On an early afternoon in April 2006, Sami Hamad walked up to the Rosh Ha’ir shwarma and felafel stand in Tel Aviv. The restaurant’s security guard, Binyamin Hafuta, took notice and stopped Hamad at the door. The restaurant had been the target of a suicide attack three months before and the owners weren’t taking chances. Seconds later, Sami detonated his explosive device. Seventy people were wounded and nine killed in the attack, including the security guard. Did Hafuta’s actions save lives? Mark Harrison finds he likely did.

Bystanders interventions, such as challenging the attacker or informing security forces, is common. Out of the 103 Palestinian suicide attacks from 2000 to 2003, 40 experienced interventions by bystanders. Tragically, bystander interventions nearly always trigger an attack, killing the good samaritan. There are only two cases of interventions preventing an attack entirely.

In a 2006 article [PDF] in the journal Studies in Conflict & Terrorism, Harrison argues that interventions by bystanders reduce suicide attack casualties by preventing attackers from selecting optimal locations. The author finds 45.1 casualties occur on average when an attacker was not challenged, while only 16.9 casualties occur on average when a bystander intervened. He argues that bystander interventions take the initiative away from suicide attackers:

“Possibly, however, challenges in low-value locations prevented attackers from proceeding to higher-value targets. If the targets in Israeli society were arrayed in order of diminishing value … they would form steps on a ladder … The higher-value targets at the top of the ladder were cafés and buses; intermediate targets were commuter queues and shoppers in crowded streets and stores.

…

Think of the typical attacker as setting out to climb this ladder: to reach a café she had to pass a checkpoint, walk along a street, enter and leave a store, wait for a bus, and travel on it to the destination. At each step the attacker was screened by the watchful eyes of soldiers, security guards, shoppers, and commuters. By passing each step without challenge she gained access to a target of higher value. If challenged at any stage, she ended the game in sudden death. If this is the right analogy, then the effectiveness of screening is measured not just by the victims saved at each step but also by those saved because some attackers were challenged before they could reach targets of higher value.”

Harrison’s findings have strong implications. First, bystander interventions do save lives, but tragically almost always at the cost of the intervener. Second, populations under threat from suicide attackers benefit from a policy and norm of actively challenging suspicious individuals. The active challenging adds a level of randomness to a state’s security system that potential attackers must deal with. That is, while suicide attackers can plan on how to evade the static security locations, the chance of being challenged on every street and restaurant increases the probability a random intervention prevents or (more likely) mitigates an attack.

Work Cited:

Mark Harrison, “Bombers and Bystanders in Suicide,” Studies in Conflict & Terrorism 29, no. 2 (2006): 187-206.

On August 7th 1898, the American invasion force, crippled by yellow fever, started its evacuation of the island of Cuba. But, the withdrawal was not total. The black Ninth Infantry Regiment stayed behind to continue the occupation. It was believed that because of their race and the fact that many black volunteers came from southern states, they would be protected. These soldiers were nicknamed “Immunes”. However, mosquitos — the vector of yellow fever — are not influenced by skin color. By the end of their garrison duties, 73 of the 984 the soldiers contracted the disease.

Source:

Vincent J. Cirillo, Bullets and Bacilli: The Spanish-American War and Military Medicine (Rutgers University Press, 2004).

In 1898 the United States invaded the Spanish controlled island of Cuba. This “splendid little war”, as John Hay called it, was an unbridled military success. In short order the Spanish forces on the island were defeated, surrendering on July 16th 1898. Yet, within a month the US invasion would be forced to evacuate the island in what would later be called by one historian, “the American Dunkirk”.

The cause was fiebre amarilla, yellow fever. Transmitted by mosquitos, the disease quickly spread amongst the American occupation force. The infected were quarantined in a separate camp north of Siboney.

As yellow fever continued to cripple the US Army in Cuba, officers agreed that they must convince Washington to withdraw them from the island. Not wanting to damage their careers, a junior officer, Theodore Roosevelt, was chosen to draft the request. The same day, the US commander, General Shafter, asked Washington to allow the withdraw from Cuba, describing his force as an “army of convalescents”. By the time of his letter, 75% of the force in Cuba was unfit for service. The evacuation began on August 7th.

Source:

Vincent J. Cirillo, Bullets and Bacilli: The Spanish-American War and Military Medicine (Rutgers University Press, 2004).

I am moving to a new place this week, so expect only sporadic posting.

Welcome to another edition of Good Reads. This edition contains a wide variety of resources; from essays on Cuban doctors to government datasets on casualties. Enjoy!

• The Cuban revolutionary doctor as a weapon of diplomacy.
• Old: Hamas tried to hijack ambulances during Gaza war.
• Did the Persians use chemical warfare against the Romans? Probably.
• What’s So Great About White Phosphorus?
• Medical Dimensions of Security
• US Military Casualty Datasets
• Satellite data can suggest when and where epidemics will strike next
• Health in fragile states
• Blog on the data on civilian and military casualties in Iraq and Afghanistan
• Chinese, U.S. Navies Consult on Humanitarian Mission

Acquiring sub-state data on conflict is difficult. Conflict — by its nature — often destroys the very infrastructure used to collect health and related data. The end result is that civil wars are often “black boxes” with regard to quantitative data. Below are three sources of sub-state data on civil wars relating to health.

The Global Terrorism Database has information on more than 80,000 terrorist attacks from 1970 to 2007. GTD claims to be the most comprehensive unclassified database on terrorist actions available. The GTD has a clear data collection methodology and a detailed codebook (a manual detailing the dataset). Click here to download.

The Conflict Analysis Resource Center (CERAC) publishes a great dataset on the severity of the conflict in Colombia. The dataset has been used and described in a number of papers. Registration is required. Click here to download.

Ron Francisco has constructed a series datasets on the conflict events in six wars: Archidamian War, Ireland 1922-1923, Russia 1917-1920, Spain 1936-1939, and the U.S. 1861-1865. The dataset includes: date, day, action type, location, each sides’ action, captures, injuries, deaths, description of event and original source. Click here to download.

Nobody reads the saturday papers, so governments often announce items they want to keep quiet the friday before. Last friday, the US government announced Obama’s signing of a bill doubling funding to a little known project started in 2007 tackling the environmental and health aftermaths of Agent Orange in Vietnam.

During the war the US military faced a dilemma. Pound for pound, the combined military might of the US armed forces could easily crush the Viet Cong and North Vietnamese Army in open battle. However, the dense jungle terrain made identifying enemy locations difficult. You cannot bomb what you cannot see. From 1961 to 1971 the US employed a form of herbicidal warfare to negate the protection afforded by the country’s dense vegetation. Millions of gallons of the dioxin containing herbicide were stored in Da Nang airport. From here, it was loaded onto USAF aircraft and blanketed over the Vietnam countryside to destroy crops and remove the concealment the dense vegetation provided Viet Cong and North Vietnameses troops.

Most of the money will be spent on cleaning the area around Da Nang airport and not the countryside. Agent Orange has been blamed for upwards of four millions cases of serious health problems. This number is disputed by the US government. Apart from the site at Da Nang airport, there are 25 other internationally recognized Agent Orange “hotspots” in Vietnam.

The move comes just days before Vietnamese Agent Orange activists testified in front of the House of Representatives Foreign Affairs Subcommittee on Asia, the Pacific and the Global Environment. Obama’s signature of the bill is likely intended to partially placate the activists before their testimony. There is a sizable research literature exploring the effect of domestic lobbies on foreign policy. Agent Orange offers a great example of global health lobbying, where a domestic lobby triggered international health diplomacy.

I have been largely out of the loop for a month or so to prep for my oral exams. Now that I have advanced to candidacy I am trying to catch up.

• Is there less malaria in Darfur today because of the genocide?
• Internally Displaced Persons: Case Studies of Nigeria’s Bomb Blast and the Yoruba-Hausa Ethnic Conflict in Lagos, Nigeria
• Blogger’s Roundtable with Capt. Lineberry of the US Navy’s Operation Continuing Promise 2009
• Afghanistan: First Acid, Now Gas Attacks Against Girls
• USNS Comfort: Winning Hearts and Minds in Haiti
• CSIS Launches Commission on Global Health and Smart Power
• The Weapons That Kill Civilians: Deaths of Children and Noncombatants in Iraq, 2003–2008
• Health and Conflict: A Review of the Links
• Humanitarian neutrality isn’t dead because it never existed
• Policy Brief: Private security contracting in humanitarian operations

Late last week the United Nations announced that its blue helmets in the Congo helped plan and execute an aerial offensive by Congolese government forces against Hutu militias. Further details on the operation are hard to come by. What is known is that the operation was an attempt to protect civilians in North Kivu, who have suffered repeated attacks and human rights violations at the hands of Hutu armed groups.