The crucible of Iraq – causes and consequences

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<ul><li><p>This article was downloaded by: [University of California Davis]On: 21 October 2014, At: 23:07Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH,UK</p><p>Medicine, Conflict and SurvivalPublication details, including instructions for authorsand subscription information:http://www.tandfonline.com/loi/fmcs20</p><p>The crucible of Iraq causes andconsequencesJack Piachaud a &amp; Sonali Sharma ba Medact , Londonb Cornell, USAPublished online: 26 Mar 2008.</p><p>To cite this article: Jack Piachaud &amp; Sonali Sharma (2008) The crucible of Iraq causes and consequences, Medicine, Conflict and Survival, 24:2, 115-129, DOI:10.1080/13623690801950419</p><p>To link to this article: http://dx.doi.org/10.1080/13623690801950419</p><p>PLEASE SCROLL DOWN FOR ARTICLE</p><p>Taylor &amp; Francis makes every effort to ensure the accuracy of all theinformation (the Content) contained in the publications on our platform.However, Taylor &amp; Francis, our agents, and our licensors make norepresentations or warranties whatsoever as to the accuracy, completeness, orsuitability for any purpose of the Content. Any opinions and views expressedin this publication are the opinions and views of the authors, and are not theviews of or endorsed by Taylor &amp; Francis. The accuracy of the Content shouldnot be relied upon and should be independently verified with primary sourcesof information. Taylor and Francis shall not be liable for any losses, actions,claims, proceedings, demands, costs, expenses, damages, and other liabilitieswhatsoever or howsoever caused arising directly or indirectly in connectionwith, in relation to or arising out of the use of the Content.</p><p>This article may be used for research, teaching, and private study purposes.Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly</p><p>http://www.tandfonline.com/loi/fmcs20http://www.tandfonline.com/action/showCitFormats?doi=10.1080/13623690801950419http://dx.doi.org/10.1080/13623690801950419</p></li><li><p>forbidden. Terms &amp; Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions</p><p>Dow</p><p>nloa</p><p>ded </p><p>by [</p><p>Uni</p><p>vers</p><p>ity o</p><p>f C</p><p>alif</p><p>orni</p><p>a D</p><p>avis</p><p>] at</p><p> 23:</p><p>07 2</p><p>1 O</p><p>ctob</p><p>er 2</p><p>014 </p><p>http://www.tandfonline.com/page/terms-and-conditionshttp://www.tandfonline.com/page/terms-and-conditions</p></li><li><p>The Crucible of Iraq causes and consequences</p><p>Jack Piachauda* and Sonali Sharmab</p><p>aMedact, London; bCornell, USA</p><p>(Accepted 14 January 2008)</p><p>War can be seen as a crucible in which global geopolitical forces act on apopulation in a transformative manner. The psychological impact ofwar can be described in many ways, from the diagnostic to the narrative,from the intrapersonal to the relational. This paper explores whether theforces driving the conflict relate to the consequent psychologicalprocesses of those caught up in it. Geopolitical drivers, underlyingglobal issues and the consequences on mental well-being are described.The models we use to define the consequences of war determine thedegree to which the causes are seen as relevant to restorative,transformational or therapeutic processes; however a simple modelreducing the consequences to traumatic events and symptoms, whilsthaving some validity, is not a sufficient description of the humanexperience. Understanding the causes and consequences of war is amultidisciplinary venture.</p><p>Keywords: globalization; Iraq; psychosocial; mental health; trauma; war</p><p>Introduction</p><p>Iraq has taken on an iconic meaning in human development and humandestruction. It was a key site for the development of civilization and the firstcities, a wonder of the ancient world in Babylon, the site of the firstuniversities and precursor of the European Renaissance, and now a cruciblein the War on Terror and the Clash of Civilizations.</p><p>In its original definition a crucible is a device to transform chemicalsunder great heat; it may also be defined as a place, time, or situationcharacterized by the confluence of powerful intellectual, social, economic, orpolitical forces1. These forces act within the crucible, transforming thenature of society. Iraq has become such a place where these forces have ledto a long period of tyranny, sanctions and wars, which has had a verynegative impact on its people.</p><p>*Corresponding author. Email: m.piachaud@imperial.ac.uk</p><p>Medicine, Conflict and SurvivalVol. 24, No. 2, AprilJune 2008, 115129</p><p>ISSN 1362-3699 print/ISSN 1743-9396 online</p><p> 2008 Taylor &amp; FrancisDOI: 10.1080/13623690801950419</p><p>http://www.informaworld.com</p><p>Dow</p><p>nloa</p><p>ded </p><p>by [</p><p>Uni</p><p>vers</p><p>ity o</p><p>f C</p><p>alif</p><p>orni</p><p>a D</p><p>avis</p><p>] at</p><p> 23:</p><p>07 2</p><p>1 O</p><p>ctob</p><p>er 2</p><p>014 </p></li><li><p>This paper approaches the matter from a mental health perspective andexplores the general question of how the mental suffering created by warmight be related to the causes of the war. Put another way, do the reasonsfor a war have direct bearing on the nature of the consequent psychologicalsuffering, or are the cause and consequence separated by a disruption insocial continuity? From a therapeutic perspective does understanding thecauses of the war have importance in how we respond in our therapeuticendeavours? Do the mental phenomena of the victims tell us anything aboutthe causes of the war?</p><p>To develop this enquiry an analysis of the crucible will be made lookingat the forces at play the geopolitical context of the crucible and the broadissues that underpin the current conflict and the contents of the crucible:the people of Iraq and their suffering. This analysis reflects a model commonin the psychological analysis of behavioural problems, to examine theprecipitants, the precursors and the consequences. It is common too to lookat the behaviours themselves, in this case the actual way the war is fought;this will not be examined in this paper, though that is not to deny itsrelevance.</p><p>The geopolitical drivers for the war, although related in a variety of waysto the underlying issues, examine the factors of why these combatants atthis place and time. For example an underlying issue might be the evolvingnature of sovereignty regarding the nation state, and whilst the weakening ofsovereignty may contribute to the emergence of conflict, it is not a directdriver. The sectarianism that emerged after the war may be a long-termunderlying issue, but it was provoked and stoked by the violence and theauthority vacuum, rather than being a direct cause of the war.</p><p>These three areas the geopolitical drivers, the underlying issues and themental effects of the war on the people of Iraq will be explored, followedby an attempt to draw them together into some continuity of cause andeffect. First there will be a brief look at how a health perspective mightaddress some of these matters of human and international relations.</p><p>War in the lens of health</p><p>The relationship of health to war is often seen as simply humanitarian,responding to the suffering created by the violence, as health scienceslooking at war dispassionately and carrying out epidemiological surveys andneeds assessments whilst the health services provide for that need. There is along history however of medical professions considering war as somethingto be prevented because of the morbidity and mortality associated with it2.Preventive medicine is not simply about vaccinations or biological matters,but contains an understanding of human behaviours, how to influence thesebehaviours and the political processes that shape the broader determinantsof health and health service delivery.</p><p>116 J. Piachaud and S. Sharma</p><p>Dow</p><p>nloa</p><p>ded </p><p>by [</p><p>Uni</p><p>vers</p><p>ity o</p><p>f C</p><p>alif</p><p>orni</p><p>a D</p><p>avis</p><p>] at</p><p> 23:</p><p>07 2</p><p>1 O</p><p>ctob</p><p>er 2</p><p>014 </p></li><li><p>Three models of health inform this paper and this analysis. Inunderstanding how policy emerges it is necessary to examine the contextand the content of the policy, as well as the processes and actors involved assuggested by Walt3; although this was originated for health policy it can beapplied to any political actions that impact on health. A public health modelis suggested by Sidel4 to examine political violence at primary, secondaryand tertiary levels of prevention primary being the prevention of violenceitself, secondary being when violence is emergent but still containable, andtertiary when the violence has erupted and the health consequences must beameliorated. Finally, the bio-psycho-social model used in medicine, thoughby no means restricted to this discipline, allows examination of individualbiological factors, as well the developmental, the psychological and socialissues that determine health, health treatments and health-seekingbehaviours5.</p><p>The geopolitical drivers and precipitants of the war</p><p>The factors driving the invasion of Iraq cover a wide spectrum from currentglobal relationships in the marketplace to fears of nuclear weapons. It isimpossible to consider either the underlying issues or precipitants withoutconsidering globalization as an expression of the current global relationshipsbetween nations and other significant groupings. Whilst debate exists aboutthe nature of globalization6,7,8 and whether it represents a new phenomenonor an evolution of old practices, there is a general acceptance that newcommunications and markets have reduced the power of sovereign statesand that the transnational organizations, including massive corporationsand intergovernmental organizations such as the UN, the World TradeOrganization, World Bank and the International Monetary Fund, havegreat influence in global matters.</p><p>It is also clear that within the new global market there are winners andlosers9, and that one way to lose catastrophically is to become the place ofwar. An examination of several major conflicts such as those in theDemocratic Republic of Congo, Sierra Leone and Angola, suggests stronglythat control of important resources is a significant factor in these wars10. Topossess resources can of course be a boon in the present global markets, butfor poorer countries there is a complex balance: a failure to developsufficient state control is met by civil strife such as in the DRC and SierraLeone. To maintain control of those resources may lead to militaristic andrepressive systems, such as in Uzbekistan and Myanmar. However, attemptsto use those resources to develop power to break out of ones place in themarket structure can be met with force and condemnation, a situationrelevant to Iraq.</p><p>The suggestion that oil was a precipitant for the war in Iraq createsstrong political debate. On one side there is a view that oil was the primary</p><p>Medicine, Conflict and Survival 117</p><p>Dow</p><p>nloa</p><p>ded </p><p>by [</p><p>Uni</p><p>vers</p><p>ity o</p><p>f C</p><p>alif</p><p>orni</p><p>a D</p><p>avis</p><p>] at</p><p> 23:</p><p>07 2</p><p>1 O</p><p>ctob</p><p>er 2</p><p>014 </p></li><li><p>determinant for this war and that the essence of the War on Terror is abattle between the US market-dominated world and a loose transnationalnetwork called Al Qaeda, that wishes all the oil in the Middle East to beunder the control of a single Islamic State. This is seen to be an asymmetricwar that will rumble on for many years through acts of domination, terrorand insurgency unless there is some political compromise11.</p><p>Whilst it is hard to refute this view, it is not all that needs to beconsidered. The emergence of the US as a market state and its use of militarypower to control and contain the globalized market needs recognition. Thecurrent state of the world can be seen as the end product of a long war inwhich fascism, communism and market democracy vied for dominance12.Iraq has toyed with all three and at the time of the market democracystriumph had been a useful client of the US but chose to break the rules byinvading Kuwait, then remained intransigent; maybe Saddam had believedthat in the new world order he would be rewarded by the new superpowerfor his stand against Iran during the 1980s. Iraq then became the example tothe world of what would happen if a sufficiently weak country did not keep tothe rules of the market place, and a period of crippling sanctions wasimposed. In 2001 following the election of GWBush as President, the politicswithin the US shifted to a stronger neo-liberal agenda that wished tostrengthen the political effects of globalization in the post-Cold War era. Inthis sense Iraq then became the scapegoat that was necessary for thesuperpower to establish its new role and global superiority13.</p><p>The view that Iraq posed no military threat because it was in fact abroken state has much evidence. Throughout the 1990s Iraq had beenreduced to a poor country, with the health of its people, its social capital,external contacts, freedom and liberty all in serious decline. The control ofsanctions was very great and the roles of weapons inspectors complex,reflecting the power the US exerted within the Security Council (SC) and theUN, even though other members of the SC spoke over the years about theconsequences of the sanctions on the people of Iraq and the need to resolvethe problems14.</p><p>A critical question is whether the war would have happened without the9/11 atrocity. For the US, the outrage that its own territory had beenexposed and open to attack was another important factor in its need todemonstrate power. There was an issue of sovereignty, that its ownboundaries had been transgressed; therefore other sovereign boundariesshould be open in any response. The declaration of war is about the loss ofsovereignty as a protective device. The view that this is precisely what the AlQaeda leadership wanted warrants some consideration. The events of 9/11amounted to an act of great provocation, which led the US to retaliateand expose one of the current worlds greatest conflicts, that of secularversus spiritual leadership and the battle over which ideology shouldpredominate.</p><p>118 J. Piachaud and S. Sharma</p><p>Dow</p><p>nloa</p><p>ded </p><p>by [</p><p>Uni</p><p>vers</p><p>ity o</p><p>f C</p><p>alif</p><p>orni</p><p>a D</p><p>avis</p><p>] at</p><p> 23:</p><p>07 2</p><p>1 O</p><p>ctob</p><p>er 2</p><p>014 </p></li><li><p>The existence of a nuclear programme in Iraq is now much in doubt, butthe secrecy of all states is significant. Donald Rumsfelds phrase unknownunknowns, the ones we dont know we dont know15 or Tony Blairs use ofthe Precautionary Principle16 to justify the war, indicate the level ofparanoia in international relations. The fear that Saddam could be gettingadvantage over those in global power by some secret means could easilyhave played a significant part. And even if there was no known relationshipwith terrorism, the possibility of nuclear material going to Al Qaeda mayhave heightened these paranoid thoughts. It is quite possible that as part ofthe provocation the Al Qaeda leadership would have enhanced thisparanoia.</p><p>There was for some the need to remove a tyrant and the wish to bringliberty to a people who had been subjugated for decades. Saddam had risento power and had maintained himself through a brutal regime with littleregard for human rights. There had been long opposition to his tyrannyfrom many global political quarters.</p><p>Through our health lens we see these geopolitical issues as representinganalys...</p></li></ul>