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Health Consequences of War and Militarism


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Title: Health Consequences of War and Militarism

Health Consequences of War and Militarism
  • Martin Donohoe, MD, FACP

  • The history and epidemiology of war
  • Nuclear weapons
  • Chemical weapons
  • Biological weapons

  • Economic and environmental consequences of
    militarism and war
  • Health consequences of militarism and war
  • Contemporary conflicts
  • Afghanistan, War on terror, Middle East
  • Solutions

History of War
  • Violent conflict ubiquitous in the animal
  • Interspecies conflict food, territory
  • Intraspecies conflict food, territory, mates
    (usually not directly fatal)
  • Violence among non-human primates
  • Gorilla infanticide
  • Chimpanzee killing bands

History of war
  • 10,000 yrs ago agriculture
  • Stable populations, division of labor, warrior
  • 3500 yrs ago bronze weapons and armor
  • 2200 yrs ago iron
  • 1900 yrs ago - horses

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

History of War
  • 1903 Wright brothers/Kitty Hawk airplane
  • 20th Century nuclear submarines, predator
    drones, weaponization of space

History of War
  • Belief that each new invention would eliminate
  • Instead, increased casualties, killing at a

Epidemiology of Warfare
  • Deaths 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)

War Deaths, 1945-2000
Legacies of Colonial Exploitation
  • Christopher Columbus log entry upon meeting the
    Arawaks of the Bahamas
  • Theybrought usmanythingsThey willingly
    traded everything they ownedThey do not bear
    armsThey would make fine servantsWith fifty men
    we could subjugate them all and make them do
    whatever we want.

Legacies of Colonial Exploitation
  • Winston Churchill (speaking in favor of RAFs
    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
    terroragainst recalcitrant Arabs as an

Legacies of Colonial Exploitation
  • Cecil 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.

Contemporary Wars
  • 250 wars in the 20th Century
  • Incidence of war rising since 1950
  • Most conflicts within poor states
  • 27 separate civil wars currently underway
  • 19 involve U.S.-supplied weapons

Contemporary Wars
  • 72 million lives lost in 20th Century wars,
    another 52 million through genocides
  • WW II first war with more battle deaths than
    deaths from other causes, such as accidents,
    disease, and infections

Vietnam War
  • US dropped the equivalent of one 500 lb. bomb on
    every person in Vietnam
  • Vietnam War 11.5 to 3 million Vietnamese
    casualties 58,000 American
  • More US soldiers died of suicide after Vietnam
    than died in combat during the war.

Contemporary Wars
  • Gulf War I US planted one land mine for every
    Iraqi citizen
  • 310,000 direct war-related deaths in 2000 (0.5
    of worldwide mortality) indirect deaths much

Consequences of War
  • Deaths, injuries, psychological sequelae
  • Collapse of health care system affecting those
    with acute and chronic illnesses
  • Famine
  • Environmental degradation
  • Increasing poverty and debt
  • All lead to recurrent cycles of violence

Consequences of War
  • Contributes, along with persecution, poverty, and
    environmental degradation, to the 240 million
    people on the move
  • International migrants 168 million
  • Refugees, including Palestinians 16 million
  • Internally displaced due to conflict or
    persecution (25 million) or natural disasters and
    other causes (30 million)
  • Asylum seekers 940,000

Atomic Weapons - History
  • Hiroshima, 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

The Hiroshima Bomb
Atomic Explosion
Atomic Weapons Other Victims
  • Hundreds of thousands of hibakusha atomic bomb
  • 1054 U.S. nuclear tests since 1940s, 331 in
  • 80,000 cancers (15,000 fatal) in US citizens as a
    result of fallout from atmospheric testing

Atomic Weapons Other Victims
  • Thousands of illnesses and deaths, higher CA risk
    in 600,000 former employees
  • - DOE
  • Bush administration trying to limit payments
    mandated by Congress in 2001 (150,000 plus
    lifetime medical benefits)

Atomic Weapons Today
  • Approximately 23,360 nuclear weapons at 11 sites
    in 14 countries (1/2 active or operationally-deplo
  • Down from over 71,000 at height of Cold War
  • 5,200 active U.S. warheads today (more than ½ on
    hair-trigger alert) 8,000 in Russia
  • Several thousand megatons (100,000 Hiroshimas)

Atomic Weapons Today
  • US and Russia have 13,000 actively deployed
  • 2500 (US) and 2000 (Russia) on high alert
  • Fired within 15 minutes, reach targets in 30
  • Vastly redundant arsenal
  • 150-200 weapons adequate to destroy all major
    urban centers in Russia

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

Nuclear Weapons Oops!
  • Pentagon 32 nuclear weapons accidents since 1950
  • GAO 233
  • Since 1950, 10 nuclear weapons lost and never
  • All laying on seabed, potentially leaking

Effects of a Nuclear Explosion
  • Immediate
  • Vaporized by thermal radiation
  • Crushed by blast wave
  • Burned and suffocated by firestorm

Effects of a Nuclear Explosion
  • Intermediate
  • Suffering, painful deaths
  • Health care personnel/resources overwhelmed
  • Famine
  • Refugees
  • Devastated transportation infrastructure

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

Effects of a 20 megaton nuclear explosion
  • Ground 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

Effects of a 20 megaton nuclear explosion
  • 4 - 10 miles
  • 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

Effects of a 20 megaton nuclear explosion
  • 21 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

Effects of a 20 megaton nuclear explosion over
  • 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

Types of Injuries
  • Burns
  • Blindings
  • Deafenings
  • PTX
  • Fxs
  • Shrapnel wounds

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

Effects on health professionals
  • 70 killed or fatally wounded
  • 15 injured
  • lt 1000 survive

Effects on health care system
  • Most 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

Effects on Health Care System
  • 1500 patients/doctor
  • 10 min/pt
  • 4 hours sleep/noc
  • 2 weeks to see all injured

Ultimate Outcomes
  • Boston (pop. 2.8 million in 1998)
  • gt 2.5 million dead after one month
  • More than 6x as many Americans as died in WW II

Health hazards of the Nuclear Cycle
  • Ecosystem degradation e.g., Bikini Island
  • Uranium mining 5-fold increase in lung cancer
  • Depleted uranium
  • increased stillbirths, birth defects, childhood
    leukemias, other cancers in Southern Iraq
  • Possible increase in lung CA in U.S. soldiers
    (data sparse)

Nuclear Waste Disposal
  • On-site storage
  • 118 commercial reactors
  • 10 weapons plants
  • 37 research reactors

Nuclear Waste Disposal
  • Skull 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

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

Nuclear Waste Disposal Yucca Mountain
  • Est. 100,000 shipments of 70,000 120,000 tons
    of waste over 25 yrs
  • Coming within ½ mile of 50 million Americans
  • Est. 200-350 accidents
  • Nuclear roulette
  • Unlikely to occur other options being considered

Nuclear Power Plants
  • 104 plants in US
  • Aging, equipment failures (8 from 3/00-4/01 ?
  • 435 plants worldwide (generate 16 of planets
  • 60 plants in Russia
  • ? Condition, safety

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

Nuclear Power Plant Accidents
  • Three Mile Island (1979)
  • 50,000 to 100,000 excess deaths
  • Chernobyl, USSR, 1986 - nuclear power plant
  • 200 times the radiation of Hiroshima Nagasaki
  • 25-100 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

  • Higher risk of neural tube defects and childhood
    leukemia among those living near nuclear power
  • Anxiety a major problem
  • Ukraine still spends 6 of its GDP each year on
    Chernobyl-related matters

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
  • Nuclear power industry receives 10 billion/yr in
    taxpayer subsidies
  • Precautionary principle

Nuclear Power Plants
Nuclear Terrorism
  • Attack on nuclear power plant or other nuclear
  • 47 of nuclear plants failed to repel mock
    terrorist attacks conducted by the NRC in the
  • Dirty bomb
  • Potential 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

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 Russias fissile materials are
    located in 171 buildings, only 11 of which have
    been fully secured
  • 175 cases of nuclear trafficking from 1993 2001

Nuclear Terrorism
  • Reports of weapons missing from Soviet arsenal
  • Non-proliferation efforts, including the DOEs
    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

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
  • Franz Haber chlorine gas
  • 91,000 deaths and 1.3 million injuries

Chemical Weapons
  • Egypt vs. South Yemen (1963-7)
  • Iran/Iraq War (1980s)
  • Gulf War (versus Kurds, ? Others)
  • Gulf War Syndrome (real per Congressionally-mandat
    ed scientific panel, 2008)
  • 1995 Tokyo subway attack by Aum Shrinko cult
    using sarin
  • 12 dead, 5000 injured or incapacitated

Types of Chemical Weapons
  • Nerve 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)

Types of Chemical Weapons
  • Blistering agents
  • E.g., sulphur mustard
  • S/S burns, blindness, pulmonary toxicity, BM
    suppression, N/V/D
  • Rx decontamination, analgesia, pulmonary and eye

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

Chemical WeaponsVietnam and Napalm
Chemical WeaponsVietnam and Napalm
Chemical WeaponsVietnam and Napalm
Chemical Weapons
  • 1972 Biological and Toxic Weapons Convention
    prohibits development, production, and
  • 1989 stockpiles
  • US 36,000 tons
  • Russia 270,000 tons (1/2 nerve gas)

Other Chemical WeaponsTear gas
  • Use 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

Other Chemical WeaponsPepper Spray
  • Derived from cayenne peppers (contains 10-15
    oleoresin capsicum)
  • 1.5-2 million Scoville unit heat rating
  • Jalapeño pepper 2500-5000 Scoville units
  • Habañero pepper (worlds hottest) 300,000
    Scoville units
  • Use in civil and political unrest

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

Biological Weapons - History
  • Sixth Century BC Assyrians poison wells with rye
  • 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

Biological Weapons - History
  • Kochs postulates anthrax first linkage of a
    specific disease with a specific pathogen
  • Louis Pasteur anthrax and cholera vaccines

Biological Weapons - History
  • Sir 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

Biological Weapons WW II
  • Unit 731, Manchuria, Shiro Ishii
  • British Operation Vegetarian (anthrax cakes /
  • 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

Biological Weapons WW II
  • Unlicensed yellow fever vaccine contaminated with
    hepatitis B
  • 330,000 infections
  • 51,000 cases of symptomatic hep B
  • Long term outcomes good

Biological Weapons Post WWII
  • Swerdlosk
  • Zimbabwe
  • False alarms

Biological Weapons Today
  • 17 countries possess ( Al Qaeda?)
  • US role in supplying other nations
  • e.g., 1985-1989 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

Biological Weapons Today
  • 1972 Biological Weapons Protocol signed by 158
  • Lacks adequate enforcement mechanisms
  • US has rejected enforcement (wary of foreign
    inspectors discovering military secrets and/or
    trade secrets of biotechnology and pharmaceutical

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

Biological Weapons Today
  • Genetic weapons targeted at specific ethnic
  • 1999 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

Biological Weapons Today
  • Use, along with chemical weapons, in The Drug
  • 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

Biological Weapons Today
  • Quarantine Issues
  • Quarantine versus Isolation
  • National versus foreign outbreaks / border
  • Adverse consequences increased risk of disease
    transmission in quarantined population, violence,
    mistrust of government, ethnic bias

  • DNA virus decimated native American populations
    eradicated by WHO vaccination campaign in 1972
    genome sequenced
  • ?Only remaining viral stocks at CDCP and in
  • WHO Executive Board recommended retaining stores

  • 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

  • Dx clinical, EM of vesicular fluid
  • Rx isolation, post-exposure vaccination,
    supportive care, ?antivirals
  • 30 fatality rate

Smallpox Vaccination
  • Vaccinia
  • US ended in 1972
  • Waning (?negligible) immunity
  • Effects local reaction. Lymphadenopathy
  • Side effects postvaccinial encephalitis
    (1/300,000), progressive vaccinia eczema
    vaccinatum, generalized vaccinia
  • Vaccinia immune globulin may modulate

Smallpox Vaccination
  • Acambis and subcontractor Baxter Intl. - 428
    million contract to produce 155 million doses of
    smallpox vaccine by the end of 2002
  • Would bring total to 286 million (enough for
    every American)
  • Fed govt has ordered 209 million doses from a
    British company

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
  • ? vaccinate health professionals, public servants
  • Infectivity, disability, workmans comp issues

  • Bacillus anthracis, aerobic, G, spore-forming
  • Zoonosis
  • Invisible and odorless when aerosolized

  • 1979 accidental release at Swerdlosk (USSR) 250
    cases, 100 deaths, town abandoned due to
  • Aum Shrinko cult attempted aerosol dispersal

  • 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

Cutaneous Anthrax
  • 2000 cases/yr worldwide
  • Due to exposure to infected animals / animal
  • Epidemic in Zimbabwe, 1989-1995 10,000 cases

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

Cutaneous Anthrax
  • Antibiotic Rx (doxy, cipro, pcn) decreases
    likelihood of systemic disease
  • Fatality rate 20 without antibiotics rare with
  • Following 9/11 11 cases

Cutaneous Anthrax - Ulcer
Cutaneous Anthrax - Eschar
Gastrointestinal Anthrax
  • From 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

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

Inhalational Anthrax
  • Stage II
  • F/dyspnea/diaphoresis/shock
  • CXR with widened mediastinum due to
  • pleural effusions
  • 50 develop hemorrhagic meningitis meningismus,
    delirium and obtundation
  • Rapid progression to cyanosis, hypotension and

Inhalational AnthraxWidened Mediastinum
Inhalational Anthrax
Inhalational Anthrax
  • Dx blood cultures, XR/CT, post-mortem serology
    not helpful
  • Case fatality rate approx. 50
  • Rx
  • post-exposure antibiotics (doxycycline,
    ciprofloxacin, penicillin)
  • Supportive care

Anthrax Vaccine
  • 3 or 4 dose series
  • US armed service members approx 450K vaccinated
    to date
  • Side 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

Anthrax Vaccine
  • Pre/post exposure vaccination
  • Improved vaccine under development
  • ?Groups to vaccinate?

Anthrax The Band
Non-lethal weapons
  • High-power microwaves (crammed into cruise
    missiles, discharge a huge energy pulse to damage
  • Soft bombs
  • E.g., carbon fiber showers to short circuit
    electrical power grids (used in former Yugoslavia
    and in Gulf War I)

Non-lethal Weapons Proposed and Under
  • Acoustic
  • Acoustic bullets
  • Curdler unit shrieks, clangs
  • Infrasound penetrates most buildings and
    vehicles, causes nausea, diarrhea,
    disorientation, internal organ damage and even
  • Squawk box intolerable ultrasound pulses

Non-lethal Weapons Proposed and Under
  • Acoustic and optical weapons
  • Photic driver ultrasound plus stroboscopic
    infrared flasher to penetrate closed eyelids and
    cause seizures
  • Psycho-correction devices send subliminal
    visual and aural messages

Non-lethal Weapons Proposed and Under
  • Barrier 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

Non-lethal Weapons Proposed and Under
  • Riot Control
  • Invisible tear gas
  • Electrical
  • Police or soldiers jacket which jolts anyone who
    touches it
  • Cattle prods (malicious and accidental use by

Non-lethal Weapons Proposed and Under
  • Biotechnical
  • 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)

Non-lethal Weapons Proposed and Under
  • Holograms
  • God/gods/other religious figures or symbols
  • Soldier forces
  • Death, dead comrades
  • Others

Other WMDs
  • Small arms
  • Land mines
  • Cluster bombs

Health Care System Preparedness for Weapons of
Mass Destruction
  • ¾ of US ERs not fully prepared for treating mass
  • Only 12 of US hospitals have bioterrorism
    response measures developed and in place
  • Congressional panel estimates gt 50 chance of
    terrorist act involving WMDs by 2013

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

Costs of Militarization
  • US over ½ of discretionary tax dollars spent on
    the military
  • US military budget represents 43 of total world
    military budget (1.5 trillion in 2009)
  • Increased spending on nuclear weapons
  • Inadequate spending to prevent the spread of
    chemical, biological, and nuclear weapons

2009 Federal Budget2.65 trillion
Missile Defense ShieldThe Militarization of Space
  • Star 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

Missile Defense ShieldThe Militarization of Space
  • Shield or very porous umbrella
  • Easily overwhelmed and fooled by inexpensive
  • No protection against internal accidents or
    terrorists bringing weapon onto US soil or dirty
  • Proposed use of moon for spy observatories and

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

Meanwhile...Social Injustices Abound
  • 51 million Americans lack health insurance
  • 25 of US children live in poverty
  • Homelessness, public educational system a
    shambles, increasing jail populations, etc.
  • 2.5 billion people worldwide live in abject
    poverty (earn less than 500 per year, lack
    access to clean drinking water)

Meanwhile...Social Injustices Abound
  • Worldwide
  • poverty increasing
  • maldistribution of wealth
  • corporatization
  • global debt crisis
  • environmental destruction and global warming
  • AIDS epidemic in sub-Saharan Africa

Environmental Consequences of Militarization
  • Worlds single largest polluter
  • 8 of global air pollution
  • 2-11 of raw material use
  • Almost all high and low level radioactive waste

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
  • 2000 abandoned firing ranges
  • E.g., Kahoolawe
  • 60 people killed by unexploded ordnance since WWII

Societal Costs of Militarization
  • An 8.5 cut in the Pentagons 2003 budget could
  • rebuild Americas public schools over the next 10
    years - 12 billion
  • Feed and provide basic health care to all the
    worlds poor - 12 billion
  • Buy health insurance for every uninsured American
    child - 6 billion
  • Military experts agree that a cut double this
    size would not affect our war-making powers

Health Costs of Militarization
  • 3 hours of world arms spending annual WHO
  • ½ day of world arms spending immunization for
    all the worlds children
  • 3 days of US arms spending amount spent on
    health, education and welfare programs for US
    children in one year

Health Costs of Militarization
  • 3 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

Skewed Priorities
  • The world spends 1.6 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

Skewed Priorities
  • Prevent global warming
  • Stop deforestation
  • Aid all refugees
  • Retire developing nations debt
  • Provide clean, safe energy (through efficiency
    and renewables)

Skewed Priorities
  • Prevent acid rain
  • Fix the ozone hole
  • Stabilize world population
  • Provide basic universal health care and AIDS
  • Eliminate nuclear weapons and land mines

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

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.

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.

US Foreign Aid
  • US ranks 21st in the world in foreign aid as a
    percentage of GDP (0.7, versus UN recommended
  • Foreign Aid
  • 1/3 military
  • 1/3 economic
  • 1/3 food and development
  • US worlds second largest arms exporter

Military Spending
  • US ½ of discretionary tax dollars spent on the
  • US military budget represents 34 of total world
    military budget (1.5 trillion in 2009)
  • Iraq War costs could reach 2-3 trillion

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Economic Cost of War, U.S.
Arms Exports
Arms Imports
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Top Pentagon Prime Contractors Fiscal Year 2009
  • Lockheed Martin Corp.
  • Northrop Grumman Corp.
  • Boeing Corp.
  • Raytheon Corp.
  • General Dynamics Corp.
  • KBR, Inc.

September 11, 2001
World Trade Center Bombing
  • 3300 fatalities - foreign nationals outnumbered
  • Environmental health consequences unknown
  • 300-400 tons asbestos
  • 130,000 gallons of transformer oil contaminated
    with PCBS
  • Lead, sulfuric acid, silicon
  • Fine dust particles

September 11, 2001
  • Pentagon 286 casualties
  • Pennsylvania approximately 100 casualties

The War on Terror(The War on Afghanistan, Iraq,
and ?)
  • May last 50 or more years Cheney
  • Afghanistan
  • Ruled by repressive
  • human-(womens-)rights-abusing Taliban, then
    corrupt quasi-democratic kleptocracy
  • Potential transit route for oil and gas pipeline
    from Central Asia
  • Strategic importance in Middle East

  • Population 27 million
  • Life expectancy 46 years
  • Literacy rate 32
  • Avg. annual income 280

  • 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

Afghanistan/Iraq Parallels
  • 10 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

Afghanistan/Iraq Parallels
  • Literacy decreased from 89 to 57
  • Infrastructure devastated, Environment degraded
  • Rebuilding post-war?

What goes around comes around
  • 1980s 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 6000-8000 feet
  • 24 diverted to Iran

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

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

Kuwaiti Oil Fires
Gulf War II
  • Approximately 4,500 U.S. military deaths, over
    40,000 injuries (2010)
  • Traumatic brain injuries common
  • Over 100,000 civilian deaths (Iraq)
  • Over 2,400 civilian deaths (Afghanistan, 2009
  • Massive humanitarian crisis

Gulf War II
  • Financial cost of war 2-3 trillion (est.)
  • Includes fighting, rebuilding, veterans health
    care, economic losses, etc.
  • Global travel industry expected to lose over 500
  • Distraction from North Korea, other threats
  • Shock and awe battle plan targeting
    infrastructure explicitly prohibited by the
    Geneva Conventions

George W Bushs Military Record
  • February, 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

George W Bushs Military Record
  • June, 1968 Student deferment expires
  • September, 1968 Pulls inactive duty to serve on
    Florida Senators re-election campaign
  • November, 1968 Re-activated

George W Bushs Military Record
  • November, 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 Guards Champagne Unit,
    flying with sons of Texas elite

George W Bushs Military Record
  • May, 1972 Transfers to Alabama Guard unit so he
    can work on Senator Blounts re-election campaign
  • His commanding officer states he never showed up
    for duty
  • Grounded for missing a mandatory physical

George W Bushs Military Record
  • Returns to Houston but never reports for Guard
  • December, 1972 DUI arrest
  • October, 1973 Air National Guard relieves him
    from commitment 8 months early, allowing him to
    attend Harvard Business School

US Nuclear Weapons PoliciesUnder GW Bush
  • Nuclear 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
  • Budgeted money to resume nuclear testing and
  • Possible use of nuclear-powered predator drones

U.S. Nuclear Policy Under Obama
  • U.S. retains first strike option against nuclear
  • START treaty signed by Obama, Putin
  • Awaiting Senate approval
  • Will limit US and Russia to 1,550 long-range
    warheads (still overkill)

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.

Disturbing TrendsThe Patriot Bill
  • 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
  • 70,000 individuals on governments list of
    suspected terrorists

Disturbing TrendsThe Homeland Security Agency
  • The 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

Special Interest Provisions in the Homeland
Security Law
  • Vaccine 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,

Special Interest Provisions in the Homeland
Security Law
  • Immunity 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
  • Secret advisory meetings with industry permitted,
    even if meeting not related to national security
  • C.f. Cheneys Energy Commission

Disturbing TrendsCensorship and Propaganda
  • US blacks out names of corporations which sold
    weapons to Iraq on UN inspectors reports
  • Covering of Picassos 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

Disturbing TrendsCensorship 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
  • 21st Century McCarthyism

Disturbing Trends
  • Hate crimes, intolerance
  • Media jingoism
  • TV shows developed/planned Profiles From the
    Front Line, Military Diaries, AFP American
    Fighter Pilot
  • Army to ignore FDA safety standards in
    experiments on soldiers (legacy of 20th Century

Disturbing Trends
  • Budget surplus/deficit
  • 2000 surplus 5.6 trillion
  • 2003 deficit 2.1 trillion
  • 2010 deficit 1.3 trillion
  • Cities and states facing huge budget shortfall
  • Bush States are on their own.
  • Obama Financial meltdown
  • Patriot II?

George W. BushAugust 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."

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.

Samuel Johnson
  • Patriotism is the last refuge of a scoundrel

Responses to TerrorJust War Theory
  • The cause must be just
  • A 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

Responses to TerrorJust War Theory
  • The probability of success should be high
  • The cost-benefit ratio must be high
  • The means used must conform with international
    humanitarian law

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Ignored Alternatives to War in Iraq
  • Border monitoring in Jordan, Syria and Turkey
  • Advanced X-ray scanning technology and an
    electronic pass system at borders
  • Sanctions assistance missions to enforce military
  • Political assurances and economic incentives to
    neighboring states

Ignored Alternatives to War in Iraq
  • Improve cargo monitoring at port of Azqaba,
    Jordan (high-volume port for sea-going cargo to
  • 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

Ignored Alternatives to War in Iraq
  • Control 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)

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
    225 year history

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

The US Rogue Nation
  • Conservative estimate 8 million killed
  • US invasions/bombings often largely at behest of
    corporate interests

The US Rogue Nation
  • In 2009, the US spent about 2,210 per US citizen
    on defense
  • vs. a few dollars per capita on peacekeeping
  • The US maintains military bases in 69 sovereign
    nations around the world

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

International Non-Cooperation/Isolationism
  • Failure to sign or approve
  • Kyoto Protocol on Climate Change
  • Convention on the Prohibition of Anti-Personnel
    Land Mines
  • Comprehensive Nuclear Test Ban Treaty

International Non-Cooperation/Isolationism
  • Failure 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
  • Convention for the Suppression of Traffic in

International Non-Cooperation/Isolationism
  • Failure 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

The US Rogue Nation
  • Death Penalty
  • US executes more of its citizens than any other
    country except China, Iran, and Saudi Arabia
  • Until recently, the US was the only country to
    execute both juveniles and the mentally ill
  • Failure to follow World Court Decisions
  • Largest debtor to the UN (only 40 of dues paid)

  • Physician activism (PSR, IPPNW, etc.)
  • Increased education public, medical and public
    health students
  • Tolerance and appreciation of diversity
  • Conservation measures
  • Assist victims of war (PHR, MSF, etc.)

Thomas Jefferson
  • Nothing can keep (government) right but (the
    peoples) vigilant and distrustful

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.

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

The role of the doctor in society
  • World Health Organization
  • The role of the physician in the preservation
    and promotion of peace is the most significant
    factor for the attainment of health for all.

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.

Contact Information
  • Public Health and Social Justice Website
  • http//
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