Shock and Awe Hits Home kanter-final.jpg

Evan Kanter MD, VA psychiatrist and past president of WPSR and now president-elect of PSR, recently completed a study of Iraq and Afghanistan war veterans that documents extraordinary disabilities and costs that may exceed the military costs of these wars in order to care for and pension returning injured soldiers.

View his presentation of this study before the Iraq Veterans Against the War in July 2007:  http://www.edmaysproductions.net/webvideo/va.wmv   

View the study Shock and Awe Hits Home:  http://www.psr.org/site/DocServer/ShockandAwe.pdf?docID=3161

 

PSR President's report on trip to Iran in March  2007 (see below)

Resolution passed by Physicians for Social Responsibility
Calling for Withdrawal from Iraq (Resolution passed April, 2005) 

Recognizing that the U.S.-led military conflict in Iraq since March 2002 has resulted in the likely death of over 100,000 Iraqi civilians (1), with untold (and deliberately uncounted) numbers of Iraqi civilian casualties, and with well-documented human rights violations against Iraqi prisoners in Abu Ghraib and other U.S.-controlled facilities; and,

Observing that the military conflict since 2003 has resulted in the extensive destruction of Iraqi society and public health infrastructure, with widespread environmental damage, including the still-unaccounted for dispersal of depleted uranium (DU) in many populated areas of Iraq (2); and,

Noting that the continued U.S. military occupation of Iraq, and reported Pentagon plans to establish “enduring bases” in Iraq (3), has provoked widespread opposition among broad sectors of Iraqi society, engendering continued support for a growing insurgency, currently estimated at 40,000 active paramilitary insurgents with a base of at least 160,000 supporters (4); and,

Noting that the continued U.S. military occupation has undermined U.S. national security by providing fertile ground for the recruitment of global terrorist forces, by building increased hostility to the US throughout the Islamic world, and by damaging US relations with longstanding friends throughout the world; and,

Noting that the military conflict has already resulted in the deaths of over 1,800 U.S. and allied soldiers (5), as well as hundreds of forces serving as private contractors hired by Foreign Military Firms (FMFs) (3); and,

Observing that the military conflict has resulted in over 12,000 reported casualties to aforementioned U.S. and allied forces, many of which have been documented as resulting in very serious and debilitating injuries, with likely consequential long-term serious disability and need for rehabilitation services (6); and,

Noting that the military conflict has already resulted in a total estimated $200 billion in supplemental appropriations beyond the annual approximately $425 billion U.S. military budget (7); and,

Recognizing that the fiscal costs of the continued military conflict in Iraq, occurring in the context of large and rising domestic U.S. budget deficits, have already led to proposed slashing of programs necessary to the public and environmental health needs of the American people, including the care of U.S. veterans suffering from the consequences of the current conflicts in Iraq and Afghanistan, as well as previous wars; and,

Noting that the current and anticipated future expanded fiscal costs of the military conflict in Iraq represent resources that could better be used to address current and future global public and environmental health needs, including developing alternative and sustainable energy sources that could address the looming crisis of global climate change while reducing the risks of terrorism; and,

Understanding PSR’s core commitment to the ethical and moral imperatives of physicians to “First, Do No Harm,”

Therefore, be it resolved that Physicians for Social Responsibility:

Calls on the U.S. government to immediately develop and announce a timeline, with clear deadline dates of phased military withdrawal, whereby all U.S. and allied foreign forces would be removed from Iraq as soon as possible, with commensurate selected deployment of replacement international peacekeeping troops under the command of the United Nations in areas of potential significant risk for inter-ethnic conflict or civil war; and,

Calls on the U.S. government to halt plans to establish “enduring” military bases in Iraq; and,

Calls on the U.S. government to support a United Nations-led process to oversee the continued efforts to develop an Iraqi constitution that respects the rights and interests of all domestic ethnic and political groupings, generally based on established UN principles of international human and economic rights; and,

Calls on the U.S. government to support a United Nations-initiated effort to convene a Mideast conference involving all regional powers to support nascent Iraqi government-determined needs for reconstruction and security assistance; and,

Calls on the U.S. government to guarantee the security for, and priority of, the reconstruction of vital health care infrastructure in Iraq and to ensure safe access to this infrastructure by the Iraqi people, while also guaranteeing that adequate resources are provided for the care and rehabilitation of US military forces and their families physically and psychologically harmed by the conflict,; and

Calls on the U.S. government, NATO nations, and regional Mideast allies to provide needed funds for aforementioned reconstruction and security assistance, to be disbursed by UN agencies and Iraqi-acceptable NGOs, with adequate funds to specifically include monies transferred from U.S. companies, private contractors and NGOs currently operating in, and to be withdrawn from Iraq; and,

Calls on the U.S. government and allied forces in Iraq to immediately allow UN agencies such as the UN Environmental Programme to begin to characterize the extent of environmental contamination in Iraq caused by the military conflict, including that caused by DU, and to assist, with adequate funding, in efforts to protect Iraqi civilians and all soldiers involved in the conflict from the consequences of any established or potential environmental exposures.

******************************************

Sources

1. Roberts L, Lafta R, Garfield R, Khudhairi J, Burnham G, Mortality before and after the 2003 invasion of Iraq: cluster sample survey The Lancet - Vol. 364, Issue 9448, 20 November 2004, Pages 1857-1864

2. See, for example, articles from the Seattle Post-Intelligencer http://seattlepi.nwsource.com/national/133581_du04.html) ; the BBC http://news.bbc.co.uk/1/hi/in_depth/2860759.stm) ; and the International Security Network (http://www.isn.ch/news/sw/details_print.cfm?id=7393).

3. Singer PW, Outsourcing War. Foreign Affairs March/April 2005

4. Times of London, Jan 4, 2005.

5. www.washingtonpost.com/nation on June 28, 2005.

6. “More Than 10,000 U.S. Troops Hurt in Iraq,” (AP) NYT January 4, 2005 and data from www.defenselink.mil (the DoD website) compiled at http://icasualties.org/oif/ on June 28, 2005.

7. Budget figures: FY06 Defense Budget at $419.2 bn, + $6bn for DOE nukes, Council for Liveable World. April 2005. Three supplemental appropriations for Iraq war ($30bn + $75bn +$82bn) may more details can be found at www.clw.org in the Military Spending section of the website.

 

War is Not the Answer: The Medical and Public Health Consequences of Attacking Iran

Executive Summary - Catherine Thomasson MD, PSR President 2007

(based on her trip to Iran in March 2007)

The Growing Crisis

The crisis with Iran has been building since 2002, when groups opposed to the clerical Iranian government first began to reveal previously hidden details of Iran’s nuclear program. The Bush administration has taken a consistently aggressive line in dealing with this crisis, pushing for strong action, while simultaneously refusing to negotiate directly with Iran on issues of concern.

Now, in early 2007, it seems as if the U.S. administration, certain that Iran must be prevented from acquiring a nuclear weapon by any means, is moving toward a military solution. This is consistent with counterproliferation policy and doctrine, which under the Bush Administration has come to emphasize military action over diplomatic negotiation as the preferred means to prevent and roll back nuclear proliferation, with unimpressive results.

A national security decision such as launching into a war with Iran has profound human consequences. Thousands, maybe tens of thousands, of people would immediately be killed or injured. Others would lose access to medical care, safe drinking water, and adequate supplies of food. Expensive infrastructure would be destroyed. Untreated chronic conditions such as diabetes could quickly become deadly diseases. Compromised water treatment and sanitation could cause infant mortality rates to soar. Can this be described as action proportional to the threat we face? This report considers this question.

Iran ’s Illicit Nuclear Program

From 1985 onward, Iran has pursued a clandestine nuclear program that has led to the establishment of a dispersed and sophisticated infrastructure. There is considerable, although circumstantial, evidence that Iran is seeking nuclear weapons capability. According to even the worst-case estimates, however, Iran is still several years away from being able to manufacture a nuclear weapon. [1]

The International Atomic Energy Agency (IAEA) began inspections in Iran in September 2002. The most serious examples of specific Iranian nuclear activities that have now come to light include:

  • experiments in plutonium separation dating from 1988;
  • the purchase through the A.Q. Khan network of increasingly sophisticated centrifuges for uranium enrichment;
  • the purchase (possibly through the A.Q. Khan network) of diagrams and technical specifications (some 900 pages in all) explaining how to machine uranium into hemispherical form - something that has no use except in a nuclear weapon;
  • the refusal to hand over copies of this documentation to the IAEA for analysis;
  • the creation of technical drawings and plans for a nuclear test bore hole and measuring instrumentation;
  • the refusal of full access to IAEA inspectors at Lavizan and Parchin, both sites controlled not by the Energy Ministry of Iran but by the Revolutionary Guards; and
  • a refusal to allow access to two sites, at Lavizan and in Tehran, followed by the bulldozing of the suspect buildings and the removal of everything at both sites, including several inches of topsoil. [2]

This constitutes substantial circumstantial evidence that Iran is pursuing a nuclear weapons program. This poses a direct threat to the nuclear non-proliferation regime, since Iran is a member of the Non-Proliferation Treaty and has, for nearly 20 years, been covertly pursuing nuclear activities which it is legally bound to report to the IAEA. This serious non-compliance with IAEA safeguards, and thus the NPT, raises the issue of how best to deal with the risk of proliferation by Iran.

How to Deal with Iran?

In 2003, Iran offered to negotiate with the United States directly, not just on the nuclear issue, but on the full range of issues of concern to Washington. Some insiders thought the Administration should have accepted, but more senior figures in the Administration spurned the chance to talk. From 2003 to 2006, the EU3 (France, Germany, and the UK) pursued talks with Iran. In late 2004, Iran again offered to include the United States in the four party talks. Again, the White House decided to stay away. Ultimately, these talks came to nothing because the EU3 could not offer the one thing Iran sought: guarantees that the United States would not attack. Negotiations to date have failed, largely because they have not--at least on the part of the United States-- even been tried.

There were persistent media reports throughout 2006 that the Administration was preparing plans for air strikes or another form of attack on Iran. [3] [4] Military planning is said to include options for both limited and more wide-ranging air strikes, with the intent of destroying either a few nuclear facilities or hundreds of nuclear and military sites. According to media reports, these plans could include the use of nuclear weapons against some targets. Other reports have also indicated Israeli preparations for strikes of their own. [5] It is clear that pressure from the United States on Iran was stepped up beginning in early 2007, with a surge in military deployments aimed at Iran.

Detailed consideration of the major health consequences of U.S. actions should be an integral part of national security decision-making. This report examines the likely medical consequences of a limited military attack on Iran of the kind under consideration by the Pentagon.


There are a number of attack scenarios that seem credible:

In a ‘minimalist’ scenario a small number of targets might be attacked, so-called “chokepoints” which, if destroyed, might delay the Iranian nuclear program by a number of years. This option, focusing on a narrow range of targets, is most likely one that Israel might plan. Such an attack carries the same political and military risks of Iranian retaliation as do larger attack scenarios, but the operation would do the least to delay the Iranian program. [6]

A broader scenario might include attacks on a wider range of nuclear facilities, yet stop short of massive attacks against Iranian military infrastructure in general. In this scenario, President Bush would order attacks on many or all of the 23 sites shown in the map below. Strikes might also be ordered against other research sites linked to the nuclear program at universities across Iran. This scenario is unlikely, as it would increase potential risks, without dramatically increasing the likelihood of setting back the Iranian program.

Figure 1: Iranian Nuclear Facilities Source: www.nti.org

The broadest approach would entail attacks on nuclear sites, command and control facilities, and military units, as well as power plants and other civilian infrastructure essential to resistance, such as roads, bridges, and ports. This approach would be the most likely to delay the Iranian nuclear program for a sufficiently long period of time to meet the administration’s current counterproliferation goals. It would also be consistent with the possible goal of overthrowing the current Iranian government. This is also the option that carries the greatest risk of Iranian retaliation, and of increased global tension and hatred of the United States. Obviously, such wide-ranging attacks would also result in the most serious collateral damage to public health facilities, roads, and electrical centers, as well as the greatest number of civilian casualties.

Likely Medical Consequences of a Major Attack on Iran

Widespread air strikes against a broad mix of targets inside Iran, including those located in heavily populated areas, now seem increasingly likely. Some experts have assessed that the U.S. military would be able to conduct strikes on as many as 10,000 targets in the first 24 hours of an assault on Iran. [7] This report examines the likely medical effects of the use of conventional weapons against targets in Iran, and also the possible use of nuclear weapons. It also briefly reviews the capacity of the Iranian medical and public health authorities to cope with the consequences of a broad air attack.

The CDC states that:

· Bombs and explosions can cause unique patterns of injury seldom seen outside combat.

· The predominant post explosion injuries among survivors involve standard penetrating and blunt trauma. Blast lung is the most common fatal injury among initial survivors.

· Explosions in confined spaces (mines, buildings, or large vehicles) and/or structural collapse are associated with greater morbidity and mortality. [8]

Any U.S. air assault would not be limited to the use of high explosive weapons, however. Attacks on hardened and buried facilities would very likely also involve the use of both thermobaric and depleted uranium weapons.

Thermobaric weapons produce a fireball capable of reaching temperatures up to 3000 o C and blast overpressure in excess of 430 pound per square inch (psi). The fireball not only burns, it creates a vacuum which kills everything in its path. The primary injury mechanisms are blast and heat, with secondary effects from flying fragments and toxic detonation gases. [9] The “kill radius” for the blast is usually greater than that for burns, so that protection against thermal injuries has little benefit. Blast injuries include internal injuries that can be difficult to diagnose and treat without sophisticated medical support. [10]

Depleted Uranium (DU) is used to ensure that a high explosive charge or kinetic warhead penetrates a hardened target. Depleted uranium is both a radiological and chemical toxic hazard. As an emitter of alpha radiation, it is potentially carcinogenic and mutagenic. Because DU is also a heavy metal, it can produce kidney damage. [11]

Would Nuclear Weapons Be Used?

Would the Administration ever sanction the use of nuclear weapons in an attack on Iran? Many observers believe that this option is unlikely, yet the Administration has prepared a policy that allows for the use of nuclear weapons for exactly this kind of mission. In the case of Iran, doubts about the vulnerability of Natanz and Isfahan to conventional attack could prompt the selection of these sites as potential targets for nuclear weapons use.

If nuclear weapons were dropped on a target as a surface or sub-surface burst, as might well be the case with Natanz, the initial heat and blast damage would be much more extensive than that from a conventional weapon. Prompt radiation effects and initial heat and blast damage would be substantial, although less severe than those from an air-burst nuclear weapon. Initial injuries suffered by troops or civilians on the ground would be immense and deadly. These effects are well known and predictable for blast injuries, burns, and radiation. The nuclear scenarios in this report reveal that, because the Natanz facility is located in a mountainous desert region, the number of dead and injured might be limited to the low hundreds in the short term. Even in such a remote area, however, the number of people exposed to ionizing radiation would be in the tens of thousands, and the panic caused by the detonation of a nuclear weapon would undoubtedly affect many more. [12]

How Many Casualties Can Be Expected?

It is impossible to predict in advance the number of people that would be killed and injured in an attack on Iran’s nuclear facilities. If only the “chokepoints” were attacked, civilian and other casualties would likely be limited, unless a large nuclear weapon were used. If many nuclear-related sites were attacked, a higher number of casualties could be expected, because many of those sites are located in cities, on university campuses, or near business zones or residential neighborhoods. Logically, the greatest number of casualties would be expected from a wide-ranging target set, including the nuclear-related sites, military bases and command and control facilities, and even power plants and other infrastructure targets.

Could Iranian Health Services Cope?

There is no direct example from which to draw an analysis of Iran’s ability to provide medical care for victims of major air strikes. The case of the earthquake measuring 6.6 on the Richter scale that hit the city of Bam in December 2003--killing some 30,000 people and leaving more than 30,000 in need of medical care--can provide some guidance. [13] Despite major investment in medical and public health networks, Iran was immediately forced to rely on support marshaled by the World Health Organization from more than 40 countries. This is same scale of disaster relief operation that might be needed after a major series of air strikes against hundreds of targets, including nuclear, military, and leadership facilities in a number of Iranian cities, as well as in more isolated areas.

In the event of nuclear weapons use, Iran would undoubtedly need assistance with housing of internally displaced persons fleeing the fallout and assessing and treating those exposed. Afghanistan, Pakistan and other countries in the region--might also require assistance, either for treatment and decontamination of fallout victims, or simply to cope with internally displaced persons fleeing fallout plumes. In the end, the ability of Iran’s health services to cope would be determined by the scale of the attack, whether basic public health necessities such as water and electricity could be maintained, the condition of roads needed to transport the injured, the number of essential personnel injured or killed, and other factors. If Iran required outside support, UN or NGO agencies would be hesitant to assist unless they could be certain that their staff would not be subject to further waves of air strikes.

How Might Iran Retaliate?

Iran might respond to a U.S. attack by seeking to further destabilize Iraq; prompting Hezbollah in Lebanon to attack Israel; launching missile attacks against Gulf allies of the U.S., Iraq, and Israel; and/or disrupting shipping and end oil exports from the Gulf. Any military response by Iran would only spread the human consequences across international borders, fuelling instability across the wider Middle East.

Iran ’s political recourse includes withdrawal from the NPT, as well as encouraging further isolation of the U.S. from much of the international community.

Would Air Strikes Succeed?

It is possible that a thorough destruction of Iran’s known nuclear-related infrastructure would delay the bomb program, but for how long? At best, the program--which is not well understood--might be set back for a few months or a few years. But this delay would be gained at a huge security cost in terms of diplomatic disadvantage, increased hostility to the United States, and turmoil in the region. In addition, air strikes cannot destroy facilities unknown to intelligence analysts, nor the expertise and knowledge held by Iranians scientists and technicians. Nuclear physicist Frank Barnaby recently published a report detailing the possibility that air strikes could actually speed Iranian acquisition of a nuclear weapon by shifting the program from a broad-based, dual-use effort to a dedicated crash program with no international constraints. [14]

Policy Conclusions

This report examines the Iranian nuclear program and concludes that Iran has not been forthright about its proliferation activities. Iran has conducted illicit dealings on the international nuclear black market and has sought to conceal its program from the IAEA. Iran has been successful at concealing even major facilities from the international community. The point must to be underlined, however, that this does not mean that it would be sensible or effective policy to isolate and attack Iran in an attempt to delay, disrupt, or even terminate its nuclear program.

The devastating short-term medical consequences of massive attacks on the full range of Iranian nuclear and military infrastructure could only increase enmity against the United States and allies, in the region and across the globe – increasing the threat from extremist groups such as Al Qaeda against all Americans.

But the principle argument against the use of military force in Iran is that it would cause terrible human suffering without achieving our goals. War is not the answer.

Recommendations

PSR has a number of policy recommendations that would enhance the likelihood of a successful, effective, and nonviolent end to the Iranian nuclear program:

  • Offer Immediate Negotiations

As President Nixon went to China, President Bush should go to Tehran. The United States should offer immediate and unconditional talks to the Iranian government. Such talks would have no preconditions of any kind.

  • Put Iran’s Nuclear Program in the Context of a WMD-Free Middle East

Iran undoubtedly has its own security concerns relating to Israeli and American nuclear weapons and their overall military power in the Middle East. Iran is one of several countries in the region with stocks of chemical and biological weapons. It could only contribute to the security of this unstable region if Middle East nations were to commit themselves to a Weapons of Mass Destruction Free Zone. This would surely entail complex negotiations, but it is an approach that is eminently worth pursuing.

  • Strengthen the Global Non-Proliferation Regime

Other countries find it hard to take the United States seriously when it calls for them to abstain from nuclear weapons acquisition, while it designs its own new warheads and makes plans to build a nuclear weapons infrastructure that would last for the next century. If the United States were to show good faith in implementing its own NPT promise to disarm, Iran would have more incentive to reciprocate by upholding its NPT promise not to acquire nuclear weapons.

  • Strengthen IAEA Safeguards and Enforcement Mechanisms

The lesson we must take from this case is that more frequent and intrusive inspections backed by early, non-military enforcement through the United Nations Security Council must be employed as a tool to prevent proliferation.

  • Incorporate Medical and Public Health Consequences of Actions into Decision-Making Processes

We likely have 5-10 years before Iran acquires nuclear weapons. That gives us a significant period of time to try to solve this crisis through diplomatic and political channels. Before using military force, the United States should, as a matter of policy, consider the short-term medical and long-term public health consequences of its actions, especially since the chances of securing the desired outcome through military action are so poor.


[1] Deutch, John. “The Threat of Nuclear Diversion,” Statement for the Record to the Permanent Subcommittee on Investigations of the Senate Committee on Government Affairs." Washington, DC. March 20, 1996.

[2] A collection of IAEA documents on Iran is available at the website of the Federation of American Scientists http://www.fas.org/nuke/guide/iran/nuke/index.html - accessed December 28, 2006. The website of the IAEA has a special page on its relationship with Iran. Available at http://www.iaea.org/NewsCenter/Focus/IaeaIran/index.shtml - accessed December, 28 2006.

[3] Hersh, Seymour. “Last Stand—The Military’s Problem with the President’s Iran Policy." The New Yorker, July 10, 2006.

[4] Peter Baker, Dafna Linzer and Thomas E. Ricks. “U.S. Is Studying Military Strike Options on Iran.” The Washington Post, April 9, 2006.

[5] Mahnaimi, Uzi and Sarah Baxter. “Revealed: Israel plans nuclear strike on Iran.” The Sunday Times, January 7, 2007.

[6] A detailed and excellent treatment of this attack scenario and the possibility of an Israeli attack on Iran can be found at the MIT website at http://web.mit.edu/ssp/Publications/working_papers/wp_06- 1.pdf – accessed on January 17, 2007.

[7] Plesch, Dan. “Iran – Ready to Attack.” New Statesman. London. February 18, 2007.

[8] U.S. Government. Centers for Disease Control and Prevention. Explosions and Blast Injuries: A Primer for Clinicians. Atlanta: 2003.

[9] "Thermobaric Weapon." Chemistry Daily January 4, 2007. Accessed March 2, 2007 http://chemistrydaily.com/chemistry/Fuel-air_explosive

[10] Wildegger-Gaissmaier, Anna E., Aspects of Thermobaric Weaponry. Weapons Systems Division, Defence Science and Technology Organisation, Edinburgh, SA, 12 February 2003. Accessed on January 17, 2007. http://www.defence.gov.au/dpe/dhs/infocentre/publications/journals/NoIDs/adfhealth_apr03/ADFHealth_4_1_03-06.html

[11] Bernard, Kimberly, Butcher, Martin, Farrell, Roy, et al. Physicians for Social Responsibility. DU: Health and Public Health Issues Arising from the Use of Depleted Uranium Munitions. Washington, 2005.

[12] This section is based in large part on the May 2005 PSR publication Projected Casualties Among U.S. Military Personnel and Civilian Populations from the Use of Nuclear Weapons Against Hardened and Deeply Buried Targets by Peter Wilk MD, Sarah Stanlick, Martin Butcher, Michael McCally MD, Ira Helfand MD, Robert Gould MD, John Pastore MD. All references to this section can be found in that report available at www.psr.org.

[13] U.S. Geological Survey. Preliminary Earthquake Report. http://earthquake.usgs.gov/eqcenter/eqinthenews/2003/uscvad/ - accessed 3/1/2007.

[14] Barnaby, Frank. Oxford Research Group. Would Air Strikes Work? Understanding Iran’s Nuclear Programme and the Possible Consequences of a Military Strike. London: 2007.