By Dr Peter Wigg.
I have recently returned to Melbourne after fifteen months on a reconstructive surgery program for victims of armed conflict in the Middle East. Medecins Sans Frontieres (MSF), for whom I worked, has hired hospital and accommodation space in Amman in Jordan, and brings patients there on short-term visas from Iraq, Yemen, Palestine, Libya, Egypt and Syria. All have long-standing disfigurement or disability acquired in bullet, rocket and bomb attacks. The majority are young men, but 20 per cent are women and 10 per cent children. These patients stay in Amman for several months, being admitted repeatedly to hospital for orthopaedic, plastic or maxillofacial surgery, and are also given psychological support. They return home better off, but remain disfigured or disabled to varying degrees.
… a lot of anaesthetics, sterilised instrument packs, theatre teams getting scrubbed up and surgeons working painstakingly for hours on end in response to an event of a few seconds’ duration
The impact on me, not as a representative of MSF, nor even as a doctor, but as an observing individual Australian, was one of shocked, increased awareness of the extent and intensity of long-term suffering that armed conflict leaves in its wake. The project accepts fifty new cases each month; in their home countries tens of thousands of others wait for possible treatment. Here is the story of one man.
Forty-year-old Ahmad was attacked while driving a truck-load of onions into Baghdad in 2005. He was driving the truck for his older brother who ran a market garden in their village to support the extended family. Ahmad had his ten-year-old son Hussein with him. Near the centre of Baghdad there was a traffic hold-up at a busy intersection. He was worried because no-one liked being stopped in Baghdad in those days. Suddenly soldiers were there, shooting at people in their stationary vehicles. Little Hussein was killed by a bullet to his head. Ahmad lost his right eye and his lower jaw.
After initial emergency treatment Ahmad continued to suffer not only from the loss of his son, the loss of his eye and the gross injuries he had received, but also from recurrent infections and severe facial pain, both treated ineffectively in Iraq. He was unable to speak until recently and eats only with great difficulty, not in front of other people. He has been to Amman for treatment three times and has had over forty surgeries. That is a lot of anaesthetics, sterilised instrument packs, theatre teams getting scrubbed up and surgeons working painstakingly for hours on end in response to an event of a few seconds’ duration.
There is more regulation of the world trade in bananas than of the arms trade
As I came to appreciate what the use of arms has inflicted on Ahmad, and tens of thousands of others in Iraq and elsewhere in the region, I also came to a realisation of how little concern is shown by the world for people like him. Those who use weapons recklessly, and their commanders and governments, are simply not accountable. Nor do we ask those who manufacture and trade in weapons to bear any responsibility. There is more regulation of the world trade in bananas than of the arms trade.
Weapons are sold indiscriminately to regimes and groups of all kinds. An amazing fifteen hundred people die in armed conflict every day, one per minute, and for every death there are up to twenty-eight serious injuries. Civilians are the vast majority of those killed, injured or forced from their homes. Nineteen countries use tens of thousands of child soldiers, yet the world supplies them too. The destabilising accumulation, spread and misuse of arms contributes, in addition, to the breakdown of law and order in many regions, adversely affecting good governance and socio-economic development.
Since 2006, the Australian Government has been working at the UN in helping lay the groundwork for a global agreement to regulate this, and this July a four week UN Conference in New York attempted to negotiate the wording of the world’s first Arms Trade Treaty. The draft under consideration would not stop the trade in arms, nor stop armed conflicts, nor even stop the reckless use of dangerous weapons. What it would do, however, is require subscribing governments, and their citizens who manufacture and trade in these weapons, to acknowledge the responsibility and accountability involved, at least to some extent. According to the draft, each state when considering whether to approve arms exports should consider taking feasible measures to avoid the arms being diverted to illicit markets, being used for gender-based violence or violence against children, or being used for transnational organised crime.
All hard to oppose, you might think. The draft also emphasised the role of national governments, rather than some international body, in deciding how to do this, and contained various loopholes allowing noncompliance. Yet opposed it was by many national governments including the United States backed by Russia and China, and the talks failed. International debate on this will continue, but the estimated $60bn international arms trade will remain unregulated for now.
Dr Peter Wigg is a Melbourne psychiatrist who has spent the past three years supervising psychiatric teams on MSF programs for victims of armed conflicts. He is a graduate of Monash Medical School, trained in psychiatry mainly in the UK and returned to Australia in the late 1980s. In Melbourne he undertook further training as a psychoanalytic psychotherapist. He is also a member of the Victorian Branch of the Medical Association for the Prevention of War.