In Afghanistan, the death toll continues to rise, says Mehdi Hasan

The number of US military fatalities has remained virtually unchanged, year on year.

In this week's New Statesman, we take a look at the quagmire in Afghanistan, in the wake of President Obama's recent announcement of a "drawdown" in US forces from the so-called graveyard of empires. My own piece, not yet published online, asks why Obama, as well as David Cameron, is intent on keeping combat troops in action in Kabul, Kandahar, Lashkar Gah and the rest when the war is lost and negotiations with the Taliban have begun. Why not bring them home sooner? I remind the readers of John Kerry's famous 1971 statement regarding Vietnam in front of a congressional committee:

How do you ask a man to be the last man to die for a mistake?

Four decades on, the same point applies to the war in Afghanistan.

According to a new report from Associated Press:

Despite US reports of progress on the battlefield, American troops were killed in the first half of this year at the same pace as in 2010 -- an indication that the war's toll on US forces has not eased as the Obama administration moves to shift the burden to the Afghans.

While the overall international death toll dropped by 14 per cent in the first half of the year, the number of Americans who died remained virtually unchanged, 197 this year compared with 195 in the first six months of last year, according to a tally by the Associated Press.

Americans have been involved in some of the fiercest fighting as the US administration sent more than 30,000 extra troops in a bid to pacify areas in the Taliban's southern heartland and other dangerous areas. US military officials have predicted more tough fighting through the summer as the Taliban try to regain territory they have lost.

President Barack Obama has begun to reverse the surge of American forces, ordering a reduction of 10,000 by the end of the year and another 23,000 by September 2012. But the US military has not announced which troops are being sent home, or whether they will be withdrawn from any of the most violent areas in the south and east.

. . . According to the AP tally, 271 international troops, including the Americans, were killed in the first half of the year -- down 14 per cent from the 316 killed in the first six months of last year.

With the American deaths virtually unchanged, the decline reflects a drop off in deaths of troops from other contributing nations. In the first half of the year, 74 of these troops -- from countries like Britain, France and Australia -- died compared with 121 in the first six months of last year.

In the most recent deaths, Nato said two coalition service members were killed in roadside bombings -- one Saturday in the west who was identified as an Italian, and another Friday in the south whose nationality was not available.

It is also worth noting that there is an obsession in the west with the number of deaths and injuries related to "our boys" -- and I suppose it could be argued that my own piece in this week's magazine is a part of this phenomenon -- while civilian casualties of the conflict -- Afghanistan's "unpeople", to quote historian Mark Curtis -- go unnoticed and largely unreported by western governments and the media, despite the number of civilian deaths being far higher than the number of military fatalities.

The AP report says:

[A] recent UN report found that May was the deadliest month for civilians since it began keeping track in 2007 and it said insurgents were to blame for 82 percent of the 368 deaths recorded. The UN does not usually release monthly civilian casualty figures but said it was compelled to do so in May because of the high number.

Before you get too excited: if the Taliban and their allies are responsible for four out of five innocent deaths in Afghanistan, that means "our side" is responsible for one in five of those deaths (18 per cent).

The sooner we stop killing people in Afghanistan, innocent or otherwise, the better.

 

Mehdi Hasan is a contributing writer for the New Statesman and the co-author of Ed: The Milibands and the Making of a Labour Leader. He was the New Statesman's senior editor (politics) from 2009-12.

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Why does the medical establishment fail to take women in pain seriously?

Women with mesh implants have been suffering for years. And it's not the only time they have been ignored. 

Claire Cooper’s voice wavered as she told the BBC interviewer that she had thought of suicide, after her mesh implant left her in life-long debilitating pain. “I lost my womb for no reason”, she said, describing the hysterectomy to which she resorted in a desperate attempt to end her pain. She is not alone, but for years she was denied the knowledge that she was just one in a large group of patients whose mesh implants had terribly malfunctioned.

Trans-vaginal mesh is a kind of permanent “tape” inserted into the body to treat stress urinary incontinence and to prevent pelvic organ prolapse, both of which can occur following childbirth. But for some patients, this is a solution in name only. For years now, these patients – predominantly women – have been experiencing intense pain due to the implant shifting, and scraping their insides. But they struggled to be taken seriously.

The mesh implants has become this month's surgical scandal, after affected women decided to sue. But it should really have been the focus of so much attention three years ago, when former Scottish Health Secretary Alex Neil called for a suspension of mesh procedures by NHS Scotland and an inquiry into their risks and benefits. Or six years ago, in 2011, when the US Food and Drug Administration revealed that the mesh was unsafe. Or at any point when it became public knowledge that people were becoming disabled and dying as a result of their surgery.

When Cooper complained about the pain, a GP told her she was imagining it. Likewise, the interim report requested by the Scottish government found the medical establishment had not believed some of the recipients who experienced adverse effects. 

This is not a rare phenomenon when it comes to women's health. Their health problems are repeatedly deprioritised, until they are labelled “hysterical” for calling for them to be addressed. As Joe Fassler documented for The Atlantic, when his wife's medical problem was undiagnosed for hours, he began to detect a certain sexism in the way she was treated:

“Why”, I kept asking myself, when reading his piece, “are they assuming that she doesn’t know how much pain she’s feeling? Why is the expectation that she’s frenzied for no real reason? Does this happen to a lot of women?”

This is not just a journalist's account. The legal study The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain found that women report more severe levels of pain, more frequent incidences of pain, and pain of longer duration than men, but are nonetheless treated for pain less aggressively. 

An extreme example is “Yentl Syndrome”. This is the fact that half of US women are likely to experience cardiovascular disease and exhibit different symptoms to men, because male symptoms are taught as ungendered, many women die following misdiagnosis. More often than should be acceptable, female pain is treated as irrelevant or counterfeit.

In another significant case, when the news broke that the most common hormonal birth control pill is heavily linked to a lower quality of life, many uterus-owning users were unsurprised. After all, they had been observing these symptoms for years. Social media movements, such as #MyPillStory, had long been born of the frustration that medical experts weren’t doing enough to examine or counter the negative side effects. Even after randomised trials were conducted and statements were released, nothing was officially changed.

Men could of course shoulder the burden of birth control pills - there has been research over the years into one. But too many men are unwilling to swallow the side effects. A Cosmopolitan survey found that 63 per cent of men would not consider using a form of birth control that could result in acne or weight gain. That’s 2 per cent more than the number who said that they would reject the option of having an annual testicular injection. So if we’re taking men who are afraid of much lesser symptoms than those experienced by women seriously, why is it that women are continually overlooked by health professionals? 

These double standards mean that while men are treated with kid gloves, women’s reactions to drugs are used to alter recommended dosages post-hoc. Medical trials are intended to unearth any potential issues prior to prescription, before the dangers arise. But the disproportionate lack of focus on women’s health issues has historically extended to medical testing.

In the US, from 1977 to 1993, there was a ban on “premenopausal female[s] capable of becoming pregnant” participating in medical trials. This was only overturned when Congress passed the National Institutes of Health (NIH) Revitalisation Act, which required all government funded gender-neutral clinical trials to feature female test subjects. However, it was not until 2014 that the National Institutes of Health decreed that both male and female animals must be used in preclinical studies.

Women’s exclusion from clinical studies has traditionally occurred for a number of reasons. A major problem has been the wrongful assumption that biologically women aren’t all that different from men, except for menstruation. Yet this does not take into account different hormone cycles, and recent studies have revealed that this is demonstrably untrue. In reality, sex is a factor in one’s biological response to both illness and treatment, but this is not as dependent on the menstrual cycle as previously imagined.

Even with evidence of their suffering, women are often ignored. The UK Medicines and Healthcare Regulatory Agency (MHRA) released data for 2012-2017 that shows that 1,049 incidents had occurred as a result of mesh surgery, but said that this did not necessarily provide evidence that any device should be discontinued.

Yes, this may be true. Utilitarian thinking dictates that we look at the overall picture to decide whether the implants do more harm than good. However, when so many people are negatively impacted by the mesh, it prompts the question: Why are alternatives not being looked into more urgently?

The inquiry into the mesh scandal is two years past its deadline, and its chairperson recently stepped down. If this isn’t evidence that the massive medical negligence case is being neglected then what is?

Once again, the biggest maker of the problematic implants is Johnson&Johnson, who have previously been in trouble for their faulty artificial hips and – along with the NHS – are currently being sued by over 800 mesh implant recipients. A leaked email from the company suggested that the company was already aware of the damage that the implants were causing (Johnson&Johnson said the email was taken out of context).

In the case of the mesh implants slicing through vaginas “like a cheese-wire”, whether or not the manufacturers were aware of the dangers posed by their product seems almost irrelevant. Individual doctors have been dealing with complaints of chronic or debilitating pain following mesh insertions for some time. Many of them just have not reported the issues that they have seen to the MHRA’s Yellow Card scheme for identifying flawed medical devices.

Shona Robison, the Scottish Cabinet Secretary for Health and Sport, asked why the mesh recipients had been forced to campaign for their distress to be acknowledged and investigated. I would like to second her question. The mesh problem seems to be symptomatic of a larger issue in medical care – the assumption that women should be able to handle unnecessary amounts of pain without kicking up a fuss. It's time that the medical establishment started listening instead. 

 

Anjuli R. K. Shere is a 2016/17 Wellcome Scholar and science intern at the New Statesman

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