Collective trauma: violence embodied
Collective trauma was the first of three common themes that concerned many of my interviewees in the post-conflict period. In this theme, interviewees identify a delicate balance between mental and physical health. For cancer patients, in particular, these two states are intrinsically linked. If one feels out of balance because of war-related effects, either physically or mentally, the other state may suffer as well– leading to embodiment. Another factor that leads to individual-level alienation, specifically for Kuwait, is physical vulnerability (
). Together, these factors promote self-alienation in Kuwaitis, and summarily influence poorer health-related behaviors (eg, addictions, partner violence) (
). These behaviors may be tied to feelings of social disintegration, stress and trauma that were expressed in several interviews:
The War affected all of us, all who were here. Everyone in Kuwait is marked in some way. – Sara Akbar, Environment Interest
When I first met Wael, the most remarkable thing about him was his stutter. Although he didn’t enunciate it, most likely the stutter was a result of the trauma of this one event:
I was on the roof to get water from the tank and all of a sudden, a bullet whizzed by my face. It was two inches from my hitting my nose. My two brothers were taken as POWs. One was eventually returned, the other never did. – Wael, Environment Interest
The other piece to Wael’s comment is that the war was very tangible, something palpable in the Kuwaiti existence. Wael comes from an upper-middle-class family, well-educated. The Iraqis were not targeting certain social classes or certain groups of individuals. Rather, in a small country, with a small local population, many individuals were affected.
There were many, many horrible things that happened (during the war). The Iraqis used to torture our men for days, weeks even, in secret rooms throughout the country. When they came back, they were messed up forever. – Selma, Health Sector
You couldn’t go out; the Iraqis were everywhere. Terrorizing people, absolutely, and shooting, and the killing, and raping and stealing everything. I mean brutal terrorism. Suddenly, a bomb went off near the area where I was living. And we ran to the basement and once there, I passed out. I felt something warm coming up my leg and when it reached my heart I passed out completely, and of course, we had gas masks. I thought, ‘If I pass out, how am I going to help my children (put on the masks)? I’d better get out.’ So, I had my car and headed to the Saudi border. Once we got there, I couldn’t pass. They wouldn’t let me pass. “Go back!” the guard barked at me with (his) gun in my face. “Go back!” – Wadha, Health Interest
As noted above, nearly all Kuwaitis were affected by an intense dose of trauma.While some individuals might not have been directly exposed, for example, to torture, or were in some way shielded from its effects, the long-term effects on Kuwaiti health have not been publicly studied. Indeed, the rates of PTSD (~20% of Kuwaitis) have stayed the same in Kuwait since 1991, which seems to suggest that many individuals have not recovered from these atrocious events (
). Before 1991, less than 10% of Kuwaitis were affected by PTSD (
). As Selma cites in her interview, there is a sense of the Kuwaiti psyche before and after the war. In the before period, there was a relatively good time– people were enjoying new freedoms, many Kuwaitis were traveling abroad to the West for their higher education or for leisure. For many of the Kuwaitis I interviewed, however, the post-war period is a darker time, a more severe time, when a group of individuals was forcibly expelled from the country (i.e., 400,000 Palestinians - while a few thousands stayed, the rest never returned) and new groups of individuals were brought in, and in my everyday discussions with Kuwaitis there was a great amount of suspicion toward these individuals – and, indeed, toward most foreigners in general.
I heard many such stories of despair and horror during my fieldwork in Kuwait. In general, there appears to have been a massive amount of physical and psychological torture that occurred during the occupation. I did not inquire about torture unless the participant was willing to discuss the matter, because it can serve as a unwanted trigger of a psychological response. Perhaps for now, it is most important to reiterate that the amount of suffering and stress was very high, and that in 1991 the average Kuwaiti felt like his or her world was coming to an end (
). While it is quite normal to let such events go unspoken at present, the body does not forget (
). And, indeed, the scars of the trauma may only come to the surface many years later, either as pathological behavior or as a physical outcome (
These trauma- and stress-related quotes demonstrate a sensitivity to the embodied being with a particular life meaning (
). Capturing life meaning integrates political, economic and historical approaches by examining structural, contextual factors as they pertain to health outcomes (
). For many Westerners, with the obvious exception of deployed soldiers, it would be difficult to conceptualize the Gulf War experience, as we have not lived through such an event. As Wael and Sara pointed out in their testimonies, the mind became another battlefield of the war, especially at a time when individuals often felt out of control of their own circumstances and, indeed, of their own bodies (
). Perhaps it is this fatalistic tendency, combined with a unrelenting sense of collective trauma that has become entrenched in the country’s consciousness. These dual issues have likely played a role in wreaking havoc on Kuwaiti health.
A toxic legacy: war and chemical exposures
During the Gulf War, there was no doubt that Kuwait sustained irreparable damage as a result of the massive oil well fires that plagued the country for nine months. Also, the US deployed depleted uranium munitions as a fail-proof anti-tank measure during the war. Here I will cite some portions of the interviews (see
) that focused on the notion of Gulf War pollution and disease etiology:
We know it's coming, a new diagnosis, from Iraq and oil (well fires), we know, but we not going to be normal again. – Hoda, Former Diplomat
I expect that there are only two reasons: radiation or pollution. An American doctor came to visit Ibn Sena Hospital and they came here for a gear checkup and found a huge (amount of) radiation in Kuwait after the Gulf War. – Sara
After the Gulf and Iranian Wars, the food, especially fish, was a problem. They polluted our land, air and sea. We found ourselves sniffing, eating and living in a polluted environment. – Mohamed, Health Background
Sara cites the “American” source because this lends legitimacy to her claim. Others cite the environment at large– for example, the fish. Indeed, in many of my interviews, individuals mentioned how the environment had gotten much worse since the war period. The 2001 “fish kill,” although ten years after the war ceased, represents, at the least, a symbol of the continuing contamination and delayed clean-up, and the general lack of vision that pervades Kuwaiti concern for the environment.
Moreover, Hoda cites pollution as a major cause of the rise of allergies and asthma, before honing in its role in carcinogenesis:
Everybody has asthma these days, like my neighbors and my son. Other people have allergies and itching skin. It's so polluted, that what happened in 1991 and now, I'm 100% sure that it affects us: bombing, dead bodies, the chemicals absorbed in the soil. Some people are not talking about (cancer), but it's running like a flu now. What's going on in Basra [Birth defects and childhood leukemias have risen between 200-400% in the Basra region since 1997], it's here. I mean, we're only one hour from Iraq, you know. It's in our surroundings.– Hoda, idem
In these testimonials, each individual has evoked a change in disease rates that he or she feels is, at least partially, related to the war. “It’s running like a flu now” or “Every family has a case of cancer– which we didn’t see before the war” is a common refrain I heard from my Kuwaiti participants. Patients present in clinic with cancer symptoms at a much higher rate in the post-conflict period. Moreover, these are educated individuals, so it is unlikely that they were not aware of screening or public health interventions before the war:
One thing that I have noticed: cancer appears in larger amount now, like a crowd. Before the 1990 invasion, you didn't hear about this (cancer). It was not common. How strange is that? Now it has become rather commonplace. – Mohamed, Patient
We didn't see (cancer) before the Gulf War. I remember observing effects five years after the radiation bombs were deployed. I think this is the reason, and because of the oil burning. It was terrifying and it's a really embarrassing new problem. I noticed the breast cancer statistics, and I'm worried about it. – Myriam, Environmental Sector
The main issues revealed in this section have exposed a heightened sense of awareness of environmental contamination, a clear change in rates of cancer rates pre- and post-war and, lastly, the variable nature of official statistics. Indeed, for Sara, Mohamed and Myriam, there was a general sense of the pervasiveness of the wartime toxins and how they most likely had long-term impacts on individual health. The images of the oil fires were etched into the collective memory, and, moreover, they serve as the quintessential symbol of the Gulf War. At a certain level, if the local population had noticed an increase in disease, then this observation becomes empirical evidence and should be officially taken into account. As several of my interlocuters mentioned, there is a general belief that the official government statistics have been manipulated. After all, the State has a strong interest not to divulge an abnormal increase in cases that may open the door to claims for compensation (
). Unlike Chernobyl and Russia, the Kuwait State has very deep coffers and a populace that is well aware of its legal rights and recourses under Kuwait law.
Whose clinic is it? Defining risk when the risks are invisible
How diseases are measured and recorded depends largely on the patient's contact with his or her doctor. In the clinic, doctors observe most readily the patient’s symptoms while trying to hypothesize on the origin of the disease (
). In post-conflict societies, however, this origin is often elusive and/or multifaceted (
). Clearly, there is a dependence on, but also great skepticism of, the Kuwaiti health care apparatus. In Kuwait, many of my informants cited issues around the lack of transparency or perceived neglect on behalf of the government to effectively pursue, track and document the increase of various diseases:
Three of my close friends have hyperthyroidism. I don't think the Ministry of Health wants to look into it– it might be suppressed. It's for political reasons. It (should be) about prevention– there's a screening test for breast cancer, really caring for it.
We need to document (the diseases). It is restrictive in the hospitals here. The associations (disease-environment) are a good place to start. We need your help. It's going to be used. – Hoda, idem
Now a lot of the people are dying from cancer, but we didn't find out until it was too late...We smell the same air. They shouldn't be denying it, they should just leave, then do more screening for breast cancer. – Dr. Iqstal, retired Kuwaiti pediatrician
In the end, it's all caused by politics. – Hoda, idem
These individuals highlight a certain amount of disdain, if not contempt, for the health care system and the decision-makers in charge of it. For example, the first informant uses the word “suppressed.” The last quote in particular implies that the system has been abused by external political forces. Many cancer patients wish that the Ministry of Health would take a more active role in screening, tracking and researching links to chemical exposures.
Why are we seeing the same illnesses in Gulf War veterans in your country? – Dr. Iqstal, retired Kuwaiti pediatrician
One chemical in particular that has been at the brunt of claims of contamination and exposure in post-conflict Kuwait: Depleted Uranium, also known as “DU.” Many individuals have commented to me about this noxious chemical and believe that it has clear and devastating effects on human health– namely causing cancer and birth defects:
The thyroid problems from depleted uranium are really a high number. – Hoda
They've (Iraqis) thrown bombs here and there, all over Kuwait, this small land. It's enough to cover a continent. Eventually they brought in companies for cleanup, burning oil and dumping oil in the sea. – Talal, Health Interest
The uranium (debris) is going to stay. It's not going to move unless you do something about it. A special on Al-Jazeera noted that the (uranium) dust has been detected in Europe after the sandstorms in 2004. – Talal, idem
However, many Western scientists have often minimized their claims regarding depleted uranium (DU), both in public and in private, leading Kuwaitis, as they themselves highlight above, to believe that Westerners do not take this issue seriously. Morever, radiation is an invisible substance – one cannot contain, smell or feel it. So, residents often wonder how they know if it is there. Can it dissipate? How? When? I breached the emerging concern of DU exposures in an earlier paper on the effects of the Gulf War (
Certain risks, such as physical ones, are considered more measurable and, in a biomedical sense, more valuable than mental health risks in many post-conflict societies (
). And, as implied in the data, the politics of wartime exposures ends up playing a substantial role in defining these risks for Kuwaitis. While there was one clinic established expressly for the sole purpose of treating mental health conditions (Al-Riggae), the clinic was closed in 2001. In most clinics, the doctor is the sole official who can determine– or at least authorize– the most efficacious course of treatment (
). The quotes above demonstrate a certain distrust and disbelief in the State narrative vis-à-vis environmental and health issues. In particular, they draw links between the events of the Gulf War – notably the oil well fires– and persistent environmental and health problems in Kuwait.