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Disability and povertyA global challenge$

Arne H. Eide and Benedicte Ingstad

Print publication date: 2011

Print ISBN-13: 9781847428851

Published to Policy Press Scholarship Online: March 2012

DOI: 10.1332/policypress/9781847428851.001.0001

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Poverty as trauma: methodological problems when reality gets ugly

Poverty as trauma: methodological problems when reality gets ugly

Chapter:
(p.207) Eleven Poverty as trauma: methodological problems when reality gets ugly
Source:
Disability and poverty
Author(s):

Hans Husum

Odd Edvardsen

Publisher:
Policy Press
DOI:10.1332/policypress/9781847428851.003.0012

Abstract and Keywords

People can dance around issues of poverty in the fields of philosophy and science, and many can find plausible answers that guide and provide comfort. When reality becomes ugly, the sympathetic nerve system makes the heart beat hard; muscles contract, the brain shrinks its focus: people experience trauma. Minefields and massacres are ugly; they catch people at point-blank range, and, by instinct, people protect themselves from danger. This chapter uses the examples of minefields and aerial bombing to reflect on some methodological problems in research on poverty issues. It presents a typical case story – Abdul's – as told by one of the research informants, a mine medic named Hikmat.

Keywords:   poverty, psychology, disabled people, minefield, mine medic, poverty research, aerial bombing

Rehabilitation means re-building my habitus, my home, the position where I am I. By this we are face the unpleasant question: who am I? Like it or not, we are taken deep into the field of identity politics where three basic questions have to be answered: first, accounts of reality depend on position in space – the account of reality as seen by the insiders, the downtrodden poor, is different from accounts set up by privileged outsiders of brief transit study missions. So, what are the voices we hear in research reports from oppressed communities? Second, knowledge is also situated in time – places, people and identities are in process and carry a history (Haraway, 1991). Do we find it convenient to study this history? A lecturer in international health once opened her presentation about a field mission in Africa by a beautiful landscape slide, saying, “And here was I, in the middle of nowhere.” She had spent some months exactly where one of the East-African old cities – now destroyed – was located some 3,000 years ago. Third, if it is so that differences of class, human rights, gender and so on have been disguised by privileged readings by outsiders, what are the conditions, then, for making the invisible visible, to hear the voiceless speak?

We can dance around these questions in the field of philosophy and theory of science, and we can probably also find some plausible answers by which we can comfort ourselves and guide our students. But when reality becomes ugly, the sympathetic nerve system makes our heart beat hard; muscles contract, we start sweating, our brain shrinks its focus, we stare out as through a tunnel; the back skin contracts just like a cat caught in the corner. We can agree with Sartre that ‘the Other’ is a threat to our own experience of ‘Self’. Minefields and massacres are ugly; they catch us at point blank range and by instinct we protect ourselves from danger.

In this chapter we want to use the examples of minefields and aerial bombing to reflect on some methodological problems in research on poverty issues. Here is a typical case story as told by one of the research informants. (p.208) (p.209)

(p.210) ‘The illusion of objectivity has a protective function’ (Habermas, 1979)

Our own routes to studies of poverty as a trauma has not been easy. We grew up with radio news from the bloody victory of the Algerian revolution and the US marines' massacres of Vietnamese peasant villages. When the Soviet army smashed rural Afghanistan in the 1980s we went there to study war from the point of view of ‘targets on the ground’. The Afghans taught us two lessons.

First: modern warfare is worse than ‘we’, the manufacturers of ‘smart’ bombs and jet fighters, can think of. The pain and fear of children torn to pieces at home – in their habitus, inside their safe harbour with the smell of boiling rice in their nostrils – is beyond imagination. How can we understand the hopelessness of a mother who has lost children to land mines, and still has to wait for the next bang with more children mangled or dead? And it is even harder to understand the price of endurance the poor peasants have to pay – for there is not just one bomb, but many; not one land mine, but thousands; not one war, but repeated wars of colonialisation fought by ‘us’ against ‘them’. Guernica, Dresden, My Lai, Gaza, Helmand, Fallujah, Abu Graib: structural poverty is killing millions of children yearly. In this dirty context ‘few’ and ‘many’ represent different qualities because each massacre modifies conditions for recognition. Herein lays the urgency of giving voice to the voiceless if we are to seek a serious understanding.

The second lesson told by the Afghans was this: “We will never give in!” On the one hand, this standing is based on Afghans' deep-rooted distrust and hatred of ‘us’ as Westerners – for good historical reasons. But this attitude – ‘we’ and ‘you’ are different – was as much a foundation for coping. We met the Afghan ‘we’: the Afghan patient was not a passive recipient of medical attention; rather his family and the entire village were active parts of the medical team as surgical assistants, blood donors, nurses and cooks. We thought that villages bombed to saturation level or caught inside minefields would stand no chance of survival. Instead we learned how scores of villagers rescued their wounded even under fire, organised forward clinics, built makeshift training centres and made us feel confident and ‘at home’ inside the war zones. That was during the 1980s. Now, more than 20 years later, we see in the paddy fields of Cambodia and the plains of Mesopotamia that the war is still going on. The banners and the rhetoric of the perpetrators have changed, but war is still the condition. Gradually we came to realise that the nice desktop concept of over-lapping hermeneutical circles learned in university libraries – ‘our’ world and ‘theirs’, connected by some sort of empathetic measures – breaks when it comes under fire. In war there is no safe position from where you can contemplate on ‘their’ representations of the world: either stay or leave; (p.211) either inside or outside; either with us or against us. There is no third space for ‘objective’ reflections here.

Saving lives – for what?

We are professional trauma care providers and teachers. Having learned in the war theatres of Lebanon and Afghanistan in the 1980s that at least one patient had died on the way for every patient reaching the operating room alive, we left the hospitals to set up rural chains-of-survival with some colleagues from the University Hospital Northern Norway. We deliberately sought out the world's worst landmine areas and found two of them, one at the Iranian border in Iraqi Kurdistan and the other along the Thai border in northwestern Cambodia. This was where we set up the ‘laboratories’, where we met the medic Hikmat from Tawela. The research question at that time, in 1996, was: ‘The victim starts dying at the time of injury. If half of war and mine victims die on the way and most of these deaths are avoidable, are we able then to reduce deaths by teaching somebody along the roads how to stop bleeding and how to keep the airways open?’. In a systematic massive medical intervention we set up makeshift training centres – ‘village universities’ – inside the minefield areas, where groups of carefully selected local nurses, midwives, ambulance drivers, farmers and teachers learned basic life support techniques and were certified as medical instructors. Within three years 5,000 villagers were trained by these instructors under bold slogans such as ‘Khmers teaching Khmers’. More than 1,000 victims of war and landmines were carried by a network of warm hands towards the hospital, all injuries and treatment being carefully registered, coded and computerised. When we eventually pushed the button ‘multi-factorial analysis’ in 2001, the graph came out nicely (see Figure 11.1).

Many lives saved; we seemingly had good reason to celebrate (Husum et al, 2003). However, chilling information soon started to come from partners inside the minefields of Cambodia: “Doctor, what can we do for the survivors with chronic pain? We have tried all kinds of analgesics and tranquillisers, but nothing works on them. Some of them have even killed themselves.” We were obviously facing an important problem, not previously recognised by us outsiders. Consequently we undertook a study of 57 landmine accident survivors in Cambodia and Kurdistan. All study patients had been injured at least one year ago, and all of them had severe injuries. The findings were shocking. One of the case reports goes like this: (p.212) In the study of survivors we used clinical pain examination, visual analogue scale self-rating and interviews to examine the pain problem. Three quarters of the mine accident survivors had chronic pain syndromes to such a degree that they could not carry our daily duties, socialise or wear prosthesis. Half of the patients felt that their pain was still increasing more than one year after the accident. The levels of pain carried no correlation to the quality of primary trauma care for the actual injury. However, levels of pain correlated strongly with poverty. Most (p.213) study patients belonged to poor families in work-intensive households – in those families where times became even harder after the accident – due to debt caused by medical expenditure or inability to attend their farms – we found the survivors with most pain (Husum et al, 2002).

We started to understand that pain is the price you have to pay when hardships are chronic. We can stop bleeding and heal wounds, and should, of course, do our best to heal more wounds. But poverty acts as a trauma beyond our control. This had a dramatic impact on our understanding of trauma care: the historicity of trauma, trauma as a chronic state, blasts the Eurocentric concept of ‘post-injury stress syndrome’; there is no ‘pre’ or ‘post’ for these families, but mines, war and poverty all the way. The psychiatrist Derek Summerfield conducted extensive studies of Western humanitarian psycho-trauma interventions in the war-torn South,3 and sums up:

Trauma programmes have not been asked for by survivor populations. The objectification of the understandable misery of war as a pathological entity apart (“trauma”) – a technical problem to which short-term technical solutions like counselling apply – is a serious distortion and for the vast majority posttraumatic stress is a pseudocondition. Millions of dollars from donors have flowed to programmes whose as yet unevaluated impact may include negative effects on survivors' meaning systems and traditional coping strategies at the very point when these are damaged or destabilised. No general case has yet been made for mental health to be seen as an appropriate realm for humanitarian operations for war-affected populations. The humanitarian field should go where the concerns of survivor groups direct them, towards their devastated communities and ways of life, and urgent questions about rights and justice. The core issue is the role of the social world, invariably targeted in today's “total” war and yet still embodying the capacity of survivors to manage their suffering, adapt and recover on a collective basis.

(Summerfield, 1999)

Poverty as context, or poverty as machine?

RK, the 16-year-old boy who looks far older than his age, the boy who had to keep on herding in the same minefield where he first lost his leg (see above) – who is he? What is his habitus? There are two different approaches to the study of disability and poverty. We may look at the disability problem as one where disabled people try to optimalise their function in a context signified by poverty, the unwanted condition – disability – taking place in a social setting where resources are scarce. However, if we regard poverty as an agency and not merely as a context, it becomes clear that the context approach falsely simplifies the problem. Poverty itself disables people: what is a ‘father’ but the person who takes (p.214) care of his children? As a minimum he should care for them in a way that their minimum basic requirements for life are met; the ‘father’ who cannot provide daily food and water for his children is a non-able ‘father’. He may very well be able in the instrumental sense as a farmer or fisherman, having two legs, two arms and two eyes; having a donkey or a boat and the knowledge of farming/fishing gained from his forefathers. But his instrumental resources cannot convert job hours to food for the children because somebody took the water and the land – be it the landmines, the Israeli army, United Fruit directors, river pollution and river dams, World Trade Organization (WTO) patent rights, environmental destruction…. Some external powerful agency has disabled the father as a ‘father’ and by definition made him a ‘non-father’. He is disabled in his identity as ‘father’.

Seen at a glance, by outsiders, poverty appears to be some sort of universal state rather than a specific process for a given time in a given place. We are conducting research in the matter of disability and poverty; they inform us, and we report: ‘They are poor’. Period. As if the condition of poverty is a static and (more or less) universal one. However, the study matter presents itself differently if we see poverty as the denial of rights, as a condition constantly reproduced in a process of rights claimed and rights denied.

The poor ‘father’ (normally) does not passively accept the social framing inserted on him: for love of his children and responsibility in the role of ‘father’ every hour and every day he tries to make the best out of the worst, finding a little here and a little there, always on the alert for any resources to be allocated – like a hungry fox or a street boy in an urban slum. And not only is our poor ‘father’ vigorously active, but also his wife, his brothers, his neighbours and his entire community. At any time there is an army of powerless poor on the move inside confined, narrow spaces defined for them by some powerful external agency. Being on the move, life is unpredictable and constantly changing for ‘the poor’; there are hopes as well as set-backs, small nuances of ugliness hardly observable for us, although of vital importance regarding the key question: ‘do I have food and water for my children tomorrow?’.

Second, the privileged have to protect themselves. When the army of poor pushes on the frames and borders set for them, and even more when they try to break through, the all-mighty has to try to contain them, by military coercion (Mau-Mau in 1952 and Burma in 2007, for example), controlling production and trade (the WTO, for example), censorship (embedded journalism, the war on Gaza in 2009) or political manoeuvres (UN declarations, Millennium Development Goals etc). There is a well-trimmed and well-managed politico-social system in action, reproducing conditions of poverty that constantly disable our ‘father’. We may rightly call this system ‘the poverty machine’.

Third, the poverty machine is a man-made construct; as such it has a history where outstanding social engineers like Machiavelli, Clausewitch, Stalin and Margaret Thatcher – to name but a few – have made significant contributions. Unless we take this history into account we may come to under-estimate the efficacy of the poverty machine.

(p.215) Fourth, the better we understand the poverty machine, the more we should admire our poor ‘father’ for his resistance, for his not giving in.

“War, poverty and death is normal”

We will now let some of the muted ‘others’ speak out. Some readers may ask why we find it necessary to present such ugly stories of maiming, torture and killings, maybe claiming that “these stories are extraordinary, in general the situation is not that bad”. We object; the accounts of reality are worse; the stories told are not extraordinary, but ordinary. Euro-reason has for too long dominated readings of reality with sufficient power to establish its readings as universalistic.14 In traditional Euro-representations the massacres, firebombing of civilians and silent killings by mines represent the extraordinary, but for the victims those events are ordinary – death is normal. Before we start to define research questions of poverty and oppression and enter the field of research, reality should be set on foot; the ordinary should be re-established as ordinary. Only by redefining the ‘extraordinary’ as ordinary can we understand how much it takes for the army of poor to manifest themselves as ‘normal’ human beings.

“Have you ever been caught under the F16s?”

From 1969 to 1973 the US Air Force blanket-bombed rural Cambodia (Husum, 2003). Setting up the chain-of-survival system for mine victims in Cambodia we met with some older people who were able to tell us about previous wars. One of them, an old farmer in Sompouv Lun, a Khmer Rouge base area, told us about the aerial bombing (he was unable to say exactly which year):

  • We had been in the forest for some days, hunting – my neighbours and I.
  • When we approached our village, we heard thunder in the sky.
  • Then a big noise.
  • Suddenly the ground was on fire.
  • Pieces of persons and animals were thrown in the air.
  • Houses and large trees as well.
  • But there were no enemy soldiers around, which surprised us.
  • You know, we had no knowledge of planes and bombs at that time.
  • Every night since then I have been awake thinking of my wife and daughters.
  • There was nothing left of them. (quoted in Husum, 2003, p 52)

During the US invasion of Iraq in March 2003 we sat with Saya in her house in Arbat in northern Iraq. The village is not far from the Khurmal mountains, a stronghold for the Islamic resistance. While talking we could hear F16s and B52 (p.216) bombers ‘doing their job’. During incoming fire, Saya paused and listened. This is what she said:

‘One Sunday morning in November last year, I went downstairs to get some water for the breakfast tea. I was living with my husband at that time, we were newly married. In the stairs I stumbled into a trip wire; then a sudden blast, and I was thrown to the roof. When I woke up I smelled burned flesh and saw that my leg was gone. You see, they had placed a mine inside our house during the night, to punish us because we had joined the Islamic resistance. The PUK peshmergas are clever in making booby traps.5

‘My husband is a journalist. We joined the resistance both of us because we had no other options. Facing increasing corruption, mismanagement, public poverty and destruction of our society we had to do something. The political parties are all dead here in Kurdistan. The leaders are not even looking at us, they don't even see our children. Trying to rebuild a society where people could live a decent life – not man against man – that was our crime. For that they had to destroy my body.

‘Now my husband is up there, in the mountains, under the American planes. I am proud of him. But every time I hear the planes, a tremendous pain runs from my amputation stump into my heart and all over my body. It is like electrical torture.

‘Still I don't regret. What should I regret?

‘Being in love with my husband?

‘Wanting to live as a full human being?’ (quoted in H. Husum, 2003, Notes from a field mission to Iraq)

Saya's husband was killed during a Cruise missile attack on a Khurmal village two months after the interview took place.

“Do you know the beginnings of chronic pain?”

The injured person starts dying at the time of injury. Of course the doctor asks how it happened and registers the injury mechanism and diagnosis. But everything and everybody is exterior to the person who got his body torn up. The written version, the doctor's story, is a socially produced story told by an outsider. A mountain farmer in northern Iraq tells another story – about the heart of the drama.

  • I went down to the spring where the shepherds use to make tea.
  • Suddenly I heard an explosion and was thrown to the ground.
  • When I opened my eyes, I was inside a cloud of dust.
  • (p.217) The explosion had lit the grass on fire.
  • I tried to move, but my legs were gone.
  • I looked for my knife to kill myself, but couldn't find it.
  • So I crawled to the spring and put my legs into the water.
  • The water became red.
  • I thought maybe somebody downstream will see the red water and come to help me.
  • After the accident everything changed.
  • I lost both my legs.
  • Soon after coming home, my two wives died.
  • So now we are poor.
  • Everything is over. (quoted in Hedelin et al, 2006)

“Doctor, you're too late”

The stories citied are ugly, but still just snapshots, tiny fragments of a long history of lived hardship. The research problem – rehabilitation and coping – is one of action, of building something. It is a process from one position towards another. The nature of the problem thus makes historicity a necessary condition for access as well as understanding. In 2004 we studied poverty and coping in villages in North Iraq. During a tea break in the interviews with a mine medic – one of Hikmat's colleagues (see Hikmat's story above) – the father of the house entered, watched us sharply, and said:

  • Your project is nice and we are grateful – but I am sorry, you're too late.
  • We fled the village during the Iran-Iraqi war.
  • When we came back we lost 35 neighbours to the mines in this small village.
  • They bled to death in our arms and we didn't know what to do.’ (quoted in Edvardsen, 2006, p 88)

The landmine problem is but an extension of previous wars; the villagers rightly say they are still in battle with mines sold to Saddam in the 1980s by European countries, for example, the Italian Vallmara-69 jumping fragmentation mine which maimed Abdul in 1999 (see the photograph above). So, Saddam was a customer of the West when he bombed Halabja and other Kurd villages using chemical bombs. Then, in 1990, in an elegant turnabout, the United Nations (UN) imposed an embargo on ‘The Evil’ and his people. Within a year local people had to sell all their valuables to buy food; hunger and malnutrition became endemic. This also occurred in the Kurdish zone in northern Iraq. Based on Food and Agriculture Organization (FAO) surveys The Lancet reported in 1995:

The moral, financial, and political standing of an international community intent on maintaining economic sanctions is challenged (p.218) by the estimate that since August 1990, 567,000 children in Iraq have died as a consequence.

(Zaidi and Smith Fawzi, 1995, p 1485)

On 12 May 1996 Lesley Stahl's guest on the US television news programme ‘60 Minutes’ was Madeleine Albright, at that time US ambassador to the UN:

Stahl:

  • We have heard that a half a million children have died. I mean, that's more children than died in Hiroshima. Is the price worth it?
  • Albright:

  • I think this is a very hard choice, but the price – we think the price is worth it. (quoted in Campaign Against Sanctions on Iraq, 1999)
  • We are writing in September 2009; the embargo on Iraq has been replaced by a ‘war machine’. We recently studied the atrocities at close quarters in Baqubah Province, some miles east of Baghdad. While working routinely in a crowded emergency room at a local hospital something happened; there was a sudden silence; fear could be read in everyone's faces: a canvas bag was placed on one of the beds, inside were the heads of two local youngsters – nicely cut off just below the jaw. We all got the message: in this world we – somebody unidentified or the stealthy oppressor – can make anything happen to everybody, everywhere, at any time, for no other reason than simply being who you are.

    What we want to say is simply that there are perpetrators and there are victims. Throughout history academics on research missions in the South have not always been on the right side of it – as seen by the victims. This fact poses problems of access and problems of understanding, the more so if the visitors disregard the impact of history's tracks of blood.

    “The world is a very narrow place”

    People don't hang their dirty linen out in public – they keep it ‘hidden’ in the backyard. Public stories, narratives told to outsiders at the main entrance, may not be false – which does not mean that they are true. We have to protect ourselves; it is normal not to share painful stories with anybody; we don't and neither do they. The hidden transcripts of oppression and pain are therefore hard to get hold of. Here, however, is one of them, Chit Chompa's story of her own death. This 13-year-old girl was one of four children caught in a landmine accident in January 2005 in Battambang, Cambodia. Three of the children died on the site; Chit died later in the hospital. The narrative is written by the local village medic who has spent his entire life inside the minefields, who was close to Chit and her family years before the accident happened – and all the way down. (p.219)

    (p.220) Chit's story should make us reflect on representations: “How can a dead informant talk to us? This is far from reliable research data!” Narratives of murders and massacres are not presentations (immediate and unmediated) of the world, but representations – or better, reconstructions – of lived experience set up in retrospect by the actual storyteller. Chit versus the landmine; the political prisoner versus the interrogator; Fallujah versus the US army; any photograph taken, any story told is a reconstruction defined by either of the two positions. Because both sides – for example, US marines and the citizens of Fallujah – tell a true story, ugly accounts of oppression challenge the researcher with a very basic and simple question: ‘who are you, which story are you out for?’. There are dangerous military checkpoints, (p.221) mistrust and hatred so you are not normally able to get both stories; there is no room for neutrality here. As Western researchers we roam freely worldwide, this is our normal lifestyle. Victims of war and poverty, by contrast, live in containment. By his poetic representation of her death, Chit's friend, the medic in Battambang, makes a desperate attempt to make us globetrotting outsiders understand the containment of poverty, to help us re-establish a world vision (Weltanschaung) where what we thought of as extraordinary is seen as ordinary. Readers may, of course, find Chit's story irrelevant, but it is hard to claim that it is unreliable, that it is unscientific.

    Over-defining ‘disabled’

    A mine amputee is not only defined as disabled by the damage to their body but also by the ever constant threats and damage inflicted on them by the ‘poverty machine’. The agency approach to poverty – recognising the power of the ‘poverty machine’ – shifts the representation of disability from the individual and specific to the total: disability is everywhere. This raises an epistemological problem: as fish in the water are wet, poor people are disabled. The fact of wetness and disability are not meaningful characteristics – at best the terms are confusing – for fish and for poor people. We must scrutinise the meaning carried by seemingly meaningful concepts such as ‘able/ability’ and ‘poverty’.

    For the study object, for the Kurd father with one leg left, the implications of over-definition are far more dramatic. He cannot escape the fact of being legless – and the poverty machine keeps on redefining him as poor. Adjustment is impossible; there is no way out unless he refuses to accept the identity enforced on him – and rebels.

    There is another problem here that also carries moral implications for the researcher. When people are oppressed for a long time, they tend to adopt the institutional definition of themselves as inferior – inferiority becomes internalised. There is a risk that studies where disability is seen as a marker event taking place in a non-actional and value-neutral context of poverty adds to the burden by confirming the father's self-image of being deemed a victim of the poverty machine.

    Studies of poverty and tracks of blood – which, in the era of ‘extreme sports’, we could call ‘extreme research’ – pose methodological problems. Our aim is not to provide simple solutions here, but hopefully our own experiences from the war zones can at least help disclose some of the methodological and moral difficulties faced by researchers daring to study such ugly realities close up. We would like to conclude with a reminder from a philosopher of science, Theodor Adorno, the restless critic of mainstream and easy-going research:

    … to find out what is the truth – objectively – has always been hard. One of the most reliable criteria they use against you is that your statement is “too subjective”…. The concepts of objectivity (p.222) and subjectivity have been turned totally upside-down. For them, objectivity means the non-controversial side of the matter, the uncritical accept of superficial patterns, the frontage carefully composed of classed data – which is the subjective. And they say subjectivity is everything breaking through the frontage, that penetrating the specific experience of the matter, everything liberating us from the approved convention regarding the matter, placing our relation to the matter instead of the majority decision by those who don't look at the matter, and even less study it – which is the objective…. Those in power like powerless subjects, because they fear the objectivity that only those subjects carry.

    (Adorno, 2003, p 69)

    References

    Bibliography references:

    Adorno, T.W. (2003) Minima moralia. Reflections from damaged life, London: Verso.

    (p.223) Campaign Against Sanctions on Iraq (1999) (www.ugcs.caltech.edu/∼progress/pamp_ed3.html).

    Edvardsen, O. (2006) ‘Et nettverk av førstehjelpere i det minelagte nord-Irak. Et spørsmål om liv eller død’ [“A network of first aiders in mined north Iraq. A question of life or death]”, Master's thesis [text in Norwegian], Tromsø: Institute of Clinical Medicine, University of Tromsø.

    Habermas, J. (1979) Erkäntnis und Interesse. Mit einem neuen Nachwort, [Understanding and interest: With a new postscript], Frankfurt am Main: Suhrkamp Verlag, p 316.

    Haraway, D. (1991) ‘Situated knowledges: the science question in feminism and the privilege of partial perspective’, in D. Haraway, Simians, Cyborgs and women: The reinvention of nature, London: Routledge, pp 183–201.

    Hedelin, H., Husum, H., Mudhafar, M. and Edvardsen, O. (2006) ‘Traumavård i fattiga länder – en bys kollektiva angelägenhet. Omhändertagandet av minskadade på landsbygden i norra Irak’ [Trauma care in poor countries – the collective responsibility of a city. Handling mine victims in rural north Iraq] [text in Swedish, English summary], Sv Läktid, vol 7, pp 460–3.

    Husserl, E. (1970) The crisis of European science and transcendental phenomenology, Evanston, IL: Northwestern University Press.

    Husum, H. (2003) ‘Tracks of blood. Studies of trauma and trauma systems in the rural South’, PhD thesis] Institute of Clinical Medicine, University of Tromsø, p 52.

    Husum, H., Resell, K., Vorren, G. et al (2002) ‘Chronic pain in land mine accident survivors in Cambodia and Kurdistan’, Social Science & Medicine, vol 55, pp 1813–16.

    Husum, H., Gilbert, M., Wisborg, T., Heng, Y.V. and Murad, M. (2003) ‘Rural prehospital trauma systems improve trauma outcome in low-income countries: a prospective study from North Iraq and Cambodia’, The Journal of Trauma, vol 54, pp 1188–96.

    Summerfield, D. (1999) ‘A critique of seven assumptions behind psychological trauma programmes in war-affected areas’, Social Science & Medicine, vol 48, pp 1449–62.

    Zaidi, S. and Smith Fawzi, M. (1995) ‘Health of Baghdad's children’, The Lancet, vol 346, p 1485. (p.224)

    Notes:

    (1) Trauma Care Foundation (TCF) is a Kurdish non-governmental organisation (NGO) running training programmes for trauma care providers in minefields and war zones.

    (2) The full story was written by medic Hikmat in Kurdish and translated into English by Mudhafar Murad, TCF.

    (3) ‘The South’ is a political term referring to poor and oppressed countries (see Mao Zedong's Three World Theory [http://reference.canadaspace.com/search/Three%20Worlds%20Theory/]).

    (4) Here we lean on Husserl's definition of Europe, not ‘… understood geographically as on a map, as if the group of people living together in this territory would define European humanity. In the spiritual sense the United States etc. clearly belong to Europe…. Here the title “Europe” refers to the unity of spiritual life, activity, creation, with all its ends, interests, and endeavours, with its products of purposeful institutions and organizations’ (Husserl, 1970, p 273).

    (5) At times the Kurd nationalistic freedom fighter has been called ‘peshmerga’. The Patriotic Union of Kurdistan (PUK) is one of the state-bearing parties in north Iraq, now allied with the US regime.

    (6) Barang is a common Khmer term for ‘Westerner’, originally used for the French colonialists. It means ‘long nose’.

    (7) The story was transcribed by Yang Van Heng, head of TCF, Battambang, Cambodia in January 2005. The English translation is by Merete Taksdal.