosion Immediate: Vaporized by thermal radiation Crushed by blast wave Burned and suffocated by firestorm Effects of a Nuclear Explosion Intermediate: Suffering, painful deaths Health care personnel/resources overwhelmed Famine Refugees Devastated transportation infrastructure 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) 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 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 Effects of a 20 megaton nuclear explosion 21 miles: 29 miles: 2 psi; 100 mph winds Shattered glass, flying debri 3° burns over all exposed skin 40 miles: Retinal burns blind all who witness explosion Effects of a 20 megaton nuclear explosion over Boston (1998 study) 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 Types of Injuries Burns Blindings Deafenings PTX Fxs Shrapnel wounds 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 Effects on health professionals 70% killed or fatally wounded 15% injured < 1000 survive 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 Effects on Health Care System 1500 patients/doctor 10 min/pt 4 hours sleep/noc 2 weeks to see all injured Ultimate Outcomes Boston (pop. 2.8 million in 1998) > 2.5 million dead after one month More than 6x as many Americans as died in WW II Abolition of Nuclear Weapons Supported by: APHA AMA ACP IPPNW PSR Global political and military leaders 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) Nuclear Waste 67,000 metric tons of nuclear wasted in US Most stored in overcrowded cooling pools 1/3 Americans live within 50 miles of nuclear waste On-site storage: 118 commercial reactors 10 weapons plants 37 research reactors Nuclear Waste Disposal: Hanford, WA Site of plutonium production for first atom bomb (and most of U.S. nuclear arsenal) Decommissioned at end of Cold War (1971) More than 210 million liters of radioactive and chemical waste stored in 177 deteriorating underground storage tanks at Hanford, WA 60 have leaked on site Potential risks to nearby Columbia River Nuclear Waste Disposal: Hanford, WA Plan = vitrification and underground storage Most complex and costly environmental restoration ever attempted (current price tag $12.3 billion and increasing; finish date 2019?) Site plagued by leaks, cost overruns Nuclear Waste Disposal Skull Valley, Goshute Indian Reservation, Utah Private fuel storage consortium Temporary storage of 44,000 tons of highlevel nuclear waste Bribes to tribes; environmental injustice Waste Isolation Pilot Plant, New Mexico Defense Dept. waste 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 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 After $9 billion spent, plan cancelled (2010) – other options being considered Nuclear Waste Disposal DOE has proposed recycling radioactive scrap metal into consumers goods and health care devices E.g., silverware, pots and pans, eyeglasses, braces, pacemakers, artificial joints Nuclear Power Plants Nuclear Power Plants 100 plants operating in US Aging, equipment failures (8 from 3/00-4/01 → shutdowns) 2011: 40 failed basic fire safety standards; 12 have not fully implemented terrorism prevention requirements 441 plants worldwide (in 31 countries, generate 17% of planet’s electricity) 60 plants in Russia ? Condition, safety 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 Nuclear Power Plant Accidents Three Mile Island (1979) 50,000 to 100,000 excess deaths Chernobyl, USSR, 1986 - nuclear power plant explosion 200 times the radiation of Hiroshima + Nagasaki 25-100 died immediately, up to 1,000 injured acutely, NCI estimates 10-75K thyroid cancers (other estimates much lower) Some estimates as high as almost 1 million deaths NY Acad Sci, 2010 Chernobyl Higher risk of neural tube defects and childhood leukemia among those living near nuclear power plants Anxiety a major problem Ukraine still spends 6% of its GDP each year on Chernobyl-related matters $2.1 billion structure will seal off reactor for 100 yrs. Nuclear Accidents: Fukushima 2nd largest nuclear power plant disaster after Chernobyl 50 early casualties Reactor built by GE (also responsible for Indian Point plant, 40 miles from NYC) Nuclear Accidents: Fukushima GE has built 91 nuclear power plants in 11 countries, including 23 plants at 11 sites in U.S. Full, long term costs and consequences still unknown Yet in 2012, Nuclear Regulatory Commission allows Southern Company to build and operate 2 new nuclear power plants in Georgia Nuclear Power Plants For every US plant that has its license renewed, 12 additional cancer deaths (NRC) Plus any deaths from accidents, nonroutine releases, high level waste and spent fuel Nuclear Power Plants Nuclear power industry receives billions of dollars in taxpayer subsidies Since 1948, federal government has spent $95 billion on nuclear R and D (4 times the amount spent on solar wind geothermal biomass, biofuels, and hydropower combined) Nuclear power non-viable compared to green power without subsidies Nuclear industry’s liability coverage supported by federal government through 2025(Price Anderson Act) Nuclear Power Plants Prior to London Convention(1972, revised 1993), which prohibits dumping of radioactive waste at sea, U.S. considered dumping decommissioned nuclear reactors into the world’s oceans Precautionary principle Nuclear Power Plants/ Nuclear Waste Many plants close to major population centers 40,000 metric tons of spent fuel at 110 reactor sites in U.S. Target for terrorists 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 “Axles of Evil” 600 employees, $250 million, weekly shipments of nuclear material along major US highways Potential for accidents, terrorist attacks Nuclear Terrorism 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 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 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) Nuclear Terrorism 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 The Nth Country experiment (1964): 3 science post-docs with no nuclear know-how designed a working atom bomb Nuclear Accidents Pentagon: Over 550 mistakes, malfunctions, and false alarms as of 2012 8 nuclear submarines at bottom of sea leaking uranium and plutonium 11 nuclear weapons lost (most on bottom of ocean) 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 Fritz Haber – chlorine gas 91,000 deaths and 1.3 million injuries Chemical Weapons Egypt vs. South Yemen (1963-7) Agent Orange (contains carcinogenic, feto-toxic dioxin) Defoliant herbicide Manufacturer Dow Chemical Six lbs per person dumped by US on South Vietnam (1/10 area of South Vietnam) 1 million victims (birth defects, cancers, etc.) Chemical Weapons Iran/Iraq War (1980s): sarin, nerve gas, mustard gas Gulf War (versus Kurds, ? Others) Gulf War Syndrome Real per Congressionally-mandated scientific panel, 2008 30-60% of vets affected per VA study Symptoms: Memory loss, lack of concentration, neuropathic pain, depression, rashes, sleep disturbances, GI distress, muscle and joint pain Linked to cholinergic abnormalities Brain damage noted on fMRI Chemical Weapons 1995 Tokyo subway attack by Aum Shrinko cult using sarin 12 dead, 5000 injured or incapacitated 1994-5: U.S. in Bosnia and 2004-5: U.S. vs Iraqis (depleted uranium) 2004-5: U.S. vs Iraqis and 2008-9: Israel vs Palestinians (white phosphorus) 2012 Libya (mustard gas) and Syria (sarin) 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) 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 Types of Chemical Weapons Pulmonary toxicants E.g., chlorine, phosgene S/S: pneumonitis, laryngeal spasm, pulmonary edema, ARDS Rx: O2, bronchodilators, corticosteroids, ?ibuprofen, ?acetylcysteine Chemical Weapons: Vietnam and Napalm Chemical Weapons: Vietnam and Napalm Chemical Weapons: Vietnam and Napalm Chemical Weapons 1972 Biological and Toxic Weapons Convention prohibits development, production, and stockpiling US and Russia still have significant stockpiles US has destroyed 90%, plans to complete job by 2017 480 US chemical facilities each put 100,000 or more Americans at risk of poison gas disaster Other Chemical Weapons: Tear 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 Other Chemical Weapons: Pepper 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 (world’s hottest) = 300,000 Scoville units Use in civil and political unrest Other Chemical Weapons Calmatives: mind-altering or sleepinducing 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 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 plagueinfested corpses Biological Weapons - History Koch’s postulates: anthrax – first linkage of a specific disease with a specific pathogen 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” WW I: Cholera, plague, glanders, anthrax 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 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 Biological Weapons Post WWII Swerdlosk Zimbabwe Okinawa, Utah, Hawaii, Puerto Rico, etc. 1977 H1N1 flu epidemic (likely due to lab accident releasing 1957 strain, NEJM) False alarms 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 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) 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 Biological Weapons Today Over 1,000 labs in the U.S., operated by over 300 government, university, and private organizations, registered with USDA/CDC More than 200 incidents of loss or accidental release of bioweapons reported each year Likely more Details cloaked in secrecy Biological Weapons Today 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 Genetic weapons – targeted at specific ethnic groups Synbio (synthetic biology) Publication of details re creation of novel, dangerous agents 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 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 Smallpox DNA virus; decimated native American populations; eradicated by WHO vaccination campaign in 1972; genome sequenced in 1992; recreation of virus in lab possible in 2002 ?Only remaining viral stocks at CDCP and in Siberia? WHO Executive Board recommended retaining stores 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 Smallpox Dx: clinical, EM of vesicular fluid Rx: isolation, post-exposure vaccination, supportive care, ?antivirals 30 % fatality rate Smallpox Smallpox Vaccination Vaccinia US ended in 1972 Waning (?negligible) immunity Effects: local reaction. Lymphadenopathy Smallpox Vaccination Side effects: postvaccinial encephalitis (1/300,000), progressive vaccinia; eczema vaccinatum, generalized vaccinia Vaccinia immune globulin may modulate New vaccine (Imvamune) may be safe for those with atopic dermatitis 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, workman’s comp issues Anthrax Bacillus anthracis, aerobic, G+, sporeforming rod Zoonosis Invisible and odorless when aerosolized Anthrax 1979: accidental release at Swerdlosk (USSR): 250 cases, 100 deaths, town abandoned due to contamination 1997: Aum Shrinko cult attempted aerosol dispersal – unsuccessful 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 Cutaneous Anthrax 2000 cases/yr worldwide Due to exposure to infected animals / animal products Epidemic in Zimbabwe, 1989-1995: 10,000 cases 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 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 Cutaneous Anthrax - Ulcer Cutaneous Anthrax - Eschar 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 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 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 Inhalational Anthrax Widened Mediastinum Inhalational Anthrax Inhalational Anthrax Dx: blood cultures, XR/CT, post-mortem; serology not helpful Case fatality rate approx. 50% Rx: post-exposure antibiotics (doxycycline, ciprofloxacin, penicillin), monoclonal antibody antitoxins (raxibacumab) Supportive care Anthrax Vaccine 3 or 4 dose series US armed service members 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 Anthrax Vaccine Pre/post exposure vaccination Improved vaccine under development Testing considered unethical ?Groups to vaccinate? Antibody testing may help guide Anthrax – The Band 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) “Non-lethal” Weapons Proposed and Under Development Acoustic weapons 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 “Non-lethal” Weapons Proposed and Under Development 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 “Non-lethal” Weapons Proposed and Under Development Barrier Weapons: Obscurants: Slick coatings – slippery like ice Sticky foam (used by US in Somalia) 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 “Non-lethal” Weapons Proposed and Under Development Riot Control Invisible tear gas Electrical: Police or soldier’s jacket which jolts anyone who touches it Cattle prods (malicious and accidental use by civilians) “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) “Non-lethal” Weapons Proposed and Under Development Holograms: God/gods/other religious figures or symbols Soldier forces Death, dead comrades Others Other WMDs Small arms 90% of the 300,000 yearly deaths from violent conflict • Land mines • 110 million planted since 1960 in 70 countries • 24,000 deaths/yr (est.), tens of thousands more disabled Cluster bombs High Tech Warfare Internet viruses, worms, etc. designed to disable water and power systems, air traffic control, communications, etc. E.g., Stuxnet computer worm – Iranian nuclear facilities Robotic armies Nanotech weapons Other weapons of the future (?present?) Health Care System Preparedness for Weapons of Mass Destruction Congressional panel estimates > 50% chance of terrorist act involving WMDs by 2013 ERs/hospital systems inadequately prepared Funds low 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 Costs of Militarization US: over ½ of discretionary tax dollars spent on the military Increased spending on nuclear weapons Inadequate spending to prevent the spread of chemical, biological, and nuclear weapons Discretionary Federal Spending (2013) World Military Spending (2012) Missile Defense Shield The 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 Missile Defense Shield The 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 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 49 million Americans lack health insurance 25% of US children live in poverty Homelessness, public educational system a shambles, increasing jail populations, AIDS, etc. Mass extinction, global warming 2.5 billion people worldwide live in abject poverty (earn less than $500 per year, lack access to clean drinking water) Environmental Consequences of Militarization World’s single largest polluter 8% of global air pollution 2-11% of raw material use 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) 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 Health Costs of Militarization 3 hours of world arms spending = annual WHO budget 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 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 (similar in Russia during cold war; much work has widespread applicability) Military Spending and Jobs $1 billion in military spending generates 11,200 jobs 15,1000 in consumer goods production 16,800 in green energy development 17,200 in health care 26,700 in education Skewed Priorities The world spends $1.8 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 Skewed Priorities Prevent global warming Stop deforestation Aid all refugees Retire developing nations’ debt Provide clean, safe energy (through efficiency and renewables) 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 We’re Number One U.S. #17 #26 #37 #1 in military spending in education in infant mortality in life expectancy and overall health DOD Announcement (September, 2011) “Pentagon Lacks Funding to Fix Public Schools on Military Bases” 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.” Worldwide Economic Impact of Violence $10 trillion/yr 1% of global GDP $1,350/U.S. citizen Military Spending US: ½ of discretionary tax dollars spent on the military US military budget represents 34% of total world military budget ($1.7 trillion in 2011) Iraq/Afghanistan Wars likely to cost $4-5 trillion World Military Spending (2012) ($1.8 trillion in 2012; U.S. 34% of total) War and Peace World military budget 230X what the UN spends on peacekeeping US: Largest arms supplier $66 billion in annual sales (2011) = ¾ of global market Russia second with $5 billion in annual sales Profits at top 5 defense firms up 450% since 2002 Greatest debtor to U.N. (including U.N. peacekeeping fund) Arms Exports Arms Imports Top Recipients of U.S. Military Aid Israel Egypt Iraq Pakistan Jordan Columbia Somalia Costs of Wars (2010 dollars, inflation-adjusted) American Revolution: $2.4 billion War of 1812: $1.6 billion Mexican War: $2.4 billion Civil War (both sides): $79.8 billion Spanish American War: $9 billion Costs of Wars (2010 dollars, inflation-adjusted) World War I: $334 billion World War II: $4.1 trillion Korean War: $341 billion Vietnam War: $738 billion Gulf War I: $102 billion Iraq/Afghanistan Wars likely to cost $4-5 trillion Economic Cost of War, U.S. US Foreign Aid US ranks 21st in the world in foreign aid as a percentage of GDP (0.16%, versus UN recommended 0.07%) Foreign Aid: 1/3 military 1/3 economic 1/3 food and development US world’s second largest arms exporter Major Defense Contractors Lockheed Martin Corp. Northrop Grumman Corp. Boeing Corp. Raytheon Corp. General Dynamics Corp. KBR, Inc. Large lobbying contingent; donate large amounts each election cycle September 11, 2001 World Trade Center Bombing 3300 fatalities - foreign nationals outnumbered Americans Over 18,000 people suffering health problems linked to attack and rescue Multiple toxins in air and rubble Zadroga Act (2010) provides funds for monitoring, treatment, and victim compensation World Trade Center Bombing Environmental health consequences unknown: 300-400 tons asbestos 130,000 gallons of transformer oil contaminated with PCBS Lead, sulfuric acid, silicon Fine dust particles September 11, 2001 Pentagon: 286 casualties Pennsylvania: approximately 100 casualties The War on Terror (The War on Afghanistan, Iraq, and ?) “May last 50 or more years” – Cheney Afghanistan: Ruled by repressive human-(women’s-)rights-abusing Taliban, then corrupt quasi-democratic kleptocracy Potential transit route for oil and gas pipeline from Central Asia Strategic importance in Middle East Afghanistan Population = 27 million Life expectancy = 46 years Literacy rate = 32% Avg. annual income = $280 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 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 Afghanistan/Iraq Parallels Literacy decreased from 89% to 57% Infrastructure devastated, environment degraded Rebuilding post-war? What goes around comes around 1980s: CIA arms Afghan rebels with hundreds of Stinger missiles Late 2002: Terrorists using a similar Russianmade 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 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 Gulf War I 105,000 military and 110,000 civilian deaths (almost all Iraqis) 2/3 of US casualties from “friendly fire” Cost $61 billion ($82 billion in 2003 dollars) Over 2.25 million refugees US pays only 1/6 of cost (most from Saudi Arabia, Kuwait, Germany and Japan) Environmental devastation $48 billion in claims to UN Kuwaiti Oil Fires War Deaths (as of 6/14) Second Iraq War: 4,486 U.S. soldiers 17,000 Iraqi military Estimates of civilian deaths range from 150,000 violent deaths to 1 million deaths U.S. Afghan War: Over 2,000 U.S. soldiers; 1,200 coalition forces Estimated 20,000 civilians Gulf War II Financial cost of war: $4-5 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 Gulf War II - Iraq 96% of of the $9.1 billion allocated to the Development Fund for Iraq unaccounted for Special Inspector General for Iraq Reconstruction, 2010 Ongoing audit of another $53 billion fund ongoing, but has already uncovered numerous instances of waste, fraud, and abuse (total for Iraq and Afghanisatan between $31 billion and $60 billion as of 2011) Gulf War II - Iraq WMDs found by U.S. troops Ones U.S. had sold to Iraq Major health consequences among U.S. soldiers dismantling Kept secret by Bush administration Veterans unable to file health claims Not all disposed of – some now in ISIL-controlled territory Exposed by media, 2014 Contemporary Wars Casualties among soldiers, civilians continue More US soldiers have committed suicide than have died in Afghan War More military contractors killed than US soldiers Contemporary Wars Casualties among soldiers, civilians continue Veteran health care needs massive (TBI in 1020% of U.S. soldiers, psychiatric disorders, etc.) 26% of Iraq and Afghanistan veterans are uninsured and not part of the VA health care system Young veterans: ½ believe war in Afghanistan was not worth fighting; 60% for Iraq War Contemporary Wars Libya, Syria Coming Soon: Iran? Ukraine? ISIL? South China Sea? Privatization of war and national security enterprises Plans for militarization of the U.S./Mexico border George W Bush’s 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 George W Bush’s Military Record June, 1968: Student deferment expires September, 1968: Pulls inactive duty to serve on Florida Senator’s re-election campaign November, 1968: Re-activated George W Bush’s 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 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 His commanding officer states he never showed up for duty Grounded for missing a mandatory physical George W Bush’s 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 US Nuclear Weapons Policies Under 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 U.S. Nuclear Policy Under Obama U.S. retains first strike option against nuclear states START treaty signed by Obama, Putin Awaiting Senate approval Will limit US and Russia to 1,550 long-range warheads (still overkill) 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 Act” 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 government’s list of suspected terrorists National Defense Authorization Act Signed by President Obama in 2012 Grants Pentagon right to: kidnap, indefinitely detain, torture, and kill foreigners and US citizens No right of trial / legal representation First explicit piece of legislation to repeal Bill of Rights Disturbing Trends: The 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 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 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. Cheney’s Energy Commission Disturbing Trends: Censorship and Propaganda 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 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 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 Parents can opt out CIA resumes recruiting on college campuses 21st Century McCarthyism Wikileaks, NSA, torture, etc. Disturbing Trends Hate crimes, intolerance Media jingoism Army to ignore FDA safety standards in experiments on soldiers (legacy of 20th Century crimes) Disturbing Trends NSA spying War gear utilized by police departments Co-optation of academia Use of private military subcontractors Drone attacks, suspension of habeus corpus Poor access to VA services for vets, providers pressured not to diagnose PTSD Disturbing Trends Budget surplus/deficit: Cities and states facing huge budget shortfall 2000: surplus = $5.6 trillion 2003: deficit = $2.1 trillion 2011: deficit = $1.3 trillion Bush: “States are on their own.” Obama: Financial meltdown Meanwhile, profits at America’s top 5 defense firms up 450% since 2002 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." 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” Just 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 Just 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 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 Ignored Alternatives to War in Iraq Improve cargo monitoring at port of Azqaba, Jordan (high-volume port for seagoing 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 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) 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 Over 1,000 bases worldwide today (737 in 69 other countries) 54 countries helped facilitate CIA’s secret detention, rendition, and interrogation program 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 The US: Rogue Nation Conservative estimate = 8 million killed The U.S. occupies and/or controls between 700 nad 800 military bases worldwide (in 63 countries) US invasions/bombings often largely at behest of corporate interests; military policy designed to promote economic policies The US: Rogue Nation In 2011, the US spent about $2,240 per US citizen on defense vs. a few dollars per capita on peacekeeping efforts Over 1,000 bases worldwide today (737 in other 69 other countries) 54 countries helped facilitate CIA’s secret detention, rendition, and interrogation program 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 Sham vaccination program in Pakistan International NonCooperation/Isolationism Failure to sign or approve: Kyoto Protocol on Climate Change Convention on the Prohibition of AntiPersonnel Land Mines Convention on Cluster Munitions Comprehensive Nuclear Test Ban Treaty International NonCooperation/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 UN Declaration of the Rights of Indigenous Peoples Convention for the Suppression of Traffic in Persons UN Convention on the Rights of Disabled Persons International NonCooperation/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) The US: Rogue Nation Domestic Spying (e.g., NSA) Torture (80-100 nations worldwide) Death Penalty: US executes more of its citizens than any other country except China, Iraq, Saudi Arabia, and Iran Until recently, the US was the only country to execute both juveniles and the mentally ill The US: Rogue Nation Failure to follow World Court Decisions Failure to recognize International Criminal Court Largest debtor to the UN (only 40% of dues paid) International WIN/Gallup Poll, 2014 Which country is the greatest threat to peace? U.S. – 24% Pakistan – 8% China – 6% Afghanistan – 5% 66,000 surveyed worldwide Solutions Physician activism (PSR, IPPNW, etc.) Increased education: public, medical and public health students Tolerance and appreciation of diversity Social justice, environmental preservation, etc. Eliminate or limit military recruiting in public schools Assist victims of war (PHR, MSF, etc.) Treaties 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: “The role of physicians and other health professionals 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.” Reference The Role of Public Health in the Prevention of War: Rationale and Competencies Am J Public Health 2014;104:e34–e47. Available at http://ajph.aphapublications.org/doi/pdf/10. 2105/AJPH.2013.301778 Contact Information Public Health and Social Justice Website http://www.phsj.org [email protected]