Sunday, October 26, 2014
Again, Hoping for a Brighter European Future for Ukraine after Parliamentary Elections
Expressing in short order my unsolicited long distance reaction to Ukraine's parliamentary elections, it seems that Poroshenko's political bloc will be sharing power with Yatsenyuk's People's Front and, to a lesser degree, with the All-Ukrainian Fatherland Party of Tymoshenko. Sadly, I must report that I know very little about the political positions of any of the parties involved, other than the fact that each is strongly committed to steering Ukraine in the direction of the EU (a position that I wholeheartedly embrace not only in the hopes that Ukrainian economic development will benefit from integration with Europe but also that the future prosperity of Ukraine will steer political perspectives within the Russian Federation away from confrontation and toward acquiescence in peaceful unity with Europe). Having perused the webpage for the People's Front (http://nfront.org.ua/), I can confidently assert that I can neither speak nor read Ukrainian! In this regard, it has been difficult to figure out, with any degree of confidence, what this party, whose popularity seems substantial and growing, actually stands for, with regard to economic policy, engagement with the EU, U.S., and the Russian Federation, and, perhaps most importantly, negotiation with pro-Russian groups in the eastern oblasts. As such, I remain hopeful yet sceptical. In my view, Ukraine, as a whole, certainly needs committed pro-European leadership in Kiev to drive the economic development of the country, over time, toward integration with the EU economies. This is certainly the road toward peace and prosperity for Ukraine, and it is a direction that the EU and U.S. need to aggressively support. On the other hand, I am still not sure where Donetsk, Lugansk, and Kharkiiv oblasts fit into this larger vision (I decline to say anything about Crimea - that is, rightly, a Russian issue!). In my view, these oblasts need some degree of autonomy while, simultaneously, they might benefit from a continued engagement with Kiev. In any case, the military conflict over these oblasts needs to end on terms mutually beneficial to parties representing the democratically expressed wishes of Ukrainian citizens (ethnic Ukrainians and ethnic Russians, alike) in the eastern oblasts and to the newly elected, pro-European parliament in Kiev. I do not know how such a compromise is going to come about, but the fate of the country as a whole (minus Crimea) seems to hinge on it!
Tuesday, October 21, 2014
Much Ado About Ebola
For peculiar reasons, related in part to the arrival and subsequent mortality of a Liberian victim in Texas and the infection of two American health care professionals, ebola has become a public health issue for the U.S. This post attempts to briefly articulate a perspective on the epidemic of ebola in Sierra Leone, Liberia, and Guinea, to account for the faulty initial response of health care professionals in Dallas responding to Thomas Eric Duncan's infection, and to castigate various figures in the American political establishment and, more succinctly, the corporate news media, for producing a minor outbreak of hysteria within certain quarters of the American population and for transforming the entry of one infected individual into the U.S. into a political issue. Pointedly, ebola constitutes a legitimate global public health problem that needs to be addressed through a serious, sober, rational response by health professionals on a transnational scale in order to control the spread of the disease and mitigate its impacts where infections have been prevalent, but such a response is not likely to emerge within the U.S. if discussions of the disease degenerate into hysterical diatribes against the efforts made by the Obama administration at combating ebola in Africa and safeguarding the U.S.
1. The outbreak of ebola appears as though it will, in the end, constitute a legitimate public health disaster for rural communities in eastern Sierra Leone, Guinea, and Liberia. Presently, if effective border controls are not enacted to control the spread of the disease across national frontiers, it might spread to Guinea Bissau, Senegal, Côte d'ivoire, Mali, and beyond.
Several factors appear relevant to the prevalence of deaths from ebola and to the spread of the disease across national frontiers in West Africa. First, rural areas in the affected countries are liable to suffer from a lack of readily available public health facilities to quarantine ebola patients and treat them with a satisfactory expectation that such individuals will recover (for a good summary on the current state of the recent ebola outbreak in Africa and globally, see BBC News, "Ebola: Mapping the Outbreak," 17 Oct. 2014, at: http://www.bbc.com/news/world-africa-28755033). As of October 12, the World Health Organization reported a deficiency of 3,262 beds for identified ebola patients across Sierra Leone, Liberia, and Guinea, with a deficiency of over 2,300 beds in Liberia, which has experienced the largest concentration of infections. As a result of such deficiencies and concomitant deficiencies in health care staffing and community outreach in isolated rural areas, individuals who are symptomatic for ebola infection at a local level are not being adequately treated for symptoms and not quarantined to prevent further infections.
In my understanding, the particular geographic concentration of outbreaks at the juncture of the countries in Guinea's Guéckédou prefecture is instructive of how the current outbreak may have spread from its geographic base outward (see map below, however much the inclusion of Nigeria in denoting deaths from ebola is dated - Nigeria has today, as expected, declared itself to be free of ebola infections). The highland region in southeastern Guinea/eastern Sierra Leone/northeastern Liberia where the outbreak originated is highly rural and poorly serviced by health care facilities, with the largest urban concentration and service capacity at Guéckédou in Guinea. The geographic dispersion of deaths from ebola shown below seems to suggest, however, that, at least to some extent, individuals from the highland regions where the ebola outbreak originated are leaving for the coast (perhaps in an effort to escape communities already hit by the disease, perhaps to seek treatment at hospitals in the urban centers) and taking ebola with them. Thus, Conakry, the Guinean capital, shows a concentration of heightened ebola death rates. Similarly, Monrovia, the Liberian capital, had to declare a quarantine of the entire outlying penisular slum community of West Point, where ebola infections were reported. We might, finally, note that the presence of ebola deaths in Nigeria, not to mention the arrival of a Liberian ebola victim in Texas, resulted from the departure of individuals infected with ebola from regions in one of these countries where ebola pathogens were in active transmission.
Reproduced from: BBC News, "Ebola: Mapping the Outbreak," 17 Oct. 2014, at: http://www.bbc.com/news/world-africa-28755033.
The key point to be gleaned from this geographic dispersion, as a function of the particular transmission media for ebola pathogens (i.e. direct contact with bodily fluids from an individual experiences symptoms of the disease), is that there is not apt to be any contiguous geographic field for infections. That is to say, we might expect to see large concentrations of ebola infection in Lofa county in northeastern Liberia with little or no infections in, say, River Gee county near the border with Côte d'ivoire; relatively few ebola infections at Bo in central Sierra Leone but growing numbers of infections in Freetown, the capital; and stable numbers of new infections in Conakry but the appearance of ebola infections in Parisian suburbs with significant circulating populations from Guinea. In the spread of ebola pathogens, we are dealing with a very specific and peculiar network, with its own transmission media and, at least potentially, a wildly discontinuous geographic dispersion! It is not, therefore, unreasonable to expect that individuals, flying in from Monrovia, infected with ebola but not yet symptomatic (it apparently takes 21 days) might show up at Kennedy International Airport to transit to some other urban site in the U.S. We live in a fully globalizing world in which borders are increasingly becoming irrelevant!
As such, it is not my intention to press any arguments in this post in regard to border controls, especially not in the West African context. Like many other issues that have hitherto arisen within American political discourse, ebola needs to be treated as a (global) public health problem - not as an immigration/population control issue (notwithstanding the miserly beliefs of certain Americans that we don't either hold a stake in the health and welfare of populations half way across the world or possess some deeper moral obligation, as one of the wealthiest nations on the planet, to protect human life in fragile circumstances even when the lives at stake are not those of our fellow citizens!). Granted, it would help the world greatly if Sierra Leone, Liberia, and Guinea could restrict population movements from infected regions, but, to date, they have been unable to do so. Rather, the advanced/well endowed corners of the world need to do a better job helping to fight epidemic outbreaks within poorer states.
2. The death rates among West African populations infected with ebola appear to be conditioned by a range of socio-cultural, economic, and environmental/ecological factors that make the occurance of the disease an effective death sentence for those infected. We should not expect similar death rates among affected populations outside of West Africa.
Following from the logical conclusion that it may be very difficult to prevent the flow of ebola outside of Africa (at least as much as it was difficult in our species' infancy to prevent the flow of human beings out of Africa!), I think that we need to ponder the consequences from having to deal with ebola in non-African contexts. This section specifically seeks to draw a distinction between health systems, living standards, rates and characteristics of urbanization, public investment in sanitation systems, and, for that matter, built ecology, on the one hand, in West Africa, and, on the other hand, in North America, Europe, East Asia, and, to some extent, urban South America.
A relevant comparison to what is happening in eastern Liberia, Sierra Leone, and Guinea might be the outbreak of bubonic plague in late Medieval Europe. The critical point is that populations suffering from vast disparities of wealth in addition to generalized depressed living standards and deficient levels of economic development above basic, biological subsistence for the general population are also likely to be filled with individuals characterized by relatively weakened immune systems and diminished resistance to pathogens. With regard to economic development, each of these countries has suffered the trials and tribulations of market fluctuations in basically agrarian or extractive economies, with many segments of rural populations operating at the level of biological subsistence. Moreover, Sierra Leone and Liberia have both endured recent civil wars, while political instability in Guinea has left it too on the brink of civil war several times over the last two decades. Such chronic instabilities in state political regimes have, likewise hindered the sort of capital investment that might promise rising standards of living on a national level and significantly healthier, better nourished households, with extensions of basic public services like sanitation. Each of the countries houses primate cities with significant accumulations of rural populations coming into overcrowded peripheral slum areas, the worst of which is the West Point peninsula in Monrovia. Additionally, considering the ecological features of each country, it should not be forgotten that we are dealing with a tropical climate, with relatively elevated temperatures for much of the year. Finally, ebola is not alone as a significant deadly pathogen afflicting human populations in these countries. Malarial infections spread by mosquitoes are also common. When these considerations are taken into account, against the lack of available hospital facilities and quarantine spaces, an explanation becomes evident for why death rates from ebola infections as high as seventy percent have been reported.
It suffices to say that, notwithstanding the absence of a universal "cure" or vaccination against ebola, we will discover that the two American nurses infected by Thomas Eric Duncan will stand a much greater chance of surviving ebola with minimal complications than the average ebola patient in West Africa. Apart from one health care worker in Germany who died from complications related to an ebola infection received in West Africa, I have not heard of any Western health care provider who has died from an ebola infection received during the current outbreak. Today, I heard on the evening news that a photo journalist with NBC news has been cleared of ebola infection. The same is also apparently true for one of the Dallas area nurses that treated Mr. Duncan and for a Spanish nurse who treated an ebola patient entering into that country. What might this tell us about the disease except that it is extremely susceptible to differences in the environmental contexts into which it is transferred and those in which patients are treated?
3. Contingent to perceived differences in the pathogenic effectiveness of ebola in Western contexts, we need to craft policies concerning the entry and movement of individuals from the West African countries where the recent ebola outbreak has been centered that will both preserve existing standards on free movement of individuals (conditioned, as well, by other controls on the entry and movement of non-U.S. citizens) while simultaneously recognizing that judicious tracking and surveillance of such individuals will minimize the potential for transmission of ebola within the U.S. population.
This is my way of saying that I think the policies heretofore adopted by the Obama administration on the specification of treatment protocols for health care workers, reservation of hospital facilities for potential quarantine of ebola patients, and screening/surveillance/contract tracking of entrants in airports with direct flights from Guinea, Sierra Leone, or Liberia are both reasonable and warranted. Conversely, while it may be worth considering other, more rigorous options to control and track movements of individuals coming from West Africa, we need to ponder what the various consequences would be if we enacted complete travel bans from these countries and what might, in the end, be gained and lost from enacting more rigorous entry controls and quarantine policies. I do not, in this respect, want to suggest that a travel ban, especially a selective one, might not be a reasonable step, but I do think that such efforts would have unintended negative consequences and that the demand for such policies both reflects and sustains, at least in some measure, the sort of hysterical reaction to the risk of ebola that certain groups in the American political establishment have nurtured and benefited from.
First, it seems fully intuitive that a travel restriction against entry by individuals from Guinea, Sierra Leone, and Liberia would enable U.S. Immigration and Customs Enforcement officials to unambiguously nullify any threat of an ebola epidemic in the U.S. On the other hand, we would have to consider the nature of the restriction being enacted. If U.S. aviation authorities banned direct flights from Guinea, Sierra Leone, or Liberia, then individuals from these countries would still be able to enter the U.S. by flying in through a third country, as Thomas Eric Duncan and, now, Dr. Craig Spencer, a New York physician who returned with ebola after treating ebola patients in Guinea, both had (both had flown into the U.S. from Brussels). Evaluated in these terms, we would also need to reconsider the potential effectiveness of the Obama administration's efforts to test and monitor individuals entering the U.S. is the plan is only to examine individuals coming directly from Guinea, Sierra Leone, or Liberia. If the larger principle that we should be screening individuals coming from Guinea, Sierra Leone, or Liberia makes sense, then it makes sense to conduct screenings based on the larger itineraries of entrants to the U.S., wherever such individuals transited from.
In another sense, an extension of the broader principle that we should be screening individuals coming from targeted West African countries to ensure that we fully account for all individuals that could have been potentially exposed to ebola would demand such an extensive process that Immigration and Customs Enforcement officials would be compelled to conduct thorough ebola testing at all air and sea facilities welcoming individuals from foreign contexts into the U.S. There is no conceivable way that we can flag every individual entering into the U.S. to ensure that each has not passed through a region in which ebola has been actively in transmission. In certain respects, maybe this is the point for certain individuals on the political right in the U.S. who assumed that the entry of all individuals from foreign contexts into the U.S. is an intrinsically bad thing! The larger issue with any screening process should not be to exclude individuals entering from foreign contexts who might conceivable be infected with ebola. Rather, it should be to track potentially infected entrants to ensure that the flow of ebola pathogens is strictly controlled and that any individuals infected with ebola receive proper medical treatment in lieu of suffering a gruesome death at the hands of the disease.
To these ends, the principle underlying mandatory quarantine for individuals who have come in contact with individuals infected with ebola does not necessarily make good sense. On the one hand, ebola is less contagious than influenza, a family of viral infections that will certainly inflict more deaths on the U.S. population than ebola this year and for many years to come. On the other hand, we are developing a much more thorough protocol on the treatment of ebola patients, capable of achieving a much higher recovery rate than is presently available to infected individuals in West Africa. Moreover, mandatory quarantines may hinder the effort to address infected regions in West Africa if the presence of mandatory quarantines prevents health care professionals from volunteering for treatment of ebola in Liberia, Sierra Leone, and/or Guinea. These considerations suggestively support a counterargument that we would be better off to permit free entry of health care professionals, advise voluntary minimization of contacts for the course of the disease's possible incubation period (21 days) (in order to make contact tracking more effective), and pursue aggressive treatment of the disease upon determination that an individual is symptomatic.
4. Much of the political and media reaction to ebola in the U.S. reflects a more generalized current against contemporary globalization evident on both the political right and left. Above all, the American response to ebola has to transcend ignorant, hysterical, and emphatically paranoid reactions against global integration, expressed by political figures and nurtured by the media, to realize our deeper obligation to assist other human beings struggling not merely with viral epidemics but also with abject poverty, malnutrition, chronic economic underdevelopment, and ecological devastation in the name of advancing a vision of common humanity in a process of mutual development and sustainment of our race and our ecology.
My conclusion here is directed, in part, at the response to ebola expressed by Texas Governor Perry, who advanced the first emphatic call for travel restrictions from Guinea, Sierra Leone, and Liberia, but also, in part, toward New Jersey Governor Christie, New York Governor Cuomo, and other governors enacting mandatory quarantines on health care professionals coming from West Africa. Moreover, it is directed against the major corporate news media and diverse electronic media outlets that have done their best to spread fear over the potential for ebola to be spread to the U.S. population. Notwithstanding evident recognitions of physical constraints on the communicability of ebola, numerous political actors, especially among Republican Party figures at the federal level, have engaged in a conscious effort to overinflate the threat of ebola and to connect to threat from open migration of foreigners into the U.S. There is something innately disingenuous in this politicization of a global public health problem in order to rouse the suspicions of American reactionary rightists against the actions and intentions of the Obama administration in responding to this event.
Emphatically, if no measures were taken to safeguard the U.S. population against transmissions of ebola from West Africa, then fewer Americans could be expected to die from ebola this year than would be expected to die from influenza, a largely preventable viral infection significantly more communicable than ebola against which fewer than half of susceptible Americans seek vaccinations! The reaction to ebola at the state and federal level is less about rational health policy than it is about generating fear over globalization and our lack of control over, especially, population flows in a world that is becoming increasingly borderless. At the present time, we operate under the misconception that we can or should be able to readily control cross-border flows. States have operated under such misconceptions for millenia. No doubt, the Han Chinese emperors in the First and Second centuries C.E. believed that their Great Wall could prevent the Hsung Nu (i.e. barbarians) from outer Mongolia and Manchuria from ravaging the landspace of Northern China. Now, we build better fences to keep out Mexicans from Oaxaca and Chiapas from crossing into Arizona with the help of "coyotes" and staff them with ever more border security and national guardsmen and women. And, for all the tax money we are expending on these efforts to make our borders secure, we are pissing in the wind! Our borders are as irrelevant to the rest of the world as the borders of other states, like those of Syria, Afghanistan, or Pakistan are to our enactments of national security policy and to flight paths of our unmanned drones.
With such pleasant thoughts in mind, our articulations of policy with respect to ebola need to respect the deadly nature of the disease against populations that are most susceptible to its impact on human life. Instead of enacting new restrictions on the movement of health care professionals seeking to assist populations ravaged by the disease in West Africa, we should be following the efforts of a state like Cuba, dispatching large numbers of health care volunteers to assist the health care communities of affected West African countries. To its credit, the Obama administration appears to be interested in meeting the need for development of health care facilities necessary to treat infected individuals, especially in Liberia - U.S. military forces have been mobilized to these ends. Nonetheless, our larger response has been schizophrenic, mixing concern and a willingness to engage productively with governments in West Africa to contain the disease and treat infected individuals with abject fear and a desire to disengage from affected countries as if we could somehow prevent the introduction of ebola to the U.S. by pretending that our borders were something other than porous.
1. The outbreak of ebola appears as though it will, in the end, constitute a legitimate public health disaster for rural communities in eastern Sierra Leone, Guinea, and Liberia. Presently, if effective border controls are not enacted to control the spread of the disease across national frontiers, it might spread to Guinea Bissau, Senegal, Côte d'ivoire, Mali, and beyond.
Several factors appear relevant to the prevalence of deaths from ebola and to the spread of the disease across national frontiers in West Africa. First, rural areas in the affected countries are liable to suffer from a lack of readily available public health facilities to quarantine ebola patients and treat them with a satisfactory expectation that such individuals will recover (for a good summary on the current state of the recent ebola outbreak in Africa and globally, see BBC News, "Ebola: Mapping the Outbreak," 17 Oct. 2014, at: http://www.bbc.com/news/world-africa-28755033). As of October 12, the World Health Organization reported a deficiency of 3,262 beds for identified ebola patients across Sierra Leone, Liberia, and Guinea, with a deficiency of over 2,300 beds in Liberia, which has experienced the largest concentration of infections. As a result of such deficiencies and concomitant deficiencies in health care staffing and community outreach in isolated rural areas, individuals who are symptomatic for ebola infection at a local level are not being adequately treated for symptoms and not quarantined to prevent further infections.
In my understanding, the particular geographic concentration of outbreaks at the juncture of the countries in Guinea's Guéckédou prefecture is instructive of how the current outbreak may have spread from its geographic base outward (see map below, however much the inclusion of Nigeria in denoting deaths from ebola is dated - Nigeria has today, as expected, declared itself to be free of ebola infections). The highland region in southeastern Guinea/eastern Sierra Leone/northeastern Liberia where the outbreak originated is highly rural and poorly serviced by health care facilities, with the largest urban concentration and service capacity at Guéckédou in Guinea. The geographic dispersion of deaths from ebola shown below seems to suggest, however, that, at least to some extent, individuals from the highland regions where the ebola outbreak originated are leaving for the coast (perhaps in an effort to escape communities already hit by the disease, perhaps to seek treatment at hospitals in the urban centers) and taking ebola with them. Thus, Conakry, the Guinean capital, shows a concentration of heightened ebola death rates. Similarly, Monrovia, the Liberian capital, had to declare a quarantine of the entire outlying penisular slum community of West Point, where ebola infections were reported. We might, finally, note that the presence of ebola deaths in Nigeria, not to mention the arrival of a Liberian ebola victim in Texas, resulted from the departure of individuals infected with ebola from regions in one of these countries where ebola pathogens were in active transmission.
The key point to be gleaned from this geographic dispersion, as a function of the particular transmission media for ebola pathogens (i.e. direct contact with bodily fluids from an individual experiences symptoms of the disease), is that there is not apt to be any contiguous geographic field for infections. That is to say, we might expect to see large concentrations of ebola infection in Lofa county in northeastern Liberia with little or no infections in, say, River Gee county near the border with Côte d'ivoire; relatively few ebola infections at Bo in central Sierra Leone but growing numbers of infections in Freetown, the capital; and stable numbers of new infections in Conakry but the appearance of ebola infections in Parisian suburbs with significant circulating populations from Guinea. In the spread of ebola pathogens, we are dealing with a very specific and peculiar network, with its own transmission media and, at least potentially, a wildly discontinuous geographic dispersion! It is not, therefore, unreasonable to expect that individuals, flying in from Monrovia, infected with ebola but not yet symptomatic (it apparently takes 21 days) might show up at Kennedy International Airport to transit to some other urban site in the U.S. We live in a fully globalizing world in which borders are increasingly becoming irrelevant!
As such, it is not my intention to press any arguments in this post in regard to border controls, especially not in the West African context. Like many other issues that have hitherto arisen within American political discourse, ebola needs to be treated as a (global) public health problem - not as an immigration/population control issue (notwithstanding the miserly beliefs of certain Americans that we don't either hold a stake in the health and welfare of populations half way across the world or possess some deeper moral obligation, as one of the wealthiest nations on the planet, to protect human life in fragile circumstances even when the lives at stake are not those of our fellow citizens!). Granted, it would help the world greatly if Sierra Leone, Liberia, and Guinea could restrict population movements from infected regions, but, to date, they have been unable to do so. Rather, the advanced/well endowed corners of the world need to do a better job helping to fight epidemic outbreaks within poorer states.
2. The death rates among West African populations infected with ebola appear to be conditioned by a range of socio-cultural, economic, and environmental/ecological factors that make the occurance of the disease an effective death sentence for those infected. We should not expect similar death rates among affected populations outside of West Africa.
Following from the logical conclusion that it may be very difficult to prevent the flow of ebola outside of Africa (at least as much as it was difficult in our species' infancy to prevent the flow of human beings out of Africa!), I think that we need to ponder the consequences from having to deal with ebola in non-African contexts. This section specifically seeks to draw a distinction between health systems, living standards, rates and characteristics of urbanization, public investment in sanitation systems, and, for that matter, built ecology, on the one hand, in West Africa, and, on the other hand, in North America, Europe, East Asia, and, to some extent, urban South America.
A relevant comparison to what is happening in eastern Liberia, Sierra Leone, and Guinea might be the outbreak of bubonic plague in late Medieval Europe. The critical point is that populations suffering from vast disparities of wealth in addition to generalized depressed living standards and deficient levels of economic development above basic, biological subsistence for the general population are also likely to be filled with individuals characterized by relatively weakened immune systems and diminished resistance to pathogens. With regard to economic development, each of these countries has suffered the trials and tribulations of market fluctuations in basically agrarian or extractive economies, with many segments of rural populations operating at the level of biological subsistence. Moreover, Sierra Leone and Liberia have both endured recent civil wars, while political instability in Guinea has left it too on the brink of civil war several times over the last two decades. Such chronic instabilities in state political regimes have, likewise hindered the sort of capital investment that might promise rising standards of living on a national level and significantly healthier, better nourished households, with extensions of basic public services like sanitation. Each of the countries houses primate cities with significant accumulations of rural populations coming into overcrowded peripheral slum areas, the worst of which is the West Point peninsula in Monrovia. Additionally, considering the ecological features of each country, it should not be forgotten that we are dealing with a tropical climate, with relatively elevated temperatures for much of the year. Finally, ebola is not alone as a significant deadly pathogen afflicting human populations in these countries. Malarial infections spread by mosquitoes are also common. When these considerations are taken into account, against the lack of available hospital facilities and quarantine spaces, an explanation becomes evident for why death rates from ebola infections as high as seventy percent have been reported.
It suffices to say that, notwithstanding the absence of a universal "cure" or vaccination against ebola, we will discover that the two American nurses infected by Thomas Eric Duncan will stand a much greater chance of surviving ebola with minimal complications than the average ebola patient in West Africa. Apart from one health care worker in Germany who died from complications related to an ebola infection received in West Africa, I have not heard of any Western health care provider who has died from an ebola infection received during the current outbreak. Today, I heard on the evening news that a photo journalist with NBC news has been cleared of ebola infection. The same is also apparently true for one of the Dallas area nurses that treated Mr. Duncan and for a Spanish nurse who treated an ebola patient entering into that country. What might this tell us about the disease except that it is extremely susceptible to differences in the environmental contexts into which it is transferred and those in which patients are treated?
3. Contingent to perceived differences in the pathogenic effectiveness of ebola in Western contexts, we need to craft policies concerning the entry and movement of individuals from the West African countries where the recent ebola outbreak has been centered that will both preserve existing standards on free movement of individuals (conditioned, as well, by other controls on the entry and movement of non-U.S. citizens) while simultaneously recognizing that judicious tracking and surveillance of such individuals will minimize the potential for transmission of ebola within the U.S. population.
This is my way of saying that I think the policies heretofore adopted by the Obama administration on the specification of treatment protocols for health care workers, reservation of hospital facilities for potential quarantine of ebola patients, and screening/surveillance/contract tracking of entrants in airports with direct flights from Guinea, Sierra Leone, or Liberia are both reasonable and warranted. Conversely, while it may be worth considering other, more rigorous options to control and track movements of individuals coming from West Africa, we need to ponder what the various consequences would be if we enacted complete travel bans from these countries and what might, in the end, be gained and lost from enacting more rigorous entry controls and quarantine policies. I do not, in this respect, want to suggest that a travel ban, especially a selective one, might not be a reasonable step, but I do think that such efforts would have unintended negative consequences and that the demand for such policies both reflects and sustains, at least in some measure, the sort of hysterical reaction to the risk of ebola that certain groups in the American political establishment have nurtured and benefited from.
First, it seems fully intuitive that a travel restriction against entry by individuals from Guinea, Sierra Leone, and Liberia would enable U.S. Immigration and Customs Enforcement officials to unambiguously nullify any threat of an ebola epidemic in the U.S. On the other hand, we would have to consider the nature of the restriction being enacted. If U.S. aviation authorities banned direct flights from Guinea, Sierra Leone, or Liberia, then individuals from these countries would still be able to enter the U.S. by flying in through a third country, as Thomas Eric Duncan and, now, Dr. Craig Spencer, a New York physician who returned with ebola after treating ebola patients in Guinea, both had (both had flown into the U.S. from Brussels). Evaluated in these terms, we would also need to reconsider the potential effectiveness of the Obama administration's efforts to test and monitor individuals entering the U.S. is the plan is only to examine individuals coming directly from Guinea, Sierra Leone, or Liberia. If the larger principle that we should be screening individuals coming from Guinea, Sierra Leone, or Liberia makes sense, then it makes sense to conduct screenings based on the larger itineraries of entrants to the U.S., wherever such individuals transited from.
In another sense, an extension of the broader principle that we should be screening individuals coming from targeted West African countries to ensure that we fully account for all individuals that could have been potentially exposed to ebola would demand such an extensive process that Immigration and Customs Enforcement officials would be compelled to conduct thorough ebola testing at all air and sea facilities welcoming individuals from foreign contexts into the U.S. There is no conceivable way that we can flag every individual entering into the U.S. to ensure that each has not passed through a region in which ebola has been actively in transmission. In certain respects, maybe this is the point for certain individuals on the political right in the U.S. who assumed that the entry of all individuals from foreign contexts into the U.S. is an intrinsically bad thing! The larger issue with any screening process should not be to exclude individuals entering from foreign contexts who might conceivable be infected with ebola. Rather, it should be to track potentially infected entrants to ensure that the flow of ebola pathogens is strictly controlled and that any individuals infected with ebola receive proper medical treatment in lieu of suffering a gruesome death at the hands of the disease.
To these ends, the principle underlying mandatory quarantine for individuals who have come in contact with individuals infected with ebola does not necessarily make good sense. On the one hand, ebola is less contagious than influenza, a family of viral infections that will certainly inflict more deaths on the U.S. population than ebola this year and for many years to come. On the other hand, we are developing a much more thorough protocol on the treatment of ebola patients, capable of achieving a much higher recovery rate than is presently available to infected individuals in West Africa. Moreover, mandatory quarantines may hinder the effort to address infected regions in West Africa if the presence of mandatory quarantines prevents health care professionals from volunteering for treatment of ebola in Liberia, Sierra Leone, and/or Guinea. These considerations suggestively support a counterargument that we would be better off to permit free entry of health care professionals, advise voluntary minimization of contacts for the course of the disease's possible incubation period (21 days) (in order to make contact tracking more effective), and pursue aggressive treatment of the disease upon determination that an individual is symptomatic.
4. Much of the political and media reaction to ebola in the U.S. reflects a more generalized current against contemporary globalization evident on both the political right and left. Above all, the American response to ebola has to transcend ignorant, hysterical, and emphatically paranoid reactions against global integration, expressed by political figures and nurtured by the media, to realize our deeper obligation to assist other human beings struggling not merely with viral epidemics but also with abject poverty, malnutrition, chronic economic underdevelopment, and ecological devastation in the name of advancing a vision of common humanity in a process of mutual development and sustainment of our race and our ecology.
My conclusion here is directed, in part, at the response to ebola expressed by Texas Governor Perry, who advanced the first emphatic call for travel restrictions from Guinea, Sierra Leone, and Liberia, but also, in part, toward New Jersey Governor Christie, New York Governor Cuomo, and other governors enacting mandatory quarantines on health care professionals coming from West Africa. Moreover, it is directed against the major corporate news media and diverse electronic media outlets that have done their best to spread fear over the potential for ebola to be spread to the U.S. population. Notwithstanding evident recognitions of physical constraints on the communicability of ebola, numerous political actors, especially among Republican Party figures at the federal level, have engaged in a conscious effort to overinflate the threat of ebola and to connect to threat from open migration of foreigners into the U.S. There is something innately disingenuous in this politicization of a global public health problem in order to rouse the suspicions of American reactionary rightists against the actions and intentions of the Obama administration in responding to this event.
Emphatically, if no measures were taken to safeguard the U.S. population against transmissions of ebola from West Africa, then fewer Americans could be expected to die from ebola this year than would be expected to die from influenza, a largely preventable viral infection significantly more communicable than ebola against which fewer than half of susceptible Americans seek vaccinations! The reaction to ebola at the state and federal level is less about rational health policy than it is about generating fear over globalization and our lack of control over, especially, population flows in a world that is becoming increasingly borderless. At the present time, we operate under the misconception that we can or should be able to readily control cross-border flows. States have operated under such misconceptions for millenia. No doubt, the Han Chinese emperors in the First and Second centuries C.E. believed that their Great Wall could prevent the Hsung Nu (i.e. barbarians) from outer Mongolia and Manchuria from ravaging the landspace of Northern China. Now, we build better fences to keep out Mexicans from Oaxaca and Chiapas from crossing into Arizona with the help of "coyotes" and staff them with ever more border security and national guardsmen and women. And, for all the tax money we are expending on these efforts to make our borders secure, we are pissing in the wind! Our borders are as irrelevant to the rest of the world as the borders of other states, like those of Syria, Afghanistan, or Pakistan are to our enactments of national security policy and to flight paths of our unmanned drones.
With such pleasant thoughts in mind, our articulations of policy with respect to ebola need to respect the deadly nature of the disease against populations that are most susceptible to its impact on human life. Instead of enacting new restrictions on the movement of health care professionals seeking to assist populations ravaged by the disease in West Africa, we should be following the efforts of a state like Cuba, dispatching large numbers of health care volunteers to assist the health care communities of affected West African countries. To its credit, the Obama administration appears to be interested in meeting the need for development of health care facilities necessary to treat infected individuals, especially in Liberia - U.S. military forces have been mobilized to these ends. Nonetheless, our larger response has been schizophrenic, mixing concern and a willingness to engage productively with governments in West Africa to contain the disease and treat infected individuals with abject fear and a desire to disengage from affected countries as if we could somehow prevent the introduction of ebola to the U.S. by pretending that our borders were something other than porous.
Tuesday, October 14, 2014
The Fall of Baghdad
This post is, in part, a brief response to the current movements of ISIS/ISIL in eastern Anbar province and, in part, a reflection on a documentary that I watched about a month ago on, of all things, the 1975 fall of Saigon. There are a very limited set of points that I mean to get across here.
First, I downplay the potential for ISIS/ISIL/Islamic State (IS) to take Baghdad, notwithstanding the existing weaknesses of the Iraqi Army/ex-Badr Brigades as a defensive fighting force. We need to clarify exactly what we mean in discussing the fall of Baghdad to the IS. To me, such a concept must imply being in control of central areas of the city including, obviously, the "Green Zone" along the Tigris River. Assuming such areas could be temporarily overrun by IS forces, would they be able to stabilize their control over the areas in the way that they apparently have in Mosul? Provided IS forces can seize control over areas of the city on the west bank of the Tigris, driving central governmental forces and representatives of the international community out of the city (not to mention sending a stream of civilian refugees pouring out the city to the north, south, and east), what would this mean for the state of the Iraqi central government and Iraqi military? Would the government be able to consolidate itself in new quarters outside of the Green Zone and prosecute the reconquest of central Baghdad? What about areas of the east bank of the Tigris and, especially, Sadr City? What about the international airport in the city's southwest?
All of these speculations on the capacity of Iraqi forces to hold Baghdad against the IS turn on the capacity of Iraqi forces, together with Mahdi irregulars and supported by U.S. and allied air power, to limit territorial gains by IS forces in the vicinity of Abu Gharib and hold key avenues of approach from Abu Gharib into western Baghdad. It also depends on what the cumulative tactical objectives of IS commanders might be in approaching from the area of Abu Gharib. Will these forces swing southward and attempt immediately to move against the international airport (a likely target if the IS is trying to isolate the city from air logistical support)? Will they advance straight eastward along the most developed avenues of approach from Abu Gharib into central Baghdad? What tactical obstacles and potential choke points might be available to slow their advance and render them especially vulnerable to air bombardment? Can they be effectively lured into urban warfare scenarios that might put Mahdi irregulars to best use? That is to say, if an IS assault through densely developed neighborhoods like al-Khadra can be converted into a house-to-house bloodbath, it might favor minimally trained and sufficiently fanatical irregular forces, using topography to their best advantage. Lastly, we need to consider the differential ground warfare technologies available to each side and the particular advantages and disadvantages of each in a struggle for both outlying quasi-rural areas and fully developed urban areas. Do IS forces possess advantages in artillery and variously equipped armored vehicles relative to governmental defenders? It goes without saying that Shi'a irregular forces reside at the low end on the technological scale and would probably be next to useless in defending against IS forces approaching objectives on the outlying perimeters of the city with armored vehicles and support from indirect fire absent substantial assistance from Iraqi professional(!) military units and/or substantial allied air support.
An assault by well armed IS forces into the western neighborhoods of Baghdad would, at least within my imagination, look like something akin to the 1942 German assault into central Stalingrad or, perhaps, the late 2004 U.S. operation to clear al Qaeda-linked Salafist insurgents from Falluja - a building-to-building quagmire partly supported on both sides by armored vehicles, rendered vulnerable by the nature of the terrain, the built environment, and the capacity of both sides to employ improvised explosive devices at key intersections and places where the use of heavy explosives could enable irregulars in concealed locations to manage an ambush along constricted avenues of advance. American and allied air power, in such conditions, will be nearly useless, assuming that the Iraqi government does not want us to bomb IS forces in densely crowded urban spaces. The only thing that we can really be certain of, in these circumstances, is that casualties will be high among any remaining civilians and that western neighborhoods in the city will suffer catastrophic damage to building and urban infrastructure that the Iraqi government will eventually have to address once peace is restored (assuming, someday, Baghdad will actually know peace!).
Having briefly considered the tactical aspects of an IS attack on Baghdad, if we do allow (key areas at the center of) Baghdad to fall into the hands of the IS, then it will only remain in their hands for an extraordinarily short period, punctuated by extreme acts of pillaging, destruction of buildings and infrastructure, and mass murder of Shi'a prisoners from the military and civilians who are unable to flee the onslaught of an IS assault. Thus, when the smoke from both the IS assault and the Iraqi government's eventual and certain counteroffensive have cleared, perhaps, the world might definitively know and understand the extent to which Iraq is engaged in a struggle against outright barbarism! Then again, will we be able to differentiate, definitively, the murder victims executed by IS Salafists from those executed by Shi'a Mahdi liberators?
If the Iraqi government and military forces are successfully driven from central areas of Baghdad, even temporarily, we have to consider the possibility that Tehran will actively and explicitly intervene militarily in Iraq to bolster government forces and Shi'a militias. At this point, the U.S. and our Sunni Arab allies in the Gulf monarchies would be faced with an unpleasant choice. Having signed onto the project of degrading and/or destroying the IS with the explicit exclusion of its strongest (in terms of available ground forces) and most logical regional enemy, Iran, the coalition currently prosecuting the air war against the IS would have to decide whether to continue its actions if Iran has unilaterally intervened on behalf of the Iraqi central government. As such, it would be a critical juncture in the evolving Sunni versus Shi'a struggle in the Arab world. If, in this respect, the Saudis do not want to allow a Salafist Caliphate to emerge in Iraq and Syria as a threat to its rule and its foreign policy engagement with the West, then they will have to balance this uncertain possibility against the reality that its revolutionary Shi'a enemy would be actively engaged in preserving a satellite Shi'a-dominated state on its northern border and a contiguous geographical linkage with the Assad regime in Syria. For the U.S., by contrast, continued involvement in an air campaign against the IS, in support of the Iraqi government would imply explicit collaboration with Iran military forces, something that neither the Obama administration nor Congress would be able to countenance. Assuming the U.S. would continue to operate an air campaign against the IS in Syria and against IS forces engaged against Iraqi Kurdish Peshmerga in defense of a Kurdish regime that would be more inclined than ever to abandon the Iraqi central government and go its own way, we would, likewise, be compelled to withdraw our support (and our military advisers) from the Iraqi regime or face the consequences of direct involvement within a broader regional Sunni-Shi'a civil war.
With all of this mind, the current offensive progress of the IS is a reminder of how poorly suited the U.S. remains at the task of managing hegemony against the imperative of securing domestic democratic support for global military engagement on the behalf of long term strategic objectives. This is, of course, not merely the story when it comes to the lingering U.S. engagement in Iraq. It also characterizes American and NATO involvement in the evolving struggle against the Taliban in Afghanistan. Moreover, it reflects back onto the long history of post-World War II U.S. military hegemony in which the hands-on professionalism of American military forces in prosecuting global strategic policy seldom found a satisfactory resolution in the struggle to maintain public support for long term military engagements, costly in terms of tax dollars and the lives of American service men and women. In these terms, the current fight for Baghdad against the IS hearkens back to the fall of Saigon to the North Vietnamese Army and stands as a harbinger for the coming fall of Kabul to a reinvigorated Taliban, spared the inconvenience of U.S. and NATO involvement in Afghanistan. The lesson here is certainly not that we should entirely henceforth forego military intervention in the struggle to defeat groups that commit brutal and even genocidal violence. Rather, our actions need to transcend the limited framework of American strategic self-interests to articulate and defend an international moral consensus in the interest of preserving peace and respect for basic human dignity. And those who would make the case to other countries that we need to intervene in the interests of common humanity need to further make the case to the American polity that our values rest in the security and peace of an interconnected world in which we cannot stick our heads in the sand and pretent that the evil has disappeared. The ubitiquous presence of sectarian fissures evident in the current fight for Iraq and our awkward efforts to negotiate them makes it clear to me that our involvement in this struggle needs to respect a broader vision than we have heretofore advanced in our struggle against the IS.
First, I downplay the potential for ISIS/ISIL/Islamic State (IS) to take Baghdad, notwithstanding the existing weaknesses of the Iraqi Army/ex-Badr Brigades as a defensive fighting force. We need to clarify exactly what we mean in discussing the fall of Baghdad to the IS. To me, such a concept must imply being in control of central areas of the city including, obviously, the "Green Zone" along the Tigris River. Assuming such areas could be temporarily overrun by IS forces, would they be able to stabilize their control over the areas in the way that they apparently have in Mosul? Provided IS forces can seize control over areas of the city on the west bank of the Tigris, driving central governmental forces and representatives of the international community out of the city (not to mention sending a stream of civilian refugees pouring out the city to the north, south, and east), what would this mean for the state of the Iraqi central government and Iraqi military? Would the government be able to consolidate itself in new quarters outside of the Green Zone and prosecute the reconquest of central Baghdad? What about areas of the east bank of the Tigris and, especially, Sadr City? What about the international airport in the city's southwest?
All of these speculations on the capacity of Iraqi forces to hold Baghdad against the IS turn on the capacity of Iraqi forces, together with Mahdi irregulars and supported by U.S. and allied air power, to limit territorial gains by IS forces in the vicinity of Abu Gharib and hold key avenues of approach from Abu Gharib into western Baghdad. It also depends on what the cumulative tactical objectives of IS commanders might be in approaching from the area of Abu Gharib. Will these forces swing southward and attempt immediately to move against the international airport (a likely target if the IS is trying to isolate the city from air logistical support)? Will they advance straight eastward along the most developed avenues of approach from Abu Gharib into central Baghdad? What tactical obstacles and potential choke points might be available to slow their advance and render them especially vulnerable to air bombardment? Can they be effectively lured into urban warfare scenarios that might put Mahdi irregulars to best use? That is to say, if an IS assault through densely developed neighborhoods like al-Khadra can be converted into a house-to-house bloodbath, it might favor minimally trained and sufficiently fanatical irregular forces, using topography to their best advantage. Lastly, we need to consider the differential ground warfare technologies available to each side and the particular advantages and disadvantages of each in a struggle for both outlying quasi-rural areas and fully developed urban areas. Do IS forces possess advantages in artillery and variously equipped armored vehicles relative to governmental defenders? It goes without saying that Shi'a irregular forces reside at the low end on the technological scale and would probably be next to useless in defending against IS forces approaching objectives on the outlying perimeters of the city with armored vehicles and support from indirect fire absent substantial assistance from Iraqi professional(!) military units and/or substantial allied air support.
An assault by well armed IS forces into the western neighborhoods of Baghdad would, at least within my imagination, look like something akin to the 1942 German assault into central Stalingrad or, perhaps, the late 2004 U.S. operation to clear al Qaeda-linked Salafist insurgents from Falluja - a building-to-building quagmire partly supported on both sides by armored vehicles, rendered vulnerable by the nature of the terrain, the built environment, and the capacity of both sides to employ improvised explosive devices at key intersections and places where the use of heavy explosives could enable irregulars in concealed locations to manage an ambush along constricted avenues of advance. American and allied air power, in such conditions, will be nearly useless, assuming that the Iraqi government does not want us to bomb IS forces in densely crowded urban spaces. The only thing that we can really be certain of, in these circumstances, is that casualties will be high among any remaining civilians and that western neighborhoods in the city will suffer catastrophic damage to building and urban infrastructure that the Iraqi government will eventually have to address once peace is restored (assuming, someday, Baghdad will actually know peace!).
Having briefly considered the tactical aspects of an IS attack on Baghdad, if we do allow (key areas at the center of) Baghdad to fall into the hands of the IS, then it will only remain in their hands for an extraordinarily short period, punctuated by extreme acts of pillaging, destruction of buildings and infrastructure, and mass murder of Shi'a prisoners from the military and civilians who are unable to flee the onslaught of an IS assault. Thus, when the smoke from both the IS assault and the Iraqi government's eventual and certain counteroffensive have cleared, perhaps, the world might definitively know and understand the extent to which Iraq is engaged in a struggle against outright barbarism! Then again, will we be able to differentiate, definitively, the murder victims executed by IS Salafists from those executed by Shi'a Mahdi liberators?
If the Iraqi government and military forces are successfully driven from central areas of Baghdad, even temporarily, we have to consider the possibility that Tehran will actively and explicitly intervene militarily in Iraq to bolster government forces and Shi'a militias. At this point, the U.S. and our Sunni Arab allies in the Gulf monarchies would be faced with an unpleasant choice. Having signed onto the project of degrading and/or destroying the IS with the explicit exclusion of its strongest (in terms of available ground forces) and most logical regional enemy, Iran, the coalition currently prosecuting the air war against the IS would have to decide whether to continue its actions if Iran has unilaterally intervened on behalf of the Iraqi central government. As such, it would be a critical juncture in the evolving Sunni versus Shi'a struggle in the Arab world. If, in this respect, the Saudis do not want to allow a Salafist Caliphate to emerge in Iraq and Syria as a threat to its rule and its foreign policy engagement with the West, then they will have to balance this uncertain possibility against the reality that its revolutionary Shi'a enemy would be actively engaged in preserving a satellite Shi'a-dominated state on its northern border and a contiguous geographical linkage with the Assad regime in Syria. For the U.S., by contrast, continued involvement in an air campaign against the IS, in support of the Iraqi government would imply explicit collaboration with Iran military forces, something that neither the Obama administration nor Congress would be able to countenance. Assuming the U.S. would continue to operate an air campaign against the IS in Syria and against IS forces engaged against Iraqi Kurdish Peshmerga in defense of a Kurdish regime that would be more inclined than ever to abandon the Iraqi central government and go its own way, we would, likewise, be compelled to withdraw our support (and our military advisers) from the Iraqi regime or face the consequences of direct involvement within a broader regional Sunni-Shi'a civil war.
With all of this mind, the current offensive progress of the IS is a reminder of how poorly suited the U.S. remains at the task of managing hegemony against the imperative of securing domestic democratic support for global military engagement on the behalf of long term strategic objectives. This is, of course, not merely the story when it comes to the lingering U.S. engagement in Iraq. It also characterizes American and NATO involvement in the evolving struggle against the Taliban in Afghanistan. Moreover, it reflects back onto the long history of post-World War II U.S. military hegemony in which the hands-on professionalism of American military forces in prosecuting global strategic policy seldom found a satisfactory resolution in the struggle to maintain public support for long term military engagements, costly in terms of tax dollars and the lives of American service men and women. In these terms, the current fight for Baghdad against the IS hearkens back to the fall of Saigon to the North Vietnamese Army and stands as a harbinger for the coming fall of Kabul to a reinvigorated Taliban, spared the inconvenience of U.S. and NATO involvement in Afghanistan. The lesson here is certainly not that we should entirely henceforth forego military intervention in the struggle to defeat groups that commit brutal and even genocidal violence. Rather, our actions need to transcend the limited framework of American strategic self-interests to articulate and defend an international moral consensus in the interest of preserving peace and respect for basic human dignity. And those who would make the case to other countries that we need to intervene in the interests of common humanity need to further make the case to the American polity that our values rest in the security and peace of an interconnected world in which we cannot stick our heads in the sand and pretent that the evil has disappeared. The ubitiquous presence of sectarian fissures evident in the current fight for Iraq and our awkward efforts to negotiate them makes it clear to me that our involvement in this struggle needs to respect a broader vision than we have heretofore advanced in our struggle against the IS.
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