America’s fascination with the Middle East is centuries old. Before the celebrity of T.E. Lawrence, or the popularity of Orientalist artwork such as Jean Ingres’s Grande Odalisque, the early Republic’s first intervention abroad was in the Middle East during the Barbary Wars. Now a frequent subject on the front pages of the country’s newspapers, on broadcast news segments, and on social media, the region is one of our great obsessions. Rarely, however, do those conversations include the voices of physicians. That may seem like an odd complaint—why, after all, should doctors weigh in on autocratic leaders and longstanding conflicts—but, in fact, it has created a blind spot in our understanding of the most turbulent part of the world.
It’s a mistake to see this as happenstance. It’s convenient, especially for people in power, to ignore suffering. Discussing Syria or Yemen through the abstract prism of foreign policy is more comforting. But when doctors speak about the human toll of a refugee crisis, or a cholera epidemic, or a genocide, it creates a sense of shame not just in the politicians who enable the tragedy, but in everyone who has acquiesced to their cynicism.
This is just as relevant for liberals as for conservatives. Christopher Hitchens once credited Bernard Kouchner, the French physician and activist who co-founded Doctors Without Borders, as “a pioneer in the highly necessary proclamation that left politics should always be anti-totalitarian.” Despite ascending to become the French Foreign Minister, Kouchner was always, at his best, a truth-teller. His career and influence suggests that the moral voice of medicine is strongest when it is unattached to power.
One of my proudest tasks as a doctor has been to work with Kurds. My involvement began as a medical student in 2006, when I visited Sulaimania, a sprawling and free-spirited city in the autonomous Kurdish region of Iraq. Since that initial visit, I have trekked back several times, most recently to consult with a hospital in Sulaimania that cares for injured Kurdish soldiers.
One constant in all my visits has been the presence of refugees. The details vary by year, but some themes are unchanging: Kurds in political trouble crossing the border from Iran; Iraqi Arabs resettling to avoid sectarian bloodshed; Christians, Yezidis, and other religious minorities displaced from their villages. Kurdistan has become a great net that catches millions of people fleeing the region’s failing despotisms.
President Donald Trump’s sudden decision last month to abandon the Kurds in Syria by withdrawing all U.S. troops there will destabilize the Kurdish region of that country. It’s an irony that President Trump—notorious for his hostility to refugees—appears hell bent on making millions more of them.
The human rights abuses perpetrated against the Kurds are well-documented.
My 2006 research in the Journal of Nervous and Mental Disease focused on the long-term consequences of Saddam Hussein’s 1988 chemical weapons attack on Kurds in Halabja. Hussein, at the time, had been supported by American diplomats who saw him as a kind of useful pit bull. When the Kurds resisted his authoritarian impulses, he initiated a campaign of genocide through the use of mustard gas and various nerve agents. Halabja never recovered; even decades after the violence, people were still experiencing symptoms of post-traumatic stress.
War traumas rarely come as single events. The Halabja study showed that many people suffered from multiple traumas, and that the accumulation of trauma predicted a higher level of social dysfunction. The findings were alarming on two levels: trauma is cumulative, and the ensuing social dysfunction persists for decades.
In the case of Syria, we are seeing the worst refugee crisis to impact Europe since the end of the Second World War. But Syria’s Kurdish region has now achieved a modicum of stability, and it is hosting thousands of persecuted Christians and Yezidis. The autonomous Kurdish region in Iraq plays a similar role, hosting internally displaced Iraqis, often from Arab areas that are now under the threat of sectarian militias. These are people who are struggling to rebuild their lives by removing themselves from environments in which they are subjected to recurrent violence.
The United States deployed 2,000 soldiers to help the Kurds defeat ISIS in 2014, but that didn’t happen because of an eagerness to intervene. It happened when President Obama realized it was the only way to defeat ISIS—and that there was only one reliable group with which the Americans could partner.
The soldiers deployed were mostly there in a support and intelligence role. The Kurds, for their part, have lost tens of thousands of young men and women fighting ISIS. It costs the United States roughly $550 million dollars per year to keep soldiers in Syria. To put that in perspective, it’s less than one tenth the size of the U.S. deployment to Korea and one-thousandth the annual defense budget of the United States. And with that help, Kurds have created a haven for two million people in Syria. But Trump’s view of the Kurds is that they’re disposable. Like everyone he works with, he can discard them when they’re no longer convenient.
Trump’s sudden retreat caused a wave of resignations by the people around him, most notably James Mattis, his secretary of defense. That was followed by surviving officials, like Vice President Mike Pence, struggling to explain the new reality. Defending the rapid turnabout required callousness and amnesia in equal measure. Just three months before Trump announced his Syria pullout, he said of the Kurds: “We have to help them. I want to help them … they fought with us. They died with us.”
There is a dreadful human cost to this sellout. Unless the Kurds’ autonomy is protected, our former allies will be forced to choose between a future in which one of two dictators effectively control their part of Syria: Turkey’s Recep Tayyip Erdogan or Syria’s Bashar al-Assad. Their best bet, if they want to avoid a repeat of the Turkish army’s Afrin ethnic cleansing in March, is to accept the embrace of Assad, a man who uses chemical weapons and is busy emptying his jails with mass murder.
These are the costs that Trump won’t care to acknowledge. He will stick to his slogans, insist that he delivered on a campaign promise, and hope that nobody notices the mess in human lives he’s left behind.