EDITORS NOTE: This is the first in a three-post series that engages with Anthropologist Omar Dewachi's book, Ungovernable life: Mandatory medicine and statecraft in Iraq (SUP, 2017). Subsequent posts will be posted in the coming weeks.
BY GRAHAM GOOD (PSEUDONYM), PhD CANDIDATE, UCLA
Iraq has long been subject to the brutal war powers of imperialist states. From the “aerial policing” bombings of the British Royal Air Force in the 1920s to successive US-led bombing campaigns – and crippling economic sanctions – since the early 1990s, Iraq is no stranger to military violence and occupation. In Ungovernable Life: Mandatory Medicine and Statecraft in Iraq, Anthropologist and Physician Omar Dewachi traces these imperial legacies of war through the lens of the constitution and decimation of Iraqi medicine. In contrast to isolated and bounded conceptions of medicine, this book understands the making of mandatory medicine in Iraq as a story of “statecraft and infrastructure development” (p.25) across colonial and postcolonial time, implicated in overlapping local, national and transnational histories of people, patronage, expertise and modes of governance.
The formation of Iraqi medicine has been central to Iraqi statecraft, enabling the state to expand its administrative reach through the provision of health and welfare services to its population. In turn, the dismemberment of state healthcare from decades of war and occupation has deformed the state’s capacity to care for its population, resulting in the exodus of doctors and widespread agony, affliction and death. For Dewachi, if we can understand how the engineering of medicine has been important for national statecraft, then we can better understand how the decimation of medical infrastructure and healthcare go hand in hand with the collapse of the state.
The chapters in Ungovernable Life are structured around the role that different dimensions of medicine have had in the development of state infrastructure and governance practices in Iraq. Chapter 1 situates the origins of mandatory medicine in the inception of the British colonial mandate in Iraq after the First World War. The Mandate established the territorial boundaries of Iraq, gave the British ruling classes developmental “tutelage” over the Iraqi state, and crystallized links of unequal power and imperial patronage between the elite British medical establishment and a burgeoning Iraqi medical enterprise. Chapter 2 analyses the experimental expansion and modernization of a public health infrastructure in Iraq, which functioned as a population management strategy designed to avert the dangers that disease epidemics posed to economic productivity.
In Chapters 3 and 4, Dewachi describes the consolidation of Iraqi medical expertise as a formative nation-building project, symbolized in the inauguration of the Baghdad Royal College of Medicine in 1930. Such medical-educational institutions reflected and reinforced the institutionalization of relations of exchange between the British imperial metropole and Iraqi doctors seeking specialized training. The Iraqi state sponsored doctors to receive training at British medical schools in exchange for a stint of rural service upon return to Iraq (often contested by doctors). The state cultivated the figure of the doctor as an emblem of national citizenship “who is cosmopolitan, Western oriented, and loyal to king and country” (p. 103). In this way, the doctor was made responsible for advancing Iraq into medical modernity, extending healthcare to poorer rural populations and extending the reach of the state.
Chapter 6 turns attention to the effects of the Iran-Iraq War (1980-88) on the medical infrastructure in Iraq. As a “terrain for the mobilization of different regimes of population politics,” the war enabled transformations in the “productive” politics of state medicine (p. 130). To offset human capital loss and heavy financial expenditures, the Iraqi state mobilized its doctors to respond to wartime injury, incorporated women into the diminishing labor force, and fostered pro-natal fertility and reproduction policies which encouraged population replenishment.
In 1991, the US and its allies launched Operation Desert Storm in a nominal bid to challenge Iraq’s invasion of Kuwait. Dewachi explains:
Following the US decimation of the infrastructure on which Iraq’s civilian population relied, the UN – led by the US – implemented a crippling sanctions embargo which remained in place right up to the re-invasion of Iraq in 2003. This campaign choked the Iraqi economy by restricting the importation of goods, and thus further assaulted the capacity of civilians to access basic items necessary for survival, including food and medicines. This reversed earlier reductions in infant and child mortality, and resulted in the avoidable death of an estimated half a million Iraqi children, according to the Guardian. As Dewachi writes, the “dismemberment of state infrastructure and the mass exodus of Iraq’s doctors under decades of US-led intervention has been one of the central tragedies of Iraq’s health-care system” (p. 151).
In the Conclusion, Dewachi brings the analysis of the book to bear on the contemporary social and bodily effects of decades of war and occupation in Iraq. As is now well known, in 2003 a US-led coalition launched “Operation Iraqi Freedom” under false pretenses, reinvigorating a cascade of violence in Iraq and beyond. The US invasion and counterinsurgency occupation, the ravages of the drone- and special operations-based targeted killing apparatus, sectarian civil war and the rise and fall of the Islamic State, and the continuing US-led coalition air war have all coalesced to invade and destroy the everyday lifeworlds of Iraqis.
Dewachi argues that decades of war have exposed the population of Iraq to the harmful toxicological effects of residues of exploded munitions. Multiple generations of Iraqis have absorbed the material residues of weapons ordnance, with devastating consequences for their health. Since the Gulf War, Dewachi writes, “cancer deaths in Iraq have been on the rise,” exacerbated by the deterioration of oncological care (p.179). The US bears a huge responsibility for this regime of toxicity. It deployed tens of thousands of depleted uranium shells – known to be highly carcinogenic – in both the 1991 and 2003 wars in Iraq. In a piece on “toxic war,” historian Toby C. Jones explains:
Dewachi’s analysis uncovers the “toxic legacies of war on the Iraqi population,” and shows how the disproportionate exposure to life-destroying toxic materials is a direct consequence of imperial war-making and its decimation of medical infrastructure (p.179).
Dewachi’s book opens new space for the critical exploration of the uneven effects of militarism on the lives of ordinary people. It extends analysis of the lived experience of toxic warfare, as part of a longer history of deliberate military destruction of life-sustaining environments, of which US chemical warfare during the Vietnam War (1955-1975) is another pertinent example. More broadly, Dewachi foregrounds the unequally distributed exposure to toxicity faced by poorer and marginalised peoples, evident from Iraq to the domestic United States. This suggests a connection between “internal” and “external” forms of toxification, which links the plight of Iraqis affected by the toxicities of US war to the suffering of US populations exposed to toxic substances, both of whom are harmed by the very state obligated to protect them under national and international laws. Although experienced differently and produced through distinct forms of racism and imperialism, vulnerable populations in both Iraq and the United States are subject to the structural violence of environmental contamination and infrastructural deprivation – in one case through expeditionary war and occupation, and in the other through the racialised infrastructural politics of neoliberalism. As we have seen, those negatively affected by toxic structural violence are often deemed by the state as disposable, and unworthy of medical care and social protection. In the United States, for instance, lower-income people of colour are disproportionately segregated in communities near toxic waste sites and other high-pollution areas, causing a range of chronic health problems. The 2014 Flint water crisis revealed how people of colour disproportionately face the toxic effects of contaminated water, whose origins lie not only in inept management but the privatisation of municipal water provision as part of a broader project of neoliberal governance.
In this context, the unequal social distribution of toxicity provides a useful analytical lens through which to map the entanglements of racism, war, imperialism and neoliberalism, and how these social processes collude to produce harmful effects for populations excluded from the sphere of social care and political recognition. Understanding how social toxicity – and the slow violence it sustains – is constructed through a politically generated nexus of racism, imperialism, neoliberalism and war is a critical task for interdisciplinary social science today. Through Ungovernable Life and work like it, patterns of toxification can be understood not as individuated biological phenomena isolated from power and politics, but rather as systemic forms of political violence against poor and working people born from the deep inequalities built into capitalist societies.
What work might the concept of ungovernability do when applied to new problems across different social and geographical contexts? Dewachi’s work challenges dominant state narratives of “ungoverned space” by excavating the historical and political conditions of possibility for a place to be perceived as and made to be ungovernable. This move historicises the category of “ungovernable,” to reveal how it is both socially configured within a larger field of power and instrumentalised for specific political ends. This grates against hegemonic state discourses which frame conflict and instability within “failed states” as endogenous processes disarticulated from histories of imperial intervention. How then can analysts extend this oppositional concept of ungovernability to examine how increasingly authoritarian neoliberal states justify the intensification of war and police powers through the construction of dangerous “ungoverned spaces” in need of “pacification”?
For instance, in his ethnography of police power in French banlieues, anthropologist Didier Fassin examines how police practices of the “war on crime” disproportionately target marginalized urban communities of color. These communities are understood by police as dangerous warzones populated with enemy combatants, revealing the blending of war and police logics in racialized police practices. But, as Fassin suggests, the cultural representation of the banlieues as ungoverned spaces in need of police intervention emerges from a history of racial governance and oppression intimately entwined with the legacy of French colonialism. How, in this vein, can analysts continue to think with ungovernability as a tool for contesting normative understandings of what – and who – counts as ungoverned and ungovernable?
Ungovernable Life is a masterful and timely work in historical medical anthropology, which renders visible the concealed effects of the unraveling of Iraqi medical infrastructure, and situates this unraveling in a thick national historical experience of European colonial domination, draconian sanctions, and imperialist war. It is a remarkable addition to Omar Dewachi’s impressive work on the interaction of health and war, developed in an intellectual field which has largely ignored the transformation and pulverisation of Iraq, and the larger military ecology of US imperialism. Comprehensive in historical reach, analytically powerful, and offering a profound critique of violence, Ungovernable Life opens new ethical and political possibilities for thinking about the critical role that medical infrastructure plays in making, and unmaking, both the power of the state and the lives of the people under its care.