HALABJA….The road from Sulaimania to Halabja passes through a region called the Shahrizur, which was once one of the great agricultural centers of Iraq. It makes for pleasant scenery, with broad grassy plains ringed by foothills and tall mountains in the distance. The towns along the road ? Arbat, Say Sayach, and Sirwan ? appear mere reservoirs of poverty, but to my Kurdish hosts each is a metropolis filled with acquaintances and family history.
PUK peshmerga (Kurdish fighters) operating in the Shahrizur were the chief target of Saddam Hussein’s Baath regime during the Anfal Campaign of 1988. The campaign against them included multiple chemical weapons attacks, of which Halabja is only the most notorious. In part this is because the peshmerga and the Iranian Army occupied the town and allowed observers to record the atrocity. Victims in other towns were simply swept away by the Iraqi Army.
To speak meaningfully of what happened in the Shahrizur, first you must follow the shadow of American foreign policy. The 1975 Algiers Accord, endorsed by Henry Kissinger, settled the border (temporarily) between Iraq and Iran. Part of the agreement was a sudden and unexpected end of American and Iranian support for the peshmerga, an event that was the defining disaster for the Kurdish independence movement. The KDP collapsed and Mustafa Barzani, the nationalist leader, fled the country. The socialist PUK continued to fight, which is why the Baath regime disproportionately targetted the Shahrizur in the 80s.
Kissinger’s name is a curse word in Kurdistan, and the Algiers Accord is the one topic that can cause sentiment to turn anti-American. In the arc of Kissinger’s career ? a geographical list that includes Cambodia, Chile, and East Timor ? Kurdistan may not draw much attention. But the damage done to American credibility in this country was almost fatal, and all of this was done in the name of “realism.”
In the Shahrizur the politics of the past mix with the poverty of the present. I am working with Dr. Ako, the healthcare administrator for the region, and our goal is to obtain clinical data about the population in Halabja. We hope to demonstrate an association between exposure to chemical weapons and ongoing disease, and we hope to better define the incidence of common diseases in the community. Because there are few publications on Halabja in the medical literature, even simple facts, like the incidence of Post-Traumatic Stress Disorder (PTSD), are unknown. Many other diseases are also reported, including malignancy, polycystic ovary syndrome, pulmonary fibrosis, and a wide range of opthomological and dermatological illness. But without data all of this is anecdotal.
The work in Halabja also illuminates one of the central differences between myself and my Kurdish colleagues. In New York research is a basic feature of medical education. In the wake of September 11th doctors enrolled 60,000 patients in prospective trials. Everything that happens to them will be recorded, and the information will be used to obtain resources for them as they age. In Kurdistan, by contrast, there is no research infrastructure. Medical education is antiquated, consisting of the memorization of long lists of syndromes. Skill sets like research that are essential parts of modern medical education have not yet entered the curriculum. The result is a group of intelligent, clinically skilled doctors who are ill-equipped to publish about their patient population. In Kurdistan this work seems a fantastic luxury, not a crucial piece of advocacy.
One thing that surprises me about Halabja is that it is still beautiful. Entire neighborhoods are rubble, but amongst the hills and mountains it retains its charm. This disconnect between the setting and the recent history makes it an emotionally taxing environment to work in. As I discuss my plans with the Kurdish doctors and nurses, all are friendly and eager to work with Americans. But as I think about the debate back at home, cynical and self-serving on both sides, I wonder how much more politics this place can survive.
Jonathan Dworkin, a medical student in his final year at Mount Sinai School of Medicine in New York, is travelling in Iraqi Kurdistan from January to March of 2006. Other posts in this series: