Ungovernable life in Iraq

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. 




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:

In the main, coalition forces devoted their energies to the strategic destruction of Iraq’s infrastructure. Aerial bombardment and cruise missiles hammered Iraqi cities for forty days, dropping more than 90,000 tons of bombs. In Baghdad, bridges linking the two banks of the Tigris River were demolished, power stations were destroyed, and water sanitation systems across the country were ruined. Decades of infrastructure work had been undone.
— p. 130

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:

Lurking in the detritus of war and in shelled-out buildings, coating tons of metallic scrap that line the highways and that are often collected, reused, and sold by hard-scrabble merchants, circulating in the water supply and in the soil, are the radioactive and toxic remnants of America’s technological approach to modern war. Much of the damage will only be realized decades from now, as slow developing cancers and other latent effects take shape, but Iraq already suffers from chronic crises such as alarmingly high rates of congenital birth defects. In a 2012 study, six Iraqi, Iranian, and American scholars argued that birth defects in one Basra hospital had increased seventeen-fold between 2003 and 2011. Much of this is likely the result of the widespread use of depleted uranium (DU) ordinance, thousands of tons of which the U.S. military dropped or fired on Iraq between 1991 and 2010.
— Toby C. Jones, Toxic War

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.

Syria: Irony and the refugee state

Chatty - Syria - Front.jpeg

I've just finished reading Dawn Chatty's Syria: The making and unmaking of a refugee state, published by Hurst (U.K.) and OUP (U.S. and elsewhere) just a few weeks ago. It's an impressive, far-ranging, and devastatingly timely book that intersects in all kinds of ways with my current research on war wounds and the journeys made by the injured and sick within and across borders in the Middle East (see here). I want to offer some initial reflections, but first the description from OUP:

The dispossession and forced migration of nearly 50 per cent of Syria’s population has produced the greatest refugee crisis since World War II. This new book places the current displacement within the context of the widespread migrations that have indelibly marked the region throughout the last 150 years. Syria itself has harbored millions from its neighboring lands, and Syrian society has been shaped by these diasporas.

Dawn Chatty explores how modern Syria came to be a refuge state, focusing first on the major forced migrations into Syria of Circassians, Armenians, Kurds, Palestinians, and Iraqis. Drawing heavily on individual narratives and stories of integration, adaptation, and compromise, she shows that a local cosmopolitanism came to be seen as intrinsic to Syrian society. She examines the current outflow of people from Syria to neighboring states as individuals and families seek survival with dignity, arguing that though the future remains uncertain, the resilience and strength of Syrian society both displaced internally within Syria and externally across borders bodes well for successful return and reintegration. If there is any hope to be found in the Syrian civil war, it is in this history.

Professor Dawn Chatty is a social anthropologist at the Refugee Study Centre at the University of Oxford. Both academic and practitioner, Chatty has spent prolonged periods living and working in Syria and elsewhere in the Middle East and it is immediately clear that the book is the result of many years spent on the ground talking to and living among many of those who she writes about. She draws on a seriously impressive set of interviews that span a decade (2005-2015) and which took her to Aleppo, Amman, Beirut, Damascus, Gaziantep and Istanbul. It's an anthropology that brings Syria and it's displaced to life, even amidst the death and destruction, and offers hope by turning to history and the making of a refugee state. Chatty "strives to illuminate the ethnographic, [and] the individual lived experience" (p.6) in a way that both inspires and reassures. It inspires because I think these kind of accounts are sorely missing from discussions about Syria, which are so often caught up in state- and proxy-war geopolitics, and it reassures me because this is exactly what I want to do in my research on the journeys of the sick and wounded in and out of Syria and Iraq - although I've got a lot of work to do even to come close to something like what Chatty has produced. 

When I first picked up the book, I was most interested in those displaced by the war in Syria since 2011; that is, I was interested less in the making of Syria as a refugee state, and more in its unmaking (and the implications of this unmaking across borders). But Chatty carefully shows how the history of Syria as a destination for refugees over the last 150 years has shaped not only Syrian displacements but also the regional response to those displacements today. Part of the argument is that the Greater Middle East has been marked by migration and displacement - under Ottoman rule, the British Mandate, and successive wars in the twentieth century - and that Syria has long been a place of refuge, and a place that accepts the 'Other' with local conviviality and tolerance toward difference. But Chatty goes further, and argues that if we want to understand the mass movement of Syrians to neighbouring states today (see the map below), we must take a "birds-eye view of the ethnic composition of Syria in the late Ottoman era and in the modern state carved out of the general Ottoman region known as Bilad al-Sham (Greater Syria or the Levant) " (p. 8). Ethnicity, and religious and familial ties spanning decades and centuries have a great impact on who is displaced and where individuals and groups end up - and this, of course, opens up a geography of displacement that is intimately tied to the making and unmaking of Syria as a refugee state.

Syria Regional Refugee Response. Source:  UNHCR Inter-agency Information Sharing Portal

Syria Regional Refugee Response. Source: UNHCR Inter-agency Information Sharing Portal

I have been insisting for some time that the so-called "refugee crisis" that took root in Europe in 2015 was - and still is -  minor compared to what many Middle Eastern states have faced since around 2012-2013, and indeed continue to face. To put things into perspective, in 2015 Europe received around 1 million refugee claims in total. From April 2011 to December 2017, Europe received 1,015,500 asylum applications from Syrians fleeing the violence (over 60% of these were made to only two countries - Germany and Sweden). These are not insignificant, of course, but compare them to the statistics in the following paragraph and see the infographics below produced by Al Jazeera, which help put things into perspective.

There are over 5.5 million registered Syrian refugees (and over 7 million internally displaced persons within Syria). Turkey alone has taken-in 3.5 million Syrian refugees. Lebanon, a state which had a population of around 4.4 million in 2010, has now accepted nearly 1 million Syrian refugees - Chatty claims that the influx of Syrian refugees into Lebanon increased the overall population by around 30%. For it's part, Jordan has resettled over 650,00 Syrian refugees among it's population of around 6.5 million. We must remember, pace Chatty's central argument, that these states were already home to several million refugees before the fighting even started in Syria. But for me one of the most shocking statistics is Iraq: nearly 250,000 Syrians have sought refuge there. Iraq is a state that has been decimated by war in recent decades - not just the U.S.-led invasion in 2003, but also the First Gulf War, a decade of crippling international sanctions, and - before all that - a brutal eight-year war with Iran. Dr. Omar Dewachi has written about the de-development of Iraq in his wonderful new book Ungovernable Life: Mandatory medicine and Statecraft in Iraq (Stanford UP, 2017; review coming soon); war has left what Dewachi calls  'toxic legacies' on the Iraqi population, causing many to flea across borders elsewhere in the Middle East. Iraq is an unattractive destination by many measures - and that's surely and understatement - so the fact that so many Syrian's have made their way to Iraq bears testimony to how bad things are in Syria. Despite the fact that Iraq too is a warzone, many Syrian's prefer it to many European countries because it is closer to home, they may have better connections there and, ultimately, most want to return to Syria when the circumstances permit. All of this flies in the face of the iconography of the opportunity-seeking refugees "flooding" Europe. Indeed, as Chatty suggests: "The majority of Syrians have remained close to home in the neighbouring states of Lebanon, Jordan, and Turkey" (p. 243) and only when these states began to close their borders and tighten the restrictions on movement did any serious number of Syrians begin to look to Europe and elsewhere. For more on these lines of inquiry, see Elena Fiddian-Qasmiyeh's Repressentations of Displacement from the Middle East and North Africa, Public Culture, 28 (3): 457-473 (hereand her other brilliant work. 

Where are the Syrian refugees.png
Where are the refugees - Europe.png

Chatty explains the regional response in the Middle East through the lens of Karam and the gift. In a separate paper and drawing from Andrew Shryock (2004) she explains the first term:

Karam, the Arabic term which can be translated as hospitality or generosity, is ultimately also about security, protection, and respect. The family or lineage’s reputation is in many ways hostage to correct behaviour with a guest/stranger, as inappropriate behaviour might lead to disrespect, danger, and insecurity
— Chatty, 2017 p. 190

It is an interesting concept that connects to Marcel Mauss’ seminal Essay on the Gift and Derrida's notion of hostipalité - more on these in a subsequent post - but there's more to it than a cultural ethics of generosity. One of the fascinating revelations for me in reading the final chapter - and I really should have known this already - is that neither Lebanon nor Jordan has signed the 1951 Convention on the Status of Refugees, and Turkey restricts its interpretation to mean only refugees from Europe (see the wording here). Thus, Chatty underscores:

all three states have no obligations, under international law, to provide protection. Yet in all three, the duty to be generous, to provide sanctuary to the stranger, has manifested itself as the pervasive response to Syrians, whether as kinsmen, business partners, or just fellow humans
— p.243

Contrast this with the European rights-based approach to asylum and refugees, embedded as it is in the 1951 Convention, and we begin to see that perhaps there are alternative ways for thinking about mass displacement and our obligations to distant strangers. My reading of Chatty here is that the regime of rights and the language of law through which it is articulated perhaps obfuscate our moral responsibility and our duty to provide a safe haven for the refugee. Refugee law is new and unfamiliar territory for me but in recent conversations with Christel Querton at Newcastle University, I've been learning about the uneven and inconsistent interpretations among European states of refugee law and it clearly isn't a deus ex machina. There's parallels here with my work on the international and military law of targeting - a focus on process and procedures, on tests of 'necessity' and 'proportionality' over and above a moral and ethical duty to spare and protect civilians (or, in this case, refugees), but Chatty's conclusion sounds a much brighter note:

As we enter the seventh year of the Syrian displacement crisis, it appears that the lessons learned from the late Ottoman reforms with regard to accommodating and integrating of forced migrants continue to hold true in the region once know as Greater Syria, and perhaps offer the West some salutary lessons.
— p.246

I couldn't agree more. Yet the Middle East regional response is not without it's problems - even karam has it's limits, it seems. As the number of Syrian refugees turned from thousands to tens of thousands and from hundreds of thousands into millions, the neighbouring states began to close their borders, making it more difficult for Syrians to seek asylum. Where states had once resisted the construction of settlement camps to house refugees, instead preferring local integration among families and within communities where possible, settlement camps have increasingly become the norm. Where refugees were once met with sympathy and conviviality, they are also now met with outright hostility. I will chart these transformations in a subsequent post, but one key issues is worth highlighting - access to healthcare across borders.


Syrian refugees in Lebanon, Jordan and Turkey are struggling with complex and often compounded health issues and many do not have (adequate) access to healthcare. A series of local and international organisations have been reporting serious issues with healthcare across the region for several years now. In 2014 Amnesty International issued a report on Syrian refugees in need of healthcare in Lebanon entitled Agonizing Choices, in which it claimed:

Many refugees fleeing Syria have serious health care needs due to, amongst other things, pre-existing chronic conditions and injuries suffered during the conflict. However, on arriving in Lebanon they are met with an overstretched system in which the services available to refugees are limited and difficult to access.
— Amnesty International, Agonising Choices, p.6.
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MSF - Misery in Lebanon for Syrians.png

In 2012 Médecins Sans Frontières (MSF) identified access to healthcare as one of the most pressing issues facing Syrians in Lebanon. A similar picture emerged in Jordan fairly early on. In 2014 Jordan introduced user-fees for Syrian refugees, who were subsequently made to pay 35-60% higher fees than uninsured Jordanians. The financial barrier alone is too much for many to bear and thus we have accounts like this one, which are not uncommon: 

Mouna, a 33-year-old Syrian refugee from Damascus who delivered her fourth child at the medical NGO Médecins Sans Frontières (MSF) maternity hospital in Irbid told Amnesty International that she had not gone for a check-up until her seventh month of pregnancy. She explained: “I live outside of the city and if I come for check-ups, the transport costs 5 JOD (USD $7) and my husband is sick so I cannot leave him at home. I live near a Ministry of Health hospital but if I go there I will have to pay money.”
— Amnesty International, Living on the Margins, p.6

There's a gendered violence here - and not only in relation to pregnancy - and refugee women from Syria in Lebanon (and elsewhere) face "constant sexual harassment and exploration", according to Amnesty. Turkey has passed a series of laws in recent years to secure the rights of Syrian refugees to access healthcare, and has an impressive program - with the World Health Organisation -  to integrate Syrian healthcare professionals into the domestic healthcare system. Yet Jude Alawa from the Yale Global Health Review Blog reports, "issues of implementation, demographics, communication, and institutional gridlock still create instability within Turkey and prevent Syrian refugees from accessing sufficient healthcare.

There's much, much more to say on all of this, but suffice it to say for now that Syria's neighbouring states are struggling under the weight of responsibility and some factions within these states have become more openly hostile. State policy has shifted to curtail in influx of Syrian refugees, and many resources - not to mention permanent settlement itself - have become illusive for many. At the end of summer 2017, Hezbollah began repatriating Syrian refugees across the border and back into Syria and the United Nations signalled concerns that the conditions for safe return may not have been met. The media in Lebanon increasingly report with open hostility toward Syrians in Lebanon, as detailed by a recent Al Jazeera program. In Jordan, Syrians have increasingly become framed as a security problem and since 2014-2015, the government attitude toward refugees has become less welcoming as it is seen as unsustainable (see also why Jordan is is deporting refugees).

Vehicles make their way through Lebanon as part of the repatriation of Syrian refugees in August 2017. Photograph: Anadolu Agency/Getty Images/The Guardian

Vehicles make their way through Lebanon as part of the repatriation of Syrian refugees in August 2017. Photograph: Anadolu Agency/Getty Images/The Guardian

There's a double irony in the story that Chatty tells about Syria, and which I have tried to flesh out here. The first irony is of a state that "provided refuge for so many over a century and more" and which is now "experiencing nearly half of its own population displaced and searching for safety and sanctuary" (p. 10). But the less obvious irony, and one which Chatty works so hard to elucidate, is that some of the very states from which refugees fled to Syria in the nineteenth and twentieth centuries, are now turning their backs on the Syrians who once welcomed them with with karam. Or at least this is how one incredibly articulate Yaman Birawi saw it when he took to Facebook in 2015. The last words are his, and we have Chatty to thank for bringing them to life in what is a tragically important and critical intervention: 

Screenshot of Chatty's  Syria: The making and unmaking of a refugee state , p. 219. 

Screenshot of Chatty's Syria: The making and unmaking of a refugee state, p. 219.