1 Consequences of War and MilitarismMartin Donohoe

2 Outline The history and epidemiology of war Nuclear weaponsChemical weapons Biological weapons

3 Outline Economic and environmental consequences of militarism and warHealth consequences of militarism and war Contemporary conflicts Afghanistan, Iraq, “War on terror” Solutions

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

5 Origins of War Foragers vs. Agriculturalists AgricultureHierarchical society Private property Money Subjugation of women Infectious/chronic diseases

6 Origins of War Violence TodayLink with poverty, oppression, fueled by desire for wealth/power Familial vs. Societal Gun culture Media Violence Glorification of militarism

7 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

8 Militarism Positively correlated with: Conservatism NationalismReligiosity Patriotism Authoritarianism

9 Militarism Negatively correlated with: Respect for civil libertiesTolerance 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)

10 History of war 10,000 yrs ago – agricultureStable populations, division of labor, warrior class 3500 yrs ago – bronze weapons and armor 2200 yrs ago – iron 1900 yrs ago – widespread use of horses

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

12 History of War (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 and other drones, weaponization of Arctic/space

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

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

15 War Deaths,

16 Contemporary War Deaths

17 Worldwide Violence (2013) 526,000 killed by armed violence/yr396,000 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

18 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 (suicides, homicides, and accidental shootings): 1.4 million (CDC)

19 Gun Violence Americans own million guns (#1 in world in privately owned firearms) Almost ½ of world’s civilian-owned firearms Nearly ½ stored improperly in homes with children Average gun-owning household has 8.2 guns (doubled over last 20 yrs) ½ owned by only 3% of population (avg 17 guns each)

20 Gun Violence 276 active militias (2016)40 states prohibit or limit paramilitary training and unofficial military forces, yet no known cases of laws ever being enforced against private militias

21 Gun Violence 33,000 deaths/yr due to firearm-related violence, suicides, and accidents (highest among industrialized countries) Every day in U.S.: 31 homicides, 55 suicides, 2 unintentional shootings involving guns 84,000 injuries annually

22 Gun Violence US firearm homicide rate 25X higher/suicide rate 8X higher than in other industrialized countries Direct + indirect societal costs = $230 billion/yr

23 Gun Violence FL, MI, and MT have passed laws limiting doctors’ speech/prohibiting counseling re firearms (FL law overturned by Appeals Court [2017], others tied up in courts) ¼ of physicians do not feel it is their responsibility to address gun ownership with patients CDC prohibited from studying gun violence using federal funds since 1990s

24 Gun Violence Access to firearms increases the risk of being a victim of homicide Women are especially at risk of homicide when a firearm is present Access to firearms greatly increases the risk of suicide Firearms are not very effective (if at all effective) at deterring crime

25 Legacies of Colonial ExploitationChristopher 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.”

26 Legacies of Colonial ExploitationWinston 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”

27 Legacies of Colonial ExploitationCecil 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.”

28 Contemporary Wars 250 wars in the 20th CenturyIncidence of war rising since 1950 Most conflicts within poor states Over 30 separate civil wars currently underway Most involve U.S.-supplied weapons

29 War Deaths Revolutionary War: 25,000 Civil War: 625,000World War I: 17 million World War II: 60 million Korean War: 2.9 million Vietnam War: 3.8 million

30 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

31 War Deaths Iran-Iraq War: 700,000Soviet War in Afghanistan: 1.5 million Second Congo War: 3.8 million Second Sudanese Civil War: 1.9 million

32 War Deaths (as of 7/15) Second Iraq War: 4,497 U.S. soldiersApproximately 18,000 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 Over 20,000 civilians

33 Contemporary Wars WW II: first war with more battle deaths than deaths from other causes, such as accidents, disease, and infections 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

34 War Deaths ( )

35 Child Soldiers Use of child soldiers by 19 countriesDespite 2008 Child Soldiers Prevention Act, U.S. still provides aid to some of these

36 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

37 Wars Promoted Through MilitarismMilitary buildups Exceptionalism Imperialism Glorification of war Unrealistic expectations

38 Consequences of War Deaths, injuries, physical and psychological sequelae Collapse of health care system affecting those with acute and chronic illnesses Famine

39 Consequences of War 65 million forcibly displaced persons worldwide21 million refugees (50% are children under 18) 28 million internally displaced persons Over 1 million asylum seekers Approximately ¾ of world’s refugees are hosted by developing countries

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41 Consequences of War Environmental degradationAugments global warming, which Pentagon calls an immediate national security threat Increasing poverty and debt All lead to recurrent cycles of violence

42 Atomic Weapons - HistoryHiroshima, 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)

43 The Hiroshima Bomb

44 Atomic Explosion

45 Atomic Weapons – Other VictimsHundreds of thousands of hibakusha – atomic bomb survivors 1054 U.S. nuclear tests since 1940s, 331 in atmosphere

46 Atomic Weapons – Other Victims80,000 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

47 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)

48 Atomic Weapons Today Vastly redundant arsenalweapons 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 Reliable estimates put likely cost at $1 trillion

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

50 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

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

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

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

54 Effects of a 20 megaton nuclear explosionGround 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

55 Effects of a 20 megaton nuclear explosionmiles: 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

56 Effects of a 20 megaton nuclear explosion21 miles: 2 psi; 100 mph winds Shattered glass, flying debri 29 miles: 3° burns over all exposed skin 40 miles: Retinal burns blind all who witness explosion

57 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

58 Types of Injuries Burns Blindings Deafenings PTX Fxs Shrapnel wounds

59 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

60 Effects on health professionals70% killed or fatally wounded 15% injured < 1000 survive

61 Effects on health care systemMost 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

62 Effects on Health Care System1500 patients/doctor 10 min/pt 4 hours sleep/noc 2 weeks to see all injured

63 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

64 Abolition of Nuclear WeaponsSupported by: APHA AMA ACP IPPNW PSR Global political and military leaders

65 Health hazards of the Nuclear CycleEcosystem degradation: e.g., Marshall Islands Uranium mining: 5-fold increase in lung cancer 15,000 abandoned uranium mines in U.S. Depleted uranium: increased stillbirths, birth defects, childhood leukemias, other cancers in Southern Iraq Possible increase in lung CA in U.S. soldiers (data sparse)

66 Nuclear Waste 70,000 metric tons of nuclear wasted in USMost 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

67 Nuclear Waste Disposal: Hanford, WASite of plutonium production for first atom bomb (and most of U.S. nuclear arsenal) Decommissioned at end of Cold War (1971)

68 Nuclear Waste Disposal: Hanford, WAThe most polluted place in American 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

69 Nuclear Waste Disposal: Hanford, WAPlan = vitrification and underground storage Most complex and costly environmental restoration ever attempted ($110 billion price tag; could take another 50 yrs to complete)

70 Nuclear Waste Disposal: Hanford, WASite plagued by leaks, cost overruns, underfunding With Oak Ridge (TN) and Los Alamos (NM), now part of Manhattan Profect National Historic Park

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

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

73 Nuclear Waste Disposal – Yucca MountainEst. 100,000 shipments of 70,000 – 120,000 tons of waste over 25 yrs Coming within ½ mile of 50 million Americans Est accidents Nuclear roulette After $9 billion spent, plan cancelled (2010) – other options being considered

74 Nuclear Waste DisposalDOE has proposed recycling radioactive scrap metal into consumers goods and health care devices E.g., silverware, pots and pans, eyeglasses, braces, pacemakers, artificial joints

75 Nuclear Waste 111,000 cubic yards of radioactive debris from detonation of 67 nuclear bombs (= 1.6 Hiroshimas) over Marshall Islands between 1946 and 1958) stored in unlined pit under Runit Dome Contents at risk of leaking into ocean as sea levels rise due to global warming Displaced islanders not adequately compensated

76 Nuclear Power Plants

77 Nuclear Power Plants 100 plants operating in USAging, 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

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

79 Nuclear Power Plant AccidentsThree Mile Island (1979) 50,000 to 100,000 excess deaths Chernobyl, USSR, nuclear power plant explosion 200 times the radiation of Hiroshima + Nagasaki 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

80 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.; plant to remain a threat for 3,000 yrs

81 Nuclear Accidents: Fukushima2nd largest nuclear power plant disaster after Chernobyl 50 early casualties 1,100 km declared uninhabitable, 88,000 relocated (almost as many left voluntarily) Reactor built by GE (also responsible for Indian Point plant, 40 miles from NYC)

82 Nuclear Accidents: FukushimaGE has built 91 nuclear power plants in 11 countries, including 23 plants at 11 sites in U.S. (including Hanford) 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

83 Nuclear Power Plants For every US plant that has its license renewed, 12 additional cancer deaths (NRC) Plus any deaths from accidents, non-routine releases, high level waste and spent fuel

84 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)

85 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

86 Nuclear Power Plants/ Nuclear WasteMany plants close to major population centers 70,000 metric tons of spent fuel at 70 reactor sites in 39 U.S. states Target for terrorists

87 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

88 Nuclear Terrorism Dirty bombPotential 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

89 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)

90 Nuclear Terrorism Reports of weapons missing from Soviet arsenalNon-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

91 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)

92 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

93 Chemical Weapons Egypt vs. South Yemen (1963-7)Agent Orange (contains carcinogenic, feto-toxic dioxin) Defoliant herbicide, poisoned manioc root (primary food staple Manufacturer Dow Chemical Six lbs per person dumped by US on South Vietnam (1/10 area of South Vietnam) 1 million Vietnamese victims (deaths, disabilities, birth defects, cancers, etc.); U.S. soldiers also affected

94 Chemical Weapons Iran/Iraq War (1980s): sarin, nerve gas, mustard gasGulf War (versus Kurds, ? Others)

95 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, genetic susceptibility, exposure to pyridostigmine Brain damage noted on fMRI

96 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 : U.S. vs Iraqis (depleted uranium) 2004-5: U.S. vs Iraqis and : Israel vs Palestinians (white phosphorus) 2012 Libya (mustard gas) and Syria (sarin)

97 Types of Chemical WeaponsNerve 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)

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

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

100 Chemical Weapons: Vietnam and Napalm

101 Chemical Weapons: Vietnam and Napalm

102 Chemical Weapons: Vietnam and Napalm

103 Chemical Weapons 1972 Biological and Toxic Weapons Convention prohibits development, production, and stockpiling US and Russia still have significant stockpiles US has destroyed 90% (= 30,500 tons), plans to complete job by 2017 480 US chemical facilities each put 100,000 or more Americans at risk of poison gas disaster

104 Other Chemical Weapons: Tear gasUse 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

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

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

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

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

109 Biological Weapons - HistorySir 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

110 Biological Weapons – WW IIUnit 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

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

112 Biological Weapons Post WWIISwerdlosk Zimbabwe Okinawa, Utah, Hawaii, Puerto Rico, etc. 1977 H1N1 flu epidemic (likely due to lab accident releasing 1957 strain, NEJM) False alarms

113 Biological Weapons Today17 countries possess (+ Al Qaeda?) US role in supplying other nations: e.g., : 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

114 Biological Weapons Today1972 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)

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

116 Biological Weapons TodayOver 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 Only one small fine levied

117 Biological Weapons Today1999: 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”

118 Biological Weapons TodayGenetic weapons – targeted at specific ethnic groups Gene drives (e.g., warrior gene [form of MAO A gene linked to antisocial and aggressive behaviors – present in 30% of men], insects engineered to carry disease, seeds designed to deliberately suppress food crops or crash a harvest, etc.)

119 Biological Weapons TodaySynbio (synthetic biology) Publication of details re creation of novel, dangerous agents

120 Biological Weapons TodayUse, 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

121 Biological Weapons TodayQuarantine 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

122 Smallpox DNA virus Decimated native American populationsEradicated by WHO vaccination campaign in 1972 Genome sequenced in 1992 Recreation of virus in lab possible (2002)

123 Smallpox ?Only remaining viral stocks at CDCP and in Siberia?WHO Executive Board recommended retaining stores Concerns about frozen permafrost smallpox reactivation and spread

124 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

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

127 Smallpox Vaccination Vaccinia US ended in 1972Waning (?negligible) immunity Effects: local reaction. Lymphadenopathy

128 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

129 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

130 Anthrax Bacillus anthracis, aerobic, G+, spore-forming rod ZoonosisInvisible and odorless when aerosolized

131 Anthrax 1979: accidental release at Swerdlosk (USSR): 250 cases, 100 deaths, town abandoned due to contamination 1997: Aum Shrinko cult attempted aerosol dispersal – unsuccessful 2016: Cases seen in Arctic Circle from contact with thawed human and reindeer corpses (due to melting permafrost)

132 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

133 Cutaneous Anthrax 2000 cases/yr worldwideDue to exposure to infected animals / animal products Epidemic in Zimbabwe, : 10,000 cases

134 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

135 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

138 Gastrointestinal AnthraxFrom 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

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

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

141 Inhalational Anthrax Widened Mediastinum

142 Inhalational Anthrax

143 Inhalational Anthrax Dx: blood cultures, XR/CT, post-mortem; serology not helpful Case fatality rate approx. 50%

144 Anthrax Post-exposure prophylaxis: ciprofloxacin and doxycycline for 60 days Rx: Combinations of antibiotics (ciprofloxacin, linezolid, meropenem, clindamycin); monoclonal antibody antitoxins (raxibacumab, obiltoxaximab); Anthrasil (anthrax immune globulin) Drain effusions Supportive care

145 Anthrax Vaccine 3 or 4 dose series US armed service membersSide 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

146 Anthrax Vaccine Pre/post exposure vaccinationImproved vaccine under development Testing considered unethical ?Groups to vaccinate? Antibody testing may help guide

147 Anthrax – The Band

148 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)

149 “Non-lethal” Weapons Proposed and Under DevelopmentAcoustic 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

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

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

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

153 “Non-lethal” Weapons Proposed and Under DevelopmentBiotechnical: 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)

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

155 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

156 American Weapons Gone AWOLIraq – U.S. supplied Saddam Hussein, arms ultimately used against U.S. in Iraq Wars; 30% of weapons given to Iraqi forces between 2004 and 2007 never accounted for; more recently, U.S.-supplied weapons finding their way to ISIS and Iranian-backed Shiite militias

157 American Weapons Gone AWOLAfghanistan – U.S. armed anti-Soviet soldiers, weapons ultimately ended up with Taliban; 40% of those recently given to Afghan army and police can’t be traced Libya – guns sent from Qatar as part of U.S.-approved deal (2011) now with Islamic militants

158 American Weapons Gone AWOLSomalia – almost ½ of arms supplied to Uganda and Burundi to fight al-Shabaab sold off by underpaid troops, ended up with Somali militants Yemen – U.S. lost track of $500 million worth of small arms and other gear it sent to Yemeni government before 2015 collapse

159 American Weapons Gone AWOL2016: US military has lost track of over 700,000 of the 1.45 million assault weapons, machine guns, and other firearms it provided to allied security forces, militias, and police during Iraq and Afghanistan Wars

160 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?)

161 Health Care System Preparedness for Weapons of Mass DestructionCongressional panel estimates > 50% chance of terrorist act involving WMDs by 2013 ERs/hospital systems inadequately prepared Funds low

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

163 Costs of MilitarizationUS: 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

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167 (Using “constant dollars”; excludes VA, CIA, Homeland Security, Energy, Justice, and State Departments and interest payments on past military spending)

168 Missile Defense Shield The Militarization of SpaceStar 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

169 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

170 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”

171

172 Meanwhile... Social Injustices Abound29 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)

173 Consequences of Global Warming400,000 deaths and 5.5 million disability-adjusted life years lost per year WHO, UN Environment Program Expected to double by 2020 Pentagon calls global warming an immediate national security threat

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

175 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

176 Health Costs of Militarization3 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

177 Health Costs of Militarization3 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)

178

179 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

180 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

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

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

183 We’re Number One U.S. #1 in military spending #17 in education#26 in infant mortality #37 in life expectancy and overall health

184 DOD Announcement (September, 2011)“Pentagon Lacks Funding to Fix Public Schools on Military Bases”

185 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”

186 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.”

187 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.”

188 Worldwide Economic Impact of Violence$10 trillion/yr 1% of global GDP $1,350/U.S. citizen

189 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

190

191 War and Peace World military budget230X 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)

192

193 Arms Exports

194 Arms Imports

195 Top Recipients of U.S. Military AidIsrael Egypt Iraq Pakistan Jordan Columbia Somalia

196 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

197 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

198 Economic Cost of War, U.S.

199 US Foreign Aid US ranks 1st in total dollars, but 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

200 Major Defense ContractorsLockheed Martin Corp. Northrop Grumman Corp. Boeing Corp. Raytheon Corp. General Dynamics Corp. KBR, Inc. Large lobbying contingent; donate large amounts each election cycle

201 September 11, 2001

202 World Trade Center Bombing3300 fatalities - foreign nationals outnumbered Americans Over 18,000 people suffering health problems linked to attack and rescue Multiple toxins in air and rubble Increased risk of prostate cancer and melanoma in first responders and residents of lower Manhattan Zadroga Act (2010) provides funds for monitoring, treatment, and victim compensation

203 World Trade Center BombingEnvironmental health consequences unknown: tons asbestos 130,000 gallons of transformer oil contaminated with PCBS Lead, sulfuric acid, silicon Fine dust particles

204 September 11, 2001 Pentagon: 286 casualtiesPennsylvania: approximately 100 casualties

205 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

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

207 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

208 Afghanistan/Iraq Parallels10 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

209 Afghanistan/Iraq ParallelsLiteracy decreased from 89% to 57% Infrastructure devastated, environment degraded Opium trade increasing Rebuilding post-war, yet Taliban still active

210 What goes around comes around1980s: CIA arms Afghan rebels with hundreds of Stinger missiles Late 2002: Terrorists using a similar Russian-made version of Stinger almost bring down Israeli passenger airline over Kenya CIA trying to buy back, but most unaccounted for Can shoot down a plane at up feet 24 diverted to Iran

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

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

213 Kuwaiti Oil Fires

214 War Deaths (as of 7/15) Second Iraq War: 4,497 U.S. soldiersApproximately 18,000 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 Over 20,000 civilians

215 Ratio of military contractors to US soldiers Source: Department of DefenseAfghanistan – 1.20 Iraq – 1.10 Balkans – 1.0 Gulf War – 0.01 Vietnam – 0.17 Korea – 0.40 WWII – 0.14 WWI – 0.08 Civil War – 0.20 American Revolution – 0.17

216 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

217 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 Other audits have uncovered numerous instances of waste, fraud, and abuse costing tens of billions of dollars

218 Gulf War II - Iraq WMDs found by U.S. troopsOnes 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 Today: ISIL, militias, Kurds, Sunnis and Shiites all still fighting for territory

219 Contemporary Wars Casualties among soldiers, civilians continueMore US soldiers have committed suicide than have died in Afghan War More military contractors killed than US soldiers

220 Contemporary Wars Casualties among soldiers, civilians continueVeteran health care needs massive (TBI in 10-20% 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

221 Contemporary Wars Libya, Syria, ISIL (multiple fronts)Coming Soon: Iran? Ukraine? ISIL? South China Sea? Privatization of war and national security enterprises Plans for militarization of the U.S./Mexico border

222 George W Bush’s Military RecordFebruary, 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

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

224 George W Bush’s Military RecordNovember, 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

225 George W Bush’s Military RecordMay, 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

226 George W Bush’s Military RecordReturns 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

227 US Nuclear Weapons Policies Under GW BushNuclear 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

228 U.S. Nuclear Policy Under ObamaU.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)

229 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.”

230 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

231 National Defense Authorization ActSigned 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

232 Disturbing Trends: The Homeland Security AgencyThe 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

233 Special Interest Provisions in the Homeland Security LawVaccine 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

234 Special Interest Provisions in the Homeland Security LawImmunity 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

235 Disturbing Trends: Censorship and PropagandaUS 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

236 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.

237 Disturbing Trends Hate crimes, intolerance Media jingoismArmy to ignore FDA safety standards in experiments on soldiers (legacy of 20th Century crimes)

238 Disturbing Trends NSA spying War gear utilized by police departmentsCo-optation of academia Use of private military subcontractors

239 Disturbing Trends Drone attacks (1/4 killed are non-combatants)10X more likely than conventional airstrikes to kill civilians Suspension of habeus corpus Poor access to VA services for vets, providers pressured not to diagnose PTSD

240 Disturbing Trends Budget surplus/deficit:2000: surplus = $5.6 trillion 2003: deficit = $2.1 trillion 2011: deficit = $1.3 trillion Cities and states facing huge budget shortfall Bush: “States are on their own.” Obama: Financial meltdown Meanwhile, profits at America’s top 5 defense firms up 450% since 2002

241 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."

242 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.”

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

244 Just War Theory The cause must be justA 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

245 Just War Theory The probability of success should be highThe cost-benefit ratio must be high The means used must conform with international humanitarian law

246

247 Ignored Alternatives to War in IraqBorder 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

248 Ignored Alternatives to War in IraqImprove cargo monitoring at port of Azqaba, Jordan (high-volume port for sea-going cargo to Iraq) Create a green list of approved oil companies to purchase Iraqi oil – i.e., those not providing kickbacks to Hussein Require audited financial reports from oil purchasers to enforce above

249 Ignored Alternatives to War in IraqControl 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)

250 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 240 year history

251 The US: Rogue Nation Over 1,000 bases worldwide today (737 in 69 other countries) All other countries combined occupy only 30 foreign bases 54 countries helped facilitate CIA’s secret detention, rendition, and interrogation program

252 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

253 The US: Rogue Nation Conservative estimate = 8 million killedThe 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

254 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 Guantanamo Bay

255 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

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

257 International Non-Cooperation/IsolationismFailure 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

258 International Non-Cooperation/IsolationismFailure 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)

259 The US: Rogue Nation Domestic Spying (e.g., NSA)Torture ( 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

260 The US: Rogue Nation Failure to follow World Court DecisionsFailure to recognize International Criminal Court Largest debtor to the UN (only 40% of dues paid)

261 International WIN/Gallup Poll, 2014Which country is the greatest threat to peace? U.S. – 24% Pakistan – 8% China – 6% Afghanistan – 5% 66,000 surveyed worldwide

262 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

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

264 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.”

265 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…”

266 The role of the doctor in societyWorld 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.”

267 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.”

268 Reference The Role of Public Health in the Prevention of War: Rationale and Competencies Am J Public Health 2014;104:e34–e47. Available at

269 Public Health and Social Justice WebsiteContact Information Public Health and Social Justice Website