War and Its Consequences for Cancer Trends and Services in Iraq

Iraq and Mesopotamia have been severely affected in recent decades by wars, sanctions, and embargo. Cancer is one of many examples of the medical diseases whose epidemiology and management have changed. Many Iraqi people have started to believe that cancer is fatal until proven otherwise, as its diagnosis and treatment are very challenging in a context of limited resources. This chapter discusses the status of cancer trends and care services, and how wars and their consequences have affected these trends and services. Ultimately, war has led to an increase in unnecessary suffering among innocent Iraqis.

Iraqis’ Cancer Itineraries

Since 2003, Iraqis with cancer have increasingly been forced to travel across borders for treatment unavailable at home. Two cases of Iraqi cancer patients traveling across borders to Beirut, Lebanon highlight how such travel for healthcare places enormous strains on kinship networks. While those networks enable the cobbling together of resources and information, the highly contingent character of the care-seeking journeys speaks not only to the uncertainties of chronic illness but also to the difficulties of navigating healthcare under conditions of war. The work of survival within wartime Iraq increasingly involves transnational strategies of medical travel, unsettling a picture of living and dying tethered to local relations and institutions.

The Political Capital of War Wounds

Iraq’s healthcare infrastructure has deteriorated after decades of war and sanctions. A small fraction of Iraqis injured as a result of war have accessed quality care at the American University of Beirut Medical Center (AUMC), some funded by the Iraqi government. This chapter, based on the author’s work as a surgeon treating Iraqi war wounded at the AUMC, describes how powerful elites determine the political value of a war wound, influencing what a person’s injury means to the country as a whole and hence, the kind of treatment the Iraqi government is willing to sponsor. As such, the chapter sheds light on a form of social stratification shaping access to care for war-injured populations in Iraq and around the world, as political elites seek legitimation for their projects.

War and the Public Health Disaster in Iraq

This chapter addresses the systemic health and social consequences of the 2003 US invasion of Iraq. The war and subsequent destabilization of Iraqi society represent a continuation of structural violence against Iraqis initiated in the 1990s via economic sanctions. US military operations, and subsequent ethnic cleansing and other targeted violence by Iraqis, undermined local communities, created widespread suffering, and produced a significant human toll. While violence remains pervasive in Iraq, it accounts for only one aspect of a broader public health disaster. The conflict led to the “sectarianization” of public services, including healthcare, a brain drain of health professionals and educators, and the disintegration of one of the best healthcare systems in the Middle East. The deterioration of education and health systems, and more than two decades of forced migration of Iraqis to other countries, impede its long-term stability and reconstruction.

Drone Strikes and Vaccination Campaigns

The frontier area of Afghanistan and Pakistan is one of the few remaining places on earth where polio continues to cripple and kill children. It is therefore an area of intense focus for the Global Polio Eradication Initiative. During the Bush and Obama administrations, it has also been the area where the United Statesconducted the most drone strikes, targeting insurgents, but killing thousands of civilians as well. This chapter explores how the US-led war created suspicion and ill will toward internationally supported health programming, even though that programming has no connection with drone strikes. The damage done by drone strikes to community trust in public health programs is likely to last long into the future.

“It’s Not Okay”

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Imagining Military Suicide

Military suicide is widely regarded as a crisis in the contemporary United States. Indeed, the rate of military suicide has risen consistently over the course of the US wars in Iraq and Afghanistan and is one of the leading causes of death among American military personnel. Military suicide is widely regarded as scandalous sign of the trauma of war and the indifference or failure of military institutions. This chapter places these assumptions in the broader context of the entire system of war-making that shapes military service members’ experience. It describes that system in terms of military biopolitics under which the mechanisms that seek to police and prevent military suicide are fundamentally linked to the mechanisms that have already exposed soldiers to harm and empowered them to commit violence.

Dignity under Extreme Duress

Pakistani workers who deliver humanitarian aid in the borderlands with Afghanistan live daily with the threat of targeted killings, kidnappings, and other violent attacks. However, their work also provides them with a sense of meaning and an opportunity to provide for their families. Based on interviews and group discussions with humanitarians employed by NGOs and the Pakistani government to channel health and education aid to refugees and internally displaced persons (IDPs) living in the conflict-ridden borderlands, this chapter explores workers’ motivations, emotional experiences, and coping strategies. Through psychological trainings based on the person-centered Focusing approach, humanitarians develop a sense of dignity informed by Sufi traditions, Islamic practices, and local cultural values. However, in an atmosphere of great uncertainty, violence, and gendered cultural norms restricting public emotional expression, maintaining a sense of dignity is an ongoing challenge.

Remaining Undone

Despite numerous aid programs targeting both widows and heroin users in Afghanistan, a widow and heroin user in Kabul, Aisha, does not receive humanitarian aid and is not part of an addiction treatment program. This chapter looks at forms of kinship that emerge in Aisha’s life amidst serial war in Afghanistan—her relationship to another widow who cares for her, to a wider network of friends, and to heroin. The haalat (situation, condition) of Afghanistan of serial war spanning almost four decades is taken here as an analytical category to unsettle etiologies of addiction, and to critique liberal imaginaries of resilience. By ethnographically exploring the case of Aisha, this chapter asks us to consider the effects of war and humanitarianism on the health of those repeatedly subjected to it and the varied modes of attachment to life that are forged in Afghanistan.

Afterwar Work for Life

The post–9/11 wars often result in complex and chronic conditions for US service members. The ongoing need for veteran care intersects with a broader social ideal that posits normative couplehood as the sign of a successful postwar life. Both Veterans Affairs policy and sociocultural expectation are transforming family relationships into forms of care work aimed at maintaining veterans’ lives. In the shadow of soldier and veteran suicide, death looms as the possible consequence of not having or keeping these relationships. This chapter explores the nature of these complex and chronic conditions and the forms of couplehood that are entangled with them, suggesting that women’s caregiving is transformed into an afterwar work for life in which the object of care is narrowly construed as the veteran’s life itself, and the work of care is expected to last a long lifetime.