‘Indiana Jones of surgery’ leads UK medics in war-zone training

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disaster and conflict zones, emergency response teams, humanitarian crisis, medical assistance, medical interventions, natural disasters, surgeons, training, war

‘Indiana Jones of surgery’ leads UK medics in war-zone training

More than 1,000 NHS physicians are set to receive specialist training to provide emergency medical interventions in disaster and conflict zones, under the tutelage of one of Britain’s most renowned surgeons.

The first group of 30 clinicians completed an intensive training course earlier this month which equipped them with skills needed for medical procedures with minimal equipment and support. It was funded by the Department for International Development (DFID) and led by the London vascular surgeon David Nott – dubbed the “Indiana Jones of surgery”.

Mr Nott, who has piloted the course alongside the Royal College of Surgeons, has 20 years’ experience working in regions scarred by war and natural disasters, and made headlines five years ago when he amputated a boy’s shoulder in the Democratic Republic of the Congo (DRC), taking instructions from a colleague in the UK via text message.

A register of medics willing to be deployed to humanitarian crisis zones – the UK International Emergency Trauma Register – was set up by DFID last year and now contains more than 1,000 names. Surgeons who have completed the required training may be called up to join emergency response teams in the event of a natural disaster or a major humanitarian crisis where the UK government has decided to intervene directly.

Increasing numbers of British doctors travel to Syria with NGOs to assist at hospitals overwhelmed by victims of the civil war. Although there are no plans yet for the UK government to provide direct medical assistance in Syria, DFID financially supports NGOs providing back-up at hospitals and field clinics. Overall, the UK has committed £348m to aid the Syrian people.

Mr Nott, who has been working as an emergency surgeon for the NGOs Médecins sans Frontières (MSF) and the International Committee of the Red Cross (ICRC) for 20 years, said that the training is sorely needed.

“It’s the first course run like this in the whole world,” he said. “We go through things by scenarios. If there was a chest problem and you need to sort it out but you’re working in a tent, you don’t have much blood stock and you don’t have any intensive care unit, how do you save that person? How do you save the person that is bleeding out from their arm? How do you save someone with abdominal gunshot wounds? There are ways. If you’ve had the training, even if you’ve seen it done only once or twice, then it’s much easier.”

The one-week intensive course had participants working with cadavers in simulated disaster zones. Mr Nott, who will soon travel to Syria with an NGO to teach similar techniques to local doctors in rebel-held areas, said that many doctors in the UK “have the ambition” to work in extreme circumstances.

One of his own students at Imperial College London, Dr Isa Abdur Rahman, 26, was killed working in a makeshift hospital in Syria in May. A number of young doctors, often with family ties to Syria, have risked their lives working for medical charities in the country since the conflict began two and a half years ago.

“You can’t stop the desire of people to go,” Mr Nott said. “If you want to go and do things, it’s a great thing, but you do take huge risks. We’re opening this course not only to consultants but to juniors as well, so at least if they’re not experienced enough at the present time, they are the generation that’s going to follow.”

Mr Nott first worked for MSF in Bosnia in 1993. Since then, he has travelled to dozens of countries including Sierra Leone, Sudan, the DRC and Chad, and has served with the Defence Medical Services in Basra, Iraq, at the height of violence in the city in 2007, as well as at Camp Bastion in Afghanistan.

While working 24-hour shifts with MSF in the DRC in 2008, he had to perform a life-saving amputation on a boy whose left arm had been ripped off, becoming badly infected. Although he had never performed the operation before, he took instructions via text from a colleague who had at London’s Royal Marsden Hospital, and saved the boy’s life.

The following year, while working in the wake of the Haiti earthquake, he saved the life of a baby found in the rubble of a hospital in Port-au-Prince, arranging an emergency flight to Britain for specialist surgery on her skull. The child, Landina Seignon, made global headlines when she was reunited with her mother, who rescuers had feared was dead.

Mr Nott still operates at three London hospitals, working in general surgery at Chelsea and Westminster, vascular and trauma at St Mary’s and in cancer surgery at the Royal Marsden. He takes six weeks’ unpaid leave each year to carry out his humanitarian work.

“I felt that my first mission, to Bosnia, was the most exciting thing I’ve ever done in my whole life,” he said. “To be able to help people that really needed it, who wouldn’t have help without you, was something fantastic. That always stayed with me. It was a burning flame that I couldn’t put out. Life is enriched hugely by doing something like this. We found that all it needs is somebody to get this course up and running and you suddenly see people coming out of the woodwork that also have the ambition to do this.”

In memory of dedication

Dr Isa Abdur Rahman, who trained under Mr Nott, was killed working in Syria in May. The 26-year-old graduate from Imperial College London was working for the UK charity Hand in Hand for Syria when the makeshift hospital in Idlib province where he was based was shelled. His friends set up an online fundraising page in his honour, which has raised nearly £72,000. They plan to use the funds to build a field hospital in memory of Dr Rahman in Homs, Syria.

More than 1,000 NHS physicians are set to receive specialist training to provide emergency medical interventions in disaster and conflict zones, under the tutelage of one of Britain’s most renowned surgeons.

The first group of 30 clinicians completed an intensive training course earlier this month which equipped them with skills needed for medical procedures with minimal equipment and support. It was funded by the Department for International Development (DFID) and led by the London vascular surgeon David Nott – dubbed the “Indiana Jones of surgery”.

Mr Nott, who has piloted the course alongside the Royal College of Surgeons, has 20 years’ experience working in regions scarred by war and natural disasters, and made headlines five years ago when he amputated a boy’s shoulder in the Democratic Republic of the Congo (DRC), taking instructions from a colleague in the UK via text message.

A register of medics willing to be deployed to humanitarian crisis zones – the UK International Emergency Trauma Register – was set up by DFID last year and now contains more than 1,000 names. Surgeons who have completed the required training may be called up to join emergency response teams in the event of a natural disaster or a major humanitarian crisis where the UK government has decided to intervene directly.

Increasing numbers of British doctors travel to Syria with NGOs to assist at hospitals overwhelmed by victims of the civil war. Although there are no plans yet for the UK government to provide direct medical assistance in Syria, DFID financially supports NGOs providing back-up at hospitals and field clinics. Overall, the UK has committed £348m to aid the Syrian people.

Mr Nott, who has been working as an emergency surgeon for the NGOs Médecins sans Frontières (MSF) and the International Committee of the Red Cross (ICRC) for 20 years, said that the training is sorely needed.

“It’s the first course run like this in the whole world,” he said. “We go through things by scenarios. If there was a chest problem and you need to sort it out but you’re working in a tent, you don’t have much blood stock and you don’t have any intensive care unit, how do you save that person? How do you save the person that is bleeding out from their arm? How do you save someone with abdominal gunshot wounds? There are ways. If you’ve had the training, even if you’ve seen it done only once or twice, then it’s much easier.”

The one-week intensive course had participants working with cadavers in simulated disaster zones. Mr Nott, who will soon travel to Syria with an NGO to teach similar techniques to local doctors in rebel-held areas, said that many doctors in the UK “have the ambition” to work in extreme circumstances.

One of his own students at Imperial College London, Dr Isa Abdur Rahman, 26, was killed working in a makeshift hospital in Syria in May. A number of young doctors, often with family ties to Syria, have risked their lives working for medical charities in the country since the conflict began two and a half years ago.

“You can’t stop the desire of people to go,” Mr Nott said. “If you want to go and do things, it’s a great thing, but you do take huge risks. We’re opening this course not only to consultants but to juniors as well, so at least if they’re not experienced enough at the present time, they are the generation that’s going to follow.”

Mr Nott first worked for MSF in Bosnia in 1993. Since then, he has travelled to dozens of countries including Sierra Leone, Sudan, the DRC and Chad, and has served with the Defence Medical Services in Basra, Iraq, at the height of violence in the city in 2007, as well as at Camp Bastion in Afghanistan.

While working 24-hour shifts with MSF in the DRC in 2008, he had to perform a life-saving amputation on a boy whose left arm had been ripped off, becoming badly infected. Although he had never performed the operation before, he took instructions via text from a colleague who had at London’s Royal Marsden Hospital, and saved the boy’s life.

The following year, while working in the wake of the Haiti earthquake, he saved the life of a baby found in the rubble of a hospital in Port-au-Prince, arranging an emergency flight to Britain for specialist surgery on her skull. The child, Landina Seignon, made global headlines when she was reunited with her mother, who rescuers had feared was dead.

Mr Nott still operates at three London hospitals, working in general surgery at Chelsea and Westminster, vascular and trauma at St Mary’s and in cancer surgery at the Royal Marsden. He takes six weeks’ unpaid leave each year to carry out his humanitarian work.

“I felt that my first mission, to Bosnia, was the most exciting thing I’ve ever done in my whole life,” he said. “To be able to help people that really needed it, who wouldn’t have help without you, was something fantastic. That always stayed with me. It was a burning flame that I couldn’t put out. Life is enriched hugely by doing something like this. We found that all it needs is somebody to get this course up and running and you suddenly see people coming out of the woodwork that also have the ambition to do this.”

In memory of dedication

Dr Isa Abdur Rahman, who trained under Mr Nott, was killed working in Syria in May. The 26-year-old graduate from Imperial College London was working for the UK charity Hand in Hand for Syria when the makeshift hospital in Idlib province where he was based was shelled. His friends set up an online fundraising page in his honour, which has raised nearly £72,000. They plan to use the funds to build a field hospital in memory of Dr Rahman in Homs, Syria.

Congo receives £180m boost to health system to tackle warzone rape

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abuse, conflict, Congo, DRC, rape, sexual abuse, sexual assault, Sexual Violence, soldiers, taboo, training, war, War Crimes, weapon of war

Congo receives £180m boost to health system to tackle warzone rape

When Beatrice was raped, by a gang of soldiers who sauntered by her home and saw her alone, she thought it was the end of world. She could not have imagined then that rape was only the start of a terrible downward spiral that would often seem to have no end.

“My husband came and said what happened? You can’t be telling me the truth. He no longer wanted to be with me and he left. I was alone with five children.”

Beatrice, not her real name, now has a sixth child, the result of the rape. The infant is strapped to her back, and sleeps while she sobs at the memories that stalk her, in a dark room in a hospital in Goma, in the violent south-eastern corner of the Democratic Republic of the Congo.

“My husband’s parents totally rejected my child. The village did. Everyone who sees me, curses me. They say I am a soldier’s mistress.”

Beatrice’s ever deepening tragedy is also a national nightmare. By the United Nations’ very conservative estimate, 200,000 women have been through a similar ordeal since 1998.

On a trip to Goma, William Hague, the British foreign secretary, launched the UK’s plan to help tackle the crisis, announcing £180m in new funding for the DRC health system, some of which will go to training medical staff to give proper care for rape victims.

Jonathan Lusi, a surgeon at the Goma hospital, both tends to the very serious injuries which accompany rape, and oversees his patients’ psychological recovery, training to give them independent livelihoods.

“We are in a war. It’s a legal vacuum. There is no government, no authority and no values. Rape is a warning sign something has gone very wrong.”

The DRC, after decades of conflict and turmoil is just one of the world’s battlefields where the routine sexual abuse of women and girls is a weapon of war. No one has any idea how many have been raped in Syria, for example. It is hard enough to count the bodies. It is a crime against humanity that often goes unmentioned because of the squeamishness of public officials and the many challenges to collecting evidence. Corpses are easier to count than rapes, while the victims of rape live in societies that enforce silence.

The tens of thousands of rapes during the Bosnian war, for example, have only led to 30 convictions.

The British government will attempt to break the official silence over the use of sexual violence as a weapon of war by taking the unusual step of using its presidency of the G8 this year to put it at the heart of the agenda of the rich nations’ club that has in recent years been preoccupied with economic woes.

“It’s time for the governments of the world to do something about this,” said Hague in an interview with the Guardian during a visit to Goma. “I will argue it has been taboo or ignored and taken for granted for too long … We can move the dial on something like this. We are big enough in the world to do something about this.”

As well as the money pledged to support the DRC health system, Hague also announced £850,000 in support for an advocacy group called Women’s Initiatives for Gender Justice to help it document cases in eastern DRC and push the international criminal court (ICC) to take heed of sexual crimes in its deliberations. Other funding will go to Physicians for Human Rights, another NGO, for evidence collection equipment such as locked evidence cabinets for eventual prosecutions.

Such prosecutions are not necessarily a distant aspiration. One of the leaders of the rebel M23 militia, Bosco Ntaganda, handed himself in at the US embassy in Kigali, the capital of neighbouring Rwanda, last week and was flown to face war crimes charges at the ICC in the Netherlands, where he denied charges including murder, rape, pillaging and using child soldiers in his first appearance on Tuesday.

Hague was accompanied in Goma by Angelina Jolie, with whom he has forged an unorthodox partnership to campaign on the issue. He credits Jolie’s film last year about Bosnian rape camps, In the Land of Blood and Honey, with helping to inspire the British initiative.

“The hope and the dream is that next time this happens, it is known that if you abuse women, if you rape the women, you will be accountable for your actions,” Jolie told the Guardian. “This will be a crime of war and you won’t just get away with it.”

Hague and Jolie visited a camp on the shores on Lake Kivu which has sprung up as a result of an upsurge in fighting when the M23 advanced into Goma last November.

Set against a breathtaking backdrop of lake and volcanoes, the camp of 10,000 people is a huddle of meagre straw shelters half covered with tarpaulin.

The women here are forced to venture out of the camp to collect firewood or water. Both make them vulnerable to rape and many of the women and girls have been assaulted. All the International Rescue Committee, which runs the camp, can offer to mitigate the threat are “dignity kits” that contain efficient stoves that require less firewood and extra clothes so the women have to look for washing water less often.

“It’s a sad fact that when you ask how to reduce sexual violence the answer is to help them not have to go out,” Jolie said.

On the way out of the camp a woman who had earlier given Hague and Jolie a reserved factual account of her experiences ran up to them on a last minute impulse: “Please help us. We are being raped like animals.” Hague said: “The memory of meeting her will always stay with me.”

Iraq records huge rise in birth defects

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ammunition, Basra, battle, birth defects, bombardment, brain dysfunctions, Children, Fallujah, health crisis, heart defects, Iraq, lead, malformed limbs, mercury, metals, miscarriage, neuro-toxic metal contamination, pregnancy, stress, toxicology, war, white phosphorus shells, WHO

Iraq records huge rise in birth defects

It played unwilling host to one of the bloodiest battles of the Iraq war. Fallujah’s homes and businesses were left shattered; hundreds of Iraqi civilians were killed. Its residents changed the name of their “City of Mosques” to “the polluted city” after the United States launched two massive military campaigns eight years ago. Now, one month before the World Health Organisation reveals its view on the legacy of the two battles for the town, a new study reports a “staggering rise” in birth defects among Iraqi children conceived in the aftermath of the war.

High rates of miscarriage, toxic levels of lead and mercury contamination and spiralling numbers of birth defects ranging from congenital heart defects to brain dysfunctions and malformed limbs have been recorded. Even more disturbingly, they appear to be occurring at an increasing rate in children born in Fallujah, about 40 miles west of Baghdad.

There is “compelling evidence” to link the increased numbers of defects and miscarriages to military assaults, says Mozhgan Savabieasfahani, one of the lead authors of the report and an environmental toxicologist at the University of Michigan’s School of Public Health. Similar defects have been found among children born in Basra after British troops invaded, according to the new research.

US marines first bombarded Fallujah in April 2004 after four employees from the American security company Blackwater were killed, their bodies burned and dragged through the street, with two of the corpses left hanging from a bridge. Seven months later, the marines stormed the city for a second time, using some of the heaviest US air strikes deployed in Iraq. American forces later admitted that they had used white phosphorus shells, although they never admitted to using depleted uranium, which has been linked to high rates of cancer and birth defects.

The new findings, published in the Environmental Contamination and Toxicology bulletin, will bolster claims that US and Nato munitions used in the conflict led to a widespread health crisis in Iraq. They are the latest in a series of studies that have suggested a link between bombardment and a rise in birth defects. Their preliminary findings, in 2010, prompted a World Health Organisation inquiry into the prevalence of birth defects in the area. The WHO’s report, out next month, is widely expected to show an increase in birth defects after the conflict. It has looked at nine “high-risk” areas in Iraq, including Fallujah and Basra. Where high prevalence is found, the WHO is expected to call for additional studies to pinpoint precise causes.

The latest study found that in Fallujah, more than half of all babies surveyed were born with a birth defect between 2007 and 2010. Before the siege, this figure was more like one in 10. Prior to the turn of the millennium, fewer than 2 per cent of babies were born with a defect. More than 45 per cent of all pregnancies surveyed ended in miscarriage in the two years after 2004, up from only 10 per cent before the bombing. Between 2007 and 2010, one in six of all pregnancies ended in miscarriage.

The new research, which looked at the health histories of 56 families in Fallujah, also examined births in Basra, in southern Iraq, attacked by British forces in 2003. Researchers found more than 20 babies out of 1,000 were born with defects in Al Basrah Maternity Hospital in 2003, a number that is 17 times higher than recorded a decade previously. In the past seven years, the number of malformed babies born increased by more than 60 per cent; 37 out of every 1,000 are now born with defects.

The report’s authors link the rising number of babies born with birth defects in the two cities to increased exposure to metals released by bombs and bullets used over the past two decades. Scientists who studied hair samples of the population in Fallujah found that levels of lead were five times higher in the hair of children with birth defects than in other children; mercury levels were six times higher. Children with defects in Basra had three times more lead in their teeth than children living in non-impacted areas.

Dr Savabieasfahani said that for the first time, there is a “footprint of metal in the population” and that there is “compelling evidence linking the staggering increases in Iraqi birth defects to neuro-toxic metal contamination following the repeated bombardments of Iraqi cities”. She called the “epidemic” a “public health crisis”.

“In utero exposure to pollutants can drastically change the outcome of an otherwise normal pregnancy. The metal levels we see in the Fallujah children with birth defects clearly indicates that metals were involved in manifestation of birth defects in these children,” she said. “The massive and repeated bombardment of these cities is clearly implicated here. I have no knowledge of any alternative source of metal contamination in these areas.” She added that the data was likely to be an “underestimate”, as many parents who give birth to children with defects hide them from public view.

Professor Alastair Hay, a professor of environmental toxicology at Leeds University, said the figures presented in the study were “absolutely extraordinary”. He added: “People here would be worried if there was a five or 10 per cent increase [in birth defects]. If there’s a fivefold increase in Fallujah, no one could possibly ignore that; it’s crying out for an explanation as to what’s the cause. A rapid increase in exposure to lead and mercury seems reasonable if lots of ammunition is going off. I would have also thought a major factor would be the extreme stress people are under in that period; we know this can cause major physiological changes.”

A US Defense Department spokesperson said: “We are not aware of any official reports indicating an increase in birth defects in Al Basrah or Fallujah that may be related to exposure to the metals contained in munitions used by the US or coalition partners. We always take very seriously public health concerns about any population now living in a combat theatre. Unexploded ordnance, including improvised explosive devises, are a recognised hazard.”

A UK government spokesperson said there was no “reliable scientific or medical evidence to confirm a link between conventional ammunition and birth defects in Basra”, adding: “All ammunition used by UK armed forces falls within international humanitarian law and is consistent with the Geneva Convention.”

Dr Savabieasfahani said she plans to analyse the children’s samples for the presence of depleted uranium once funds have been raised. She added: “We need extensive environmental sampling, of food, water and air to find out where this is coming from. Then we can clean it up. Now we are seeing 50 per cent of children being born with malformations; in a few years it could be everyone.”

Metal hazards

Lead

Throughout pregnancy, lead can pass from a woman’s bones to her child; the levels of lead in maternal and foetal blood are almost identical. Children and particularly the unborn are more susceptible to lead than adults. At high levels of exposure, lead attacks the brain and central nervous system, causing comas, convulsions and even death, according to the WHO. Children who survive acute lead poisoning are typically left with mental defects and behavioural problems.

Mercury

Exposure to metallic, inorganic or organic mercury can permanently damage the brain, kidneys and developing foetus. Mercury can enter the air, water and soil. Its harmful effects can be passed from mother to the unborn child, leading to brain damage, mental defects, blindness, seizures, muteness and lack of co-ordination.

Depleted uranium

A toxic heavy metal, depleted uranium is what is left over after natural uranium has been enriched, either for use in weapons or for reactor fuel. While the US and UK acknowledge that the dust can be dangerous if inhaled, the jury is still out when it comes to long-term damage to people and their children. Scientists have suggested that its molecules can travel to the sperm and eggs, increasing the probability of cancer and damage to genes.

Ivory Coast mercenaries train child soldiers for attacks across Liberia border

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Child Soldiers, Teens, war, War Crimes

Ivory Coast mercenaries train child soldiers for attacks across Liberia border

Militias loyal to the former Ivory Coast president Laurent Gbagbo are recruiting child soldiers in Liberia to launch attacks similar to that which caused the death last week of 15 people, including seven UN peacekeepers.

Child soldiers as young as 14 are being groomed in training camps and used as scouts in increasingly deadly attacks in the volatile west of Ivory Coast, witnesses said. Human Rights Watch said that youths aged between 14 and 17 were being trained.

“They call us ‘small boys unit,’ and we are always safe when we go to the war zones in Ivory Coast. I don’t know the total that we have killed,” a child soldier told the campaigning group.

Ivory Coast’s rugged western region is a stronghold of Gbagbo, whose refusal to leave power landed him in the international criminal court last May after five months of post-electoral conflict dislodged him.

But neighbouring Liberia has been reluctant to clamp down on mercenaries notorious for recruiting child soldiers, while high-profile members of the regime’s inner circle live unhindered in upmarket villas in Ghana despite international arrest warrants.

“There are training camps in Liberia, you can walk there in 20 minutes. They send boys over several hours before attacks, then they join in later,” said Traore Adama, an Ivorian soldier who fled to Abidjan after attacks in recent months. “Youths can make up to a third of the attacking groups. Some of them are older teenagers but others are waifs you’d never imagine carrying guns.”

On Friday, UN “blue helmets”, deployed to a suspected raid in a remote western village, were ambushed and killed by a large group of Liberian-based “militias or mercenaries,” Paul Koffi Koffi, Ivory Coast’s deputy defence minister, said. Eight civilians also died in the attack.

Liberia has since closed its 435-mile border with Ivory Coast, whose dense forests and maze of creeks make policing difficult. Hundreds began fleeing the mineral-rich region, where long-simmering ethnic tensions exploded in the massacres during last year’s political conflict.

Alassane Ouattara, president of Ivory Coast since 2010, has struggled to unify a post-conflict army composed of quarrelling former rebels (who are also accused of war crimes) and government soldiers whom they once fought against.

One former rebel soldier, Aboubacar Souleymane, said” “It’s very visible when an attack is imminent. Last week I told my superiors that Liberian mercenaries were planning an attack with the help of pro-Gbagbo supporters in the area. He said there was not enough evidence, so I fled the area. I wasn’t prepared to stay there and get killed.

“There are too many cases of soldiers not being on their post when they should be, and disappearing from barracks at odd hours.”

Officials say arms funding for the cross-border raids comes from Ghana, where several wanted Gbagbo insiders fled after the regime fell last year. Among them is Charles Blé Goudé, leader of the Young Patriots militia, whose armed supporters helped crush dissenters of the Gbagbo regime. Goudé, whom sources say is under investigation by the ICC, has said he is willing to face trial.

An African diplomat said cooperation was unlikely to be forthcoming from either of Ivory Coast’s neighbours in the near future. “Liberia’s armed forces’ capability is limited by its small size and corruption because they’re highly underpaid. But there’s more than just a lack of capacity in both countries for failing to go after well-known criminals.”

Serbian president denies Srebrenica genocide

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Bosnia, Genocide, massacre, trauma, war, War Crimes

Serbian president denies Srebrenica genocide

Serbia‘s new president has denied genocide took place in Srebrencia, contradicting the international criminal prosecution of Serbian leaders from the Yugoslav wars and angering the Muslim co-president of Bosnia.

Tomislav Nikolic, the rightwinger elected as Serbian president last month, said on Montenegrin television: “There was no genocide in Srebrenica. In Srebrenica, grave war crimes were committed by some Serbs who should be found, prosecuted and punished.

“It is very difficult to indict someone and prove before a court that an event qualifies as genocide.”

The former Serbian general Ratko Mladic is on trial in The Hague accused of genocide in Srebrenica. Bosnian Serb forces under his command slaughtered around 8,000 Muslim men and boys after capturing the town, which had been declared a safe haven by the United Nations, towards the end of Bosnia’s 1992-95 war. It was Europe’s worst atrocity since the second world war.

The Bosnian Serbs’ wartime political leader, Radovan Karadzic, is also on trial in The Hague accused of genocide.

Bakir Izetbegovic, who shares Bosnia’s presidency with a Croat and a Serb, said Nikolic’s comments were insulting to the survivors. “The denial of genocide in Srebrenica … will not pave the way for co-operation and reconciliation in the region, but on the contrary may cause fresh misunderstandings and tensions.

“By giving such statements Nikolic has clearly demonstrated that he is still not ready to face the truth about the events that took place in our recent past.”

Nikolic said he would not attend the annual commemoration of the Srebrenica massacre in July. “Don’t always ask the Serbian president if he is going to Srebrenica,” he said. “My predecessor was there and paid tribute. Why should every president do the same?”

Both the international criminal tribunal for the former Yugoslavia (ICTY) and the international court of justice (ICJ) have ruled that the Srebrenica massacre amounted to genocide.

Serbia wants to join the European Union. A spokeswoman for the EU’s foreign policy chief, Catherine Ashton, said her office would seek clarification of Nikolic’s statement but “would like to remind everyone that Srebrenica has been confirmed as genocide by both the ICTY and the ICJ. Srebrenica was the largest massacre in Europe since world war two, a crime against all of humankind. We should never forget and it should never be allowed to happen again.”

Nikolic’s win over the incumbent president, Boris Tadic, sent a chill through a region that still recalls his last spell in government – as deputy prime minister in a coalition with Serbia’s late strongman Slobodan Milosevic when Nato bombed Serbia to drive its forces out of Kosovo during a 1998-99 war.

Nikolic has split from ultra-nationalists, recasting himself as a pro-European conservative and saying he will pursue Serbia’s drive for EU membership.

Tadic oversaw the arrest and extradition of Karadzic and Mladic. He pushed an apology for the massacre through parliament and travelled to Srebrenica as part of a drive to foster reconciliation.

Tens of thousands flee ‘extreme violence’ in Congo

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Child Soldiers, Congo, Genocide, internally displaced people, massacre, mutilation, rape, Rwanda, Torture, war

Tens of thousands flee ‘extreme violence’ in Congo

Villagers and townspeople in eastern Democratic Republic of Congo are facing “extreme violence” with atrocities including mass executions, abductions, mutilations and rapes being committed almost daily, according to aid workers in Goma, the capital of North Kivu province.

Fighting between the government army, the FARDC, and a group of mutineers led by a fugitive UN war crimes indictee, Bosco Ntaganda, has escalated since April. Armed militias including the notorious FDLR, a Rwandan rebel group based in Congo, have joined the fray in a multi-fronted battle for territory, money and power. But the violence has received relatively little international attention so far.

“The crisis in Congo is the worst it has been for years. The activity of armed groups has exploded, with militias making the most of the chaos to prey on the local population,” Samuel Dixon, Oxfam’s policy adviser in Goma, said on Wednesday. “Large areas of [North and South] Kivu are under the control of different armed groups – some villages are being terrorised from all sides, with up to five groups battling for power.

“Local people are bearing the brunt of extreme violence, facing the risk of massacre, rape, retaliation, abduction, mutilation, forced labour or extortion … In less than two months, more than 100,000 people in North Kivu have been forced to flee,” Dixon said.

Expressing alarm at the deteriorating situation, the UN refugee agency said the violence had sent tens of thousands of refugees spilling over the border into Rwanda and Uganda, while many more people were internally displaced.

Melissa Fleming, spokeswoman for the UNHCR, said UN agencies and the Red Cross would soon begin to distribute relief supplies. “Some of the displaced report cases of extortion, forced labour, forced recruitment of minors and beatings by armed men,” Fleming said.

Aid workers said heightened instability was making it difficult to establish the true extent of the violence and to get supplies to those most in need, who had often taken refuge in remote, inaccessible areas.

“The mutiny in North Kivu is part of a broader picture of insecurity caused by multiple armed groups and by elements of the Congolese forces. Since the FARDC has been fighting the mutiny, other armed groups active in eastern Congo have opportunistically moved into areas left vacant by the army,” an internal NGO field report seen by the Guardian stated.

“In South Kivu in early May 2012, 30 people were killed in Lumenje zone by the FDLR … During the night of 13 May, at least another 40 civilians lost their lives and 35 were injured following a brutal FDLR attack on Kamananga. This incident took place only 2kms from a Monusco base [Monusco is the name of the UN’s 20,000-strong stabilisation force in Congo].”

The report went on: “A letter left by the FDLR at the scene warned of a series of revenge attacks if the opposing group, the Raia [militia], did not stop attacking them. In the last two massacres the FDLR mutilated the dead to discourage further actions against them …

“In Mambas territory, a mai mai [militia] group reportedly raped over 70 women in the second week of May and armed clashes around Itembo allegedly led to the death of 17 civilians.”

Overall, the total number of internally displaced people in Congo is believed to be at its highest level in three years: up from 1.7 million to 2 million.

The latest upheavals follow warnings, first reported in the Guardian on 16 March, that the army’s offensive against the FDLR, launched in February, could destabilise the Kivus and have disastrous consequences. Controversially, the UN supported the offensive, arguing it was the best way to end chronic instability in the region.

The army’s plan went awry last month after President Joseph Kabila of Congo called for the arrest of Bosco Ntaganda, an ex-rebel general whose forces were supposedly integrated into the FARDC in 2009.

Ntaganda is wanted by the international criminal court for alleged war crimes, including the recruitment of child soldiers, but had appeared to be enjoying to official protection. His response to Kabila’s call for his arrest was to lead a mutiny of former officers and hundreds of their men, who have formed a new rebel group called M23.

“Civilian safety has to be the number one priority for the UN and the government army,” Dixon said. “Military action against rebels must not put local people at further risk. It is unacceptable that such widespread violence in Congo goes unstopped and under-reported. More must be done to tackle the political and underlying drivers of the conflict.”

Special report: Tamil asylum-seekers to be forcibly deported

Tags

deportation, forced removal, rape, Sri Lanka, Torture, trauma, war, War Crimes

Special report: Tamil asylum-seekers to be forcibly deported

Dozens of Tamil asylum-seekers will be forcibly removed from Britain on a secretive deportation flight today despite credible evidence that they face arrest and retribution on their return.

A chartered plane, PTV030, is due to take off at 15.30 from an undisclosed London airport and fly direct to Colombo. Human-rights organisations have called on the UK Border Agency to halt the flight on the grounds that Tamils who are known to be critical of the Sri Lankan government have been brutally treated following their return.

The forced removals come as Mahinda Rajapaksa, who was the architect of Sri Lanka’s final victorious push three years ago against the Tamil Tigers – a military offensive which defeated the brutal insurgency group but also led to the deaths of tens of thousands of civilians – flies into the UK to join the Queen’s Diamond Jubilee celebrations.

Human Rights Watch has documented 13 credible cases over the past two years in which failed Tamil asylum-seekers from Europe have been tortured after landing in Sri Lanka, and warns that those cases are likely to be “just the tip of the iceberg”.

Mr Rajapaksa’s government has been accused of committing war crimes during the military offensive and of continuing to preside over a culture of impunity in which kidnap, extra-judicial killings and torture are still commonplace, particularly in the heavily militarised Tamil areas in the north.

The Foreign Office’s latest report on human rights describes Sri Lanka as an area of “serious concern” when it came to abuses. But that has not stopped the UK Border Agency, which is under political pressure from the Government to ramp up deportations, from forcibly removing hundreds of Tamils in recent months.

The agency is notoriously secretive when it comes to forcible removals, rarely announcing them until the very last minute and providing few details about who is on board.

There have been at least four chartered planes in the last six months delivering Tamils back to Sri Lanka.

Some of those on board today’s flight include people who have overstayed their visa and immigrants who have been convicted of a criminal offence. But it also contains dozens of ethnic Tamils who have had asylum bids turned down and are at risk of political persecution.

The Independent yesterday spoke to one Tamil man in his mid-twenties who is currently being held in Yarl’s Wood detention centre and is due to be on today’s flight. He said there were six people on his wing who were failed asylum-seekers who thought they would be at risk of torture or worse if they were returned. “Everybody is crying,” he said. “We all know about cases where people have been tortured or killed after they were returned. Why is the UK government doing this?”

The man, who requested his identity remain anonymous for fear of reprisals if he is removed, said he travelled from Jaffna to Britain in 2006 to escape the violence that had plagued northern Sri Lanka for three decades. He added that both he and some of his fellow deportees played prominent roles in recent protests in London against the Sri Lankan government.

“Whenever there were demonstrations the Sri Lankans would send people down to photograph the protesters,” he said. “They know exactly who we are. That’s what scares us.”

The UK Government insists that those who are forcibly removed are individually assessed to make sure that they are not at risk of torture on their return. But Human Rights Watch says they have at least three cases of Tamils who had been forcibly removed from the UK and subsequently tortured.

“There are likely to be many more cases, because these are the people who have managed to find their way from Sri Lanka to the UK, and that we have managed to interview,” said David Mepham, director of HRW UK.

“The UK should suspend the forcible removal of Tamil asylum-seekers pending a review of its processes for assessing asylum claims by Tamils.”

A UK Border Agency spokesman said: “The UK has a proud record of offering sanctuary to those who need it, but people who do not have a genuine need for our protection must return to their home country.

“We only undertake returns to Sri Lanka when we are satisfied that the individual has no international protection needs. The European Court of Human Rights has ruled not all Tamil asylum-seekers require protection.”

Tamil returnees are raped, whipped and burned

Suthan knows all too well how hollow assurances that Tamils deported back to Sri Lanka are safe can be. He first fled to the UK five years ago after the Sri Lankan Terrorist Investigations Department accused him of having links to the Tamil Tigers.

During his asylum application he presented medical evidence showing that he had been beaten with sticks and burned with cigarettes but his request was turned down.

Last year he was placed on a chartered flight and returned to Colombo. He was questioned on his arrival at the airport in the presence of an official from the British High Commission and was later released.

But the interrogations continued. After trying to return home he was picked up by security officials and claims he was tortured, including being whipped with electric flex, burned with cigarettes and having his head immersed in a bag filled with petrol.

After paying a bribe he escaped to the UK again and is now represented by Freedom from Torture, which has used medical evidence to document numerous instances of deportees being brutalised on their return to Sri Lanka.

“This situation has gone on long enough,” says Keith Best, Freedom from Torture’s chief executive. “Forcible returns of refused Tamil asylum-seekers must be halted until the UK Government is sure that they will not be delivering people into the hands of their torturers.”

Even the asylum panels have recognised that torture continues despite the end of Sri Lanka’s civil war. In late 2010 the Immigration and Asylum Chamber accepted that a Tamil woman who had been returned to Sri Lanka by the UK authorities was tortured and raped. A second 33-year-old man was also granted asylum last year after a tribunal accepted that he had been beaten and burned with hot metal sticks after his return.

Nonetheless the British Government has stepped up deportations.

Jerome Taylor

More:

Tamils deported to Sri Lanka from Britain being tortured, victim claims

PTSD: The pain of reliving trauma years after the event

Tags

anxiety, Depression, dissociation, flashback, Memory, PTSD, rape, Refugees, reliving, sexual abuse, stress, Therapy, Torture, trauma, war

http://blogs.independent.co.uk/2012/03/29/ptsd-the-pain-of-reliving-trauma-years-after-the-event/

One of my first experiences of PTSD came as a psychologist working with African and Kurdish refugees.

Many had fled oppressive regimes and been referred to our service by their GP suffering severe anxiety, depression and stress. We discovered the root of the problem often lay in terrible personal experiences including rape, torture and witnessing the murder of loved ones.

These mental scars have a long and insidious reach in the shape of PTSD whose victims can repeatedly relive a traumatic event years after the original incident took place.

I remember my shock the first time I worked with a woman who, as she described what had happened to her, lost all sense of where she was. She verbally and physically tried to fend off an imaginary attacker as well as crying and shaking with fear as part of her episodic ‘flashbacks.’

The problem can be complicated by people having great feelings of shame and guilt about what happened as if they were somehow to blame. PTSD’s victims can also include perpetrators of violence who, on reflection, feel enormous regret for their actions.

Soldiers are the most high profile casualties of PTSD but it is even more prevalent among the civilian population.

It can affect anyone involved in a near death experience and includes ‘single incident’ traumas, such as a car crash, earthquake or tsunami.

The recent sinking of an Italian passenger ship that made headline news is another example as were the terrorist bombings on London’s transport network.

It’s important to recognise that PTSD symptoms are a perfectly normal part of the healing process when they occur immediately after a trauma. Our mind is often too pre-occupied with survival to process what happened at the time so revisits the experience helping us make sense and gain perspective on what happened. In the normal process of producing memories the mind knits the various strands of an experience together based on our senses, such as sight, sound, touch and taste as well as other aspects of what we were experiencing at that time.

It also puts a ‘date stamp’ on the memory so we know when and where something has happened. When a trauma is occurring the mind is using all of its energy to keep us alive so memories often don’t get properly formed.

In the hours, days and weeks following the trauma bits of the semi-formed memory will ‘pop’ into consciousness. This can be upsetting but gives the mind the opportunity to link the various fragments together to form a normal memory.

In cases of PTSD, the healing process effectively gets stuck and, like a scratched CD, the mind repeatedly replays the trauma.

This produces a vicious circle in which the distress generated by the memories continues to stop the brain’s ability to process the memories to a level that they cause less discomfort. As a result, patients find themselves vividly reliving the experience over and over with the same intense feeling of fear they experienced during the original incident. These ‘flashbacks’ can be triggered by something that the victim associates with the original trauma, such as a sound, colour or smell.

Sensory triggers can create powerful positive and negative anchors in our minds. You could be having a bad day at work when an old friend rings and your mood switches in an instant because the sound of their voice triggers a past association of feeling good. Likewise, hearing a favourite song on the radio often makes you feel better because you associate it with a previous experience of wellbeing.

This is also true of traumatic experiences, particularly when the ‘date stamp’ has not been associated with the memory so rather than being reminded of the events it can feel exactly as if they are happening again.

A refugee suffering PTSD may link the sound of footsteps echoing down a corridor with those of events years before when their protagonist came to torture them. The smell of burning rubber and smoke may bring back the experience of watching the family home burnt to the ground by soldiers or a family member killed in front of you.

PTSD creates a vicious circle in which the distress caused by the partially formed memories stops the brain from processing them to a level where they are less intrusive. This round-robin can lead to a number of associated conditions including anxiety, depression and stress as well as ‘avoidance’ where someone will increasingly isolate themselves to avoid triggering a flashback.

Flashbacks or vividly ‘re-living’ aspects of past events are one upsetting response to trauma. Another is ‘disassociation’ where the victim’s mind psychologically removes them from an experience. This can be emotionally protective at the time but if this dissociation happens when memories of the trauma are triggered it can be hugely upsetting and disruptive to normal day-to-day life. People experiencing this can often ‘lose’ pieces of time from their day and have no recollection of what happened to them unless someone tells them.

In our clinical work we tend to see this type of response in people who have gone through repeated trauma as a child, such as prolonged periods of sexual or physical abuse.

You can imagine that to ‘remove’ themselves mentally may be the only way that a child is able to escape what is being done to them. It serves to protect the child when nothing else can but also leads to problems later in life.

Medication can help reduce stress in some patients but the main treatment for PTSD is a ‘talking therapy’ in which the patient works with the therapist to help their mind find a way process the bits of trauma memory in a more complete way.

A number of question marks remain. Why are some of us more resilient to the effects of PTSD than others? And what role do the corrosive effects of guilt, grief and shame have on recovery?

It is an often distressing area to work in as a therapist but also incredibly rewarding in helping patients first understand what is happening to them and then interrupt the cycle of PTSD symptoms.

It is, for some, the start of the long journey back to more ‘normal’ day-to-day life helping them regain control over aspects of their lives they thought they may have had lost forever.

Bosnia’s rape victims have their say

Tags

Bosnia, rape, trauma, war

http://www.guardian.co.uk/film/filmblog/2011/dec/15/angelina-jolie-bosnia-rape-victims

“I first vomited, from the sheer force of my suffering,” Enisa Salcinovic says of her initial reaction to In the Land of Blood and Honey, Angelina Jolie‘s directorial debut feature film about the 1992-1995 war in Bosnia and Herzegovina.

Her reaction was so visceral, she said, because the film, which she watched in an exclusive preview for survivors of concentration camps, and victims of wartime rape and mass killings, so captured the trauma she experienced. “Angelina touched our souls,” she tells me several hours later, still clutching a wad of tissues tightly in her fist. Salcinovic is the president of the Women’s Division of Sarajevo’s Association of Concentration Camp Survivors. Of the 8,000 or so members, approximately one quarter are rape survivors.

The film portrays a romance between Danijel (Goran Kostić), a Serb man, and Ajla (Zana Marjanović), a Bosniak Muslim woman, which blossoms as the last nails are being hammered into Yugoslavia’s coffin. Torn apart by the war, they meet unexpectedly when Ajla is taken prisoner in a concentration camp and Danijel is her jailer. Since Jolie announced her intention to film, the plot has been a source of controversy in Bosnia, a country still struggling with the legacy of a war which pitted Bosnian Serbs, Croats and Bosniaks against one another and cost an estimated 100,000 lives. The data on rape victims is not concrete: the United Nations estimates that “20,000 to 50,000 women and girls fell victim to what has been described as a ‘massive, organised and systematic’ use of rape as both a weapon of war and a form of ethnic cleansing”. The movie tackles questions that academics, activists, victims and a new generation continue to grapple with 15 years after the war’s end.

It has even exposed schisms between groups of female rape victims. Some activists, such as Salcinovic, laud Jolie for raising important questions about the still-taboo subject of wartime rape and ongoing marginalisation of victims. Others, such as Bakira Hasečić, president of the Women Victims of War Association, remain adamant that a “Hollywood outsider” could never be qualified to make a film about the war. This debate started last year when Jolie, primed to shoot the entire movie on location in Bosnia, was forced to relocate to Hungary when Hasečić lobbied the minister of culture of one of Bosnia’s two political entities, the Federation, to revoke the permit. Upon reading the script, he reversed his decision, but not before sparking a fierce debate between victims about who has the right to represent them.

Hasečić, who was not invited to the screening, continues to criticise the movie based on its trailer. “A love story between the captured Muslim and a Serb war criminal never happened during the war in Bosnia; it is impossible, a concept unthinkable, even as the idea that it displays,” she says. “And from the clips from the movie – and I could not even watch the full two minutes – what she has done is hard and disgusting,” she continues. “It became painful to watch, and still is. I felt like I was beaten, tortured and raped again, like I have once again returned to the camp. As if they raped me again. It is shameful!”

Survivors who watched the film acknowledge that it was painful, almost unbearable, to watch because of their personal identification with the plot. But this, they say, means the film is authentic. “I am Ajla,” Sadzida Hadzic, a member of Hasečić’s association, said following the screening. “This is what I went through in the rape camp in Vlasenica [eastern Bosnia] in 1992.”

“If the victims find themselves in the movie, they will agree with most of the things that they saw,” says Elmina Kulasic, who was just seven years old when she spent over one month in Trnopolje concentration camp, near the north-western Bosnian town of Prijedor. “For the victims, and for Bosnians in general, and even journalists, anyone who was in the country during the war, they will find themselves in [Jolie’s] movie,” she says.

But irrespective of the film’s resonance, many other survivors and activists say that the Bosnian government should not have given in to Hasečić’s original demands to halt the shooting because, they say, it gave her the exclusive right to speak for the victims, which she should not have. “No one has the right to say that they are the sole representative of victims,” Velma Šarić, founder and executive director of the Centre for Post-Conflict Research, which coordinated the screening, told me. “How the Federation government has allowed one association to dominate the discourse is just shocking. Who has the right to be a gatekeeper to people’s trauma?”

Belma Becirbasic, a journalist currently conducting research on war and memory as a Fulbright scholar at Columbia University in New York, says this downplays the experience of individual victims to their detriment, and could lead to government exploitation of their trauma. “A lot of women I know are not members of any organisations, and the pain and the trauma that they experienced is so strong, and it can only be intimate, personal and not collective,” she says. “But who can speak for them? The claim that Angelina has no right to tell a particular story about war rape is absurd. We can criticise the movie’s artistic dimension, its ideological dimension, but we cannot say she cannot tell a story about victims.”

Becirbasic says that by giving in to Hasečić, the Bosnian government essentially collectivised what should be individual memories of the war, which fosters a culture of collective victimhood to be used for ethno-national political purposes. “It means raped women are only embodied in national metaphors, which makes it easier to manipulate their experiences,” she said. “Unfortunately, I think this cements the trauma much more.” She says that allowing political interference actually took away victims’ sense of empowerment. “We can clearly see that politicians and clerics emerge as spokespersons for women victims, their stories and their rights, and that’s what I call the political exploitation of trauma,” she says.

Šarić and Becirbasic agree that rather than the question of whether Jolie can present a fictionalised narrative about war rape, the real discourse should focus on wartime rape itself, a topic they both agree remains taboo, which means women are still living in poor conditions. “Most of the women are completely marginalised, living below the poverty line, and many have not resolved their residential status. So they also face the stigmatisation of the community,” says Becirbasic.

What’s more, they say authorities do not help them, only meting out financial assistance through established associations, which means as few as 2,000 women have registered as rape survivors. “I have yet to see any campaign where anyone explains how to claim status as a civilian victim of war, or rape victim. Nobody wants to speak about it,” adds Šarić, who hopes that Jolie’s film will help bring these women’s struggles to the fore.

“Rape victims were recognised as civil war victims only 12 years after the war,” Šarić tells me when we meet in the Sarajevo neighbourhood of Grbavica. Occupied by Serbs during the war and notorious for rapes, the area lent its name to Jasmila Zbanic’s 2006 movie Esma’s Secret (Grbavica), about a raped woman who raises her child, which won the Golden Bear at that year’s Berlin international film festival.

“Only after the movie came out did Bosnian society start to talk about rape victims. Grbavica was a breaking point. Before then, there were sometimes sporadic efforts for others to do something. Zbanic’s movie changed the climate, it forced politicians to recognise the rights of rape victims, and I expect Angelina’s to do the same,” says Šarić.

What’s needed is an open discussion about the role of victim associations on one hand and the rights of women victims on the other. If it doesn’t happen, say Šarić, Becirbasic and other survivors who attended the screening, it could have dangerous implications for Bosnia and Herzegovina’s future. “The process of victimisation helps ethno-national elites (Muslims, Croats, Serbs) to be resistant to critics, thus enabling rampant corruption and self-interest,” says Becirbasic. “Victimhood is the main historical narrative that fuelled the ethnic conflict in the first place – you can imagine how dangerous the consequence can be, and that doesn’t contribute at all to the reconciliation process, but on the contrary undermines it.”

Another survivor, who at 26 has just returned permanently to Bosnia, says the dialogue generated by Jolie’s film is essential if her country, which still lacks state-level government 14 months after elections, is to move forward. “The movie will force us think of the future. Do we want our grandchildren to have the same conflict or a similar conflict because we have not resolved these issues?”

More (2005):

Bosnia’s rape babies: abandoned by their families, forgotten by the state