On the Issues with Michele Goodwin

On The Issues With Michele Goodwin at Ms. magazine is a show where we report, rebel and tell it like it is. On this show, we center your concerns about rebuilding our nation and advancing the promise of equality. Join Michele Goodwin as she and guests tackle the most compelling issues of our times.

Latest Episode

Preserving Health and Protecting Humanity in Times of Conflict


May 3, 2024

With Guests:

  • Lawrence Gostin: Larry Gostin is co-director of the O’Neill institute for National and Global Health Law at Georgetown, and the director of the World Health Organization’s Collaborating Center on National and Global Health.
  • Dr. Houssam al-Nahhas: Houssam al-Nahhas is a Middle East and North Africa researcher at Physicians for Human Rights, leading the organization’s work on documenting attacks on healthcare, and a Syrian physician.
  • Dr. Sima Samar: Sima Samar is a doctor, activist and human right defender. She is currently a visiting scholar with Fletcher School at Tufts University.
  • Karen Joy Greenberg: Karen Greenberg is the Director of the Center on National Security at Fordham Law School.
  • Saman Zia-Zarifi: Sam Zarifi is the Executive Director of Physicians for Human Rights.

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In this Episode:

In this episode, taped in front of a live audience at Georgetown Law in Washington, D.C., a panel of health and legal experts unpack what’s happening around the world—from Gaza, to Afghanistan and beyond. How can governments and NGOs best act to preserve health, enforce legal norms, and protect humanity in times of conflict, and what can we learn from the doctors and human rights advocates who have been on the ground in these situations?

Background Reading:


Michele Goodwin: 

Welcome to On the Issues with Michele Goodwin at Ms. magazine. As you know, we’re a show that reports, rebels, and we tell it just like it is. In this very special episode, we’re in Washington, D.C. at Georgetown University Law Center in front of a live studio audience as we tackle an urgent issue of these times—that’s war and conflict, and providing health care health care access, preserving health care institutions.

During times of war and conflict, it’s a matter that has consumed college campuses across the United States. It’s an issue that is ringing in Congress, right now. It’s a matter that’s being taken up by international tribunals. It’s a matter that we’re tackling in this podcast episode.

Before we go further, I want to issue a trigger warning because amongst my panelist are individuals who have experienced torture while trying to provide health care in places where there has been war and conflict. Joining me for this important conversation, which is a collaboration between Ms. magazine, The O’Neill Institute for national and global health law, and Physicians for Human Rights. From Physicians for Human rights, we are joined by the executive director Saman Zia-Zarifi, as well by Dr. Houssam al-Nahhas, who was a researcher and a physician of Physicians for Human Rights. Karen Joy Greenberg, who’s joined us before in prior episodes, she’s the Director for the Center on national security at Fordham Law, providing a very rich perspective about these times. Dr. Sima Samar is the chairperson of the Commission for the Prevention of Torture, a person who’s been on the ground in Afghanistan providing essential health care for women and girls in times of conflict. Rounding out this panel is Professor Lawrence Gostin, otherwise known as Larry Gostin, who is the founding director of the O’Neill Institute for national and global health law. Join us in this conversation, sit back take a listen. Let us know what you think.

As we come together on this morning on a matter of attacks on healthcare, a global crisis, what could be more important than centering humanity. That, in fact, is what brings us together, thinking about what connects us all. It’s my pleasure to be here and to join you.

And we’re here gathered today to unpack what’s happening around the world. There are deep sensitivities about the matters that we will touch upon and that we’ll think about, and we couldn’t be joined by a more impressive group of individuals than those that are here with me today. As we start off this program, I’m going to ask each panelist to very briefly just introduce themselves.

0:09:09 Lawrence Gostin:
Thank you, very much, Michele. I’m Larry Gostin. It’s been a real honor and joy to co-direct the O’Neill institute with Michele and the faculty here at the law center. I’m the director of the World Health Organization, a Collaborating Center on National and Global Health.

0:09:36 Dr. Houssam al-Nahhas:

Hello, everyone. Thank you, very much, for having me here today. My name is Houssam al-Nahhas, Middle East and North Africa researcher at Physicians for Human Rights. I lead the organization’s work on documenting attacks on healthcare, more focusing on Syria, as a Syrian physician, and I’m glad to be part of this.

0:09:55 Dr. Sima Samar:

Good afternoon, everyone. I am Sima Samar, and I’m also doctor, used to be a medical doctor, but I’m calling myself more an activist or human right defender. Currently, I’m a visiting scholar with Fletcher School at Tufts University. Thank you for having me here.

0:10:16 Karen Joy Greenberg:

Hi. Good afternoon. I’m Karen Greenberg. I’m the Director of the Center on National Security at Fordham Law School, and the Center’s mission is to look at the intersection between national and global security and the rule of law.

0:10:34 Saman Zia-Zarifi
Thanks very much. I’m Sam Zarifi. I’m the Executive Director of Physicians for Human Rights. I’m really here because I’ve spent a lot of my time working with other people on this panel. I’m really happy to be here with Houssam, with Larry, with whom I’ve worked on issues around public health, globally, and Dr. Sima Samar, going back 25 years in Afghanistan and other places where there’s insecurity and ending that.

0:11:04 Michele Bratcher Goodwin:
Thank you, all, so very much, for being here. We couldn’t be more fortunate, truly. I want to begin this conversation with a question to you, Larry. Very recently, we wrote a piece in JAMA. We were also on a podcast together, and in that podcast, in thinking about the myriad crises happening all around the world, including the ones that don’t get much attention, it was a very heartfelt conversation.


And we talked about Gaza, but you also shared that, personally, these matters touch your heart because your family members were survivors of the Holocaust. So, some might say that perhaps puts you in a very unique position to think about what is actually happening in Gaza. So, I’ll start off with that, Larry. Given the personal and the professional, what situates your thinking?

0:12:24 Lawrence Gostin: 

Thank you, Michele. I mean, the first thing that comes to my mind from your question and our conversation is just how painful it is, you know, to see children dying, hospitals not functioning. It’s just enormous pain and suffering, and I, you know, when Michele and I wrote this JAMA article, and we’ve been thinking about it, you know, all of these things, they’re full of politics and really a lot of hatred.


But one thing everyone should be able to agree on is the sanctity of health. I mean no matter where you’re from in the world, your mother will always tell you think about your health, and you know, health, it starts, of course, with having nutritious food, clean water, housing, a sense of security and stability, which we’re just not seeing in Gaza, around the world.


And then it’s the safety net. It’s the kind of, you know, if you go to a hospital or a healthcare facility in an ambulance, or you’re a healthcare worker, either domestically or from abroad, you’re a kind of a special sacred person and in a sacred place, and the fact that you would feel unsafe in those areas, I think should shock everyone’s conscience.


It just should, irrespective of where you are. You know, a lot of my friends say, you know, oh, well, there’s this side did this, this side did that, you know, and my answer is, you know, we’re not blind. We can see. We see what’s happening. That can’t be denied, and so, I start this whole conversation that we’re going to have just from the point of view of humanity, of people, of, you know, not just in a pejorative or ideological sense of the right to health, but a deep, meaningful way that people have a right to feel safe, secure, healthy.


When they’re sick or they’re injured, they have the right to be taken care of. There really is nothing more to say, and International Humanitarian Law does try to respect those things. It’s not perfect.

0:15:28 Michele Bratcher Goodwin:
No, not at all.

0:15:30 Lawrence Gostin:

But it is part of the rule of law, but beyond IHL is just, you know, the ethical value of humanity.

0:15:40 Michele Bratcher Goodwin: 

Well, let’s pick up on that, and I’m holding the book by Dr. Sima Samar, Outspoken. I think that there’s a real purpose behind that title, and in your opening, just then, Larry, you mentioned mothers, what a mother would say, and the backdrop of what people are paying attention to, Ukraine, Gaza, but we know that far beyond those spaces in the world, there’s conflict, there’s crisis, and often rendered invisible happen to be women.


On October 7, what brought attention to the world was the kidnapping, rapes, torture of individuals who were in Israel. There are individuals who were kidnapped who still have not been returned, and the aftermath has been something that has really placed a chill, in many ways, on conversations about healthcare, attacks on healthcare, and we’re unpacking that.


But one aspect of that happens to be how women fit into these conversations, and so, Dr. Samar, Sima, if you allow me, I’d like to next go to you because so much of your work has been centered on women and bringing attention to the plight of women in Afghanistan and other parts of the world, and if you could then level set with us just a bit about how these conversations really need to center women, how they deserve to be at the forefront, and what it means when women are not part of the centering.

0:17:28 Dr. Sima Samar:

Thank you, very much, for asking this question. As a medical doctor and as a woman from Afghanistan, we have been at war for 45 years, and we had almost fatwa with all the superpowers. I don’t see any country who was not involved. It’s only the underdeveloped countries in Africa, although some people from Sudan and other African countries were involved in the war in Afghanistan.


But always, in there, this 45, 46 years of war, women were not there, actually. One, because when the Russian invaded Afghanistan in 1979, the men who were carrying the gun were important. Nobody was talking about women, and the sad part was that they choose Islam as a weapon of war and try to support the most conservative group of people in order to stop the advancement of USSR and communism. So, women were not there.

0:18:45 Michele Bratcher Goodwin:
Women were there, but not there.

0:18:48 Dr. Sima Samar:
Women were there, but not part of the agenda. Just to give you an example that I was practicing medicine, and I saw and watched that a woman is dying because of incomplete abortion, which is 2 minutes or 3 minutes maneuver and her life can be saved, or dying because of retention of placenta, let alone all the other complicated things, and there were nothing for them.


So, I started as a medical doctor over there, and then it was strange because when I was going to different UN agencies or any other donors, talking about women and women’s rights and women’s access to health, nobody was really interested. No. No.

0:19:32 Michele Bratcher Goodwin:
People weren’t paying attention, even as you were saying. This is women were dying.

0:19:35 Dr. Sima Samar:
Exactly. Yes, and I went to the UNDP. This is after the Russian withdrawal from Afghanistan in 1989, after 10 years of killing and bombing, and disappearing a lot of people, arbitrary killing. They actually bombed villages, water points, livestocks of the people, and I was saying, okay, now the Russian is gone, so, I’m glad that UNDP is here, finally, that UNDP is starting some development program in Afghanistan.


He looked at me. I said do you have some program for women? He looked at me, women in Afghanistan? I said, yes, do you think all these heroes who kicked out the Russian from Afghanistan, they are drawn from the sky? They are born of their mothers. No, I was in Afghanistan for a week, I haven’t seen any women.

0:20:32 Michele Bratcher Goodwin:

I mean that is the epitome of rendering women invisible.

0:20:34 Dr. Sima Samar:
Exactly. Exactly. Even today, even today. So, anyway, we had this kind of approach to women. Women not in the center of any possibility, any decision making. In the last 20 years, when we have, after 9/11, the international community were major forces in Afghanistan. 


It gives some possibility for access to education and access to healthcare, and I keep saying that, as Larry said, access to education and access to healthcare, it’s not only the basic rights, but I think it’s a tool to give you a sense of security and the sense of living life with dignity. So, there was some development, I would say, because we had the possibility for girls to get educations.

0:21:30 Michele Bratcher Goodwin:
Oh, it’s tremendous, the work that you did, the impact. For those of you who don’t know it, her work in Afghanistan was absolutely foundational, transformational, in every kind of way. I want to come back to this because Afghanistan just seems to be a lingering question. What was old, sadly, has become new again.


But before I get to that, Sam, I want to ask you about international human rights because questions have come up as we’ve seen destruction and decimation of health institutions that are very difficult to rebuild, and as Larry and I have written about, these have intergenerational effects.


When a clinic or a hospital is decimated, intergenerationally, it means significant harms, and people often don’t think about when that destruction happens that there were babies, at that time, in the NICU, that there were people who needed dialysis and that day couldn’t get it, that there were people in the middle of treatments and could not get those treatments.


And at the same time, what’s been raised and is also important, the way in which these institutions can be exploited by others because they know that health institutions are so sacred. So, there are times in which people may weaponize health institutions.


What is the human rights law response? What is the international law response to that for people who wonder are there protocols? Is it unethical? Is it a violation of human rights? Is it a violation of international law to decimate health institutions even when one is looking for the people who’ve caused tremendous harm?

0:23:26 Saman Zia-Zarifi:
Thanks, Michele. Just to go back, to draw the line from where Larry started and where Sima was describing, the notion that healthcare providers and healthcare facilities shouldn’t be attacked is actually pretty new. It’s really after the Civil War in the US and the charnel houses of Europe in the mid-to-late 19th century, which is when the destructiveness of modern weapons really became known.


And people just started saying this is awful, like, someone has to be able to provide healthcare, and so, it really was…

0:24:03 Michele Bratcher Goodwin:
Which would seem to make sense, right? Somebody needs to be able to…

0:24:05 Saman Zia-Zarifi:
Somebody needs to be helped, and this is something where, crucially, even the military men said, yeah, actually, we need to do something, we just can’t be shooting medical workers.

0:24:22 Michele Bratcher Goodwin:
It’s in their self-interest.

0:24:24 Saman Zia-Zarifi:

It’s in their self-interest, but I want to highlight this as an incredible achievement of humanity that the development of humanitarian law and then human rights law over the last 100, 150 years, this ground-up effort to obstruct, to slow the use of violence by states and by powerful people, imposed basically because of…really, one possibility is that a growth in humanity, and another is the fear of the inhumanity that was possible.


So, humanitarian law came up, the idea of protecting first military healthcare facilities, then civilian healthcare facilities. Then the brutality of World War II happened, and after that, we said, okay, we need more than just humanitarian. We need actual human rights law, and in that first few years after the Second World War, we had the codifications of the laws of war and the Geneva Conventions, but also the Universal Declaration of Human Rights.

0:25:35 Michele Bratcher Goodwin:
And also bioethics.

0:25:38 Saman Zia-Zarifi:

And bioethics and just the recognition that humanity had to do something to control the violence.

0:25:45 Michele Bratcher Goodwin:
I want to put a thumb on that because you’ve mentioned these moments in our history that have been absolutely transformative. The first was to mention the Civil War. Sometimes we speed past matters that we should pause on. It’s so easy to do, and to think about a civil war, what does that look like?


And here was the greatest devastation in terms of lives, ever, in the history of these lands, and that was because there was tremendous devastation that was taking place and exploitations on these lands that would cause people to come from parts of the East and North to battle in the South over this issue of slavery in the United States.


And then you mentioned World War II, and there’s so much that could be said about slavery because we speed past that, too. What was that system of incredible subordination, exploitation, physically, sexually, etcetera, and then World War II. That’s the Holocaust.


And it seems to me that there are also certain ironies that are embedded in both of those moments that you’re talking about, because even as we think about the Nuremberg Trials being led by Justice Jackson from the United States Supreme Court, one irony that we skip over in our own US history is this period of eugenics where coercively sterilizing and limiting the reproductive futures of people who were considered outcast.


What’s interesting about that is that the very platform that justified it, our Supreme Court, in 1927, the Buck v. Bell decision case that involved a poor white girl, Carrie Buck, from Virginia, who had been raped, had a child out of wedlock, and it was our United States Supreme Court that said better than to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind, three generations of imbeciles are enough.


And the irony, of course, was that then the Nazis came to the United States in the Third Reich and picked up exactly that platform almost verbatim the law that the US Supreme Court upheld and then began that practice in Germany, and at the doctor’s trial in Nuremberg, the defense that was made was why are you here, we’ve only done what you did. How do we rest with that, Sam? What do we learn from that? And I know that’s a tough question, and really, that’s for us all.

0:29:05 Saman Zia-Zarifi:
Well, I’m in a positive mood. 

0:29:08 Michele Bratcher Goodwin:


0:29:10 Saman Zia-Zarifi:
So, we’ll talk about the inhumanity, but on a positive note, again, the notion that slavery is improper, the notion that discrimination is improper, the notion that all people have rights, women, minorities, is very new, and so, we really, really forget that. So, we have the Universal Declaration right after World War II, the Geneva Conventions.

0:29:43 Michele Bratcher Goodwin:
Not even 100 years old.

0:29:43 Saman Zia-Zarifi:
Not even 100 years old. I mean the notion that aggression, that invading a country is illegal, is less than 100 years old.

0:29:52 Michele Bratcher Goodwin:

It is stunning, isn’t it?

0:29:54 Saman Zia-Zarifi:

So, this is an astonishing human achievement, and so, we have these norms. They’ve mostly affected states. We then moved to individual liability. After Rwanda, after Yugoslavia, then we had the International Criminal Court set up. It’s only, what, 20, 25 years old.


And so, we’ve moved so quickly from 0, from untrammeled power of the powerful, from no restrictions, to a place where I would say, right now, looking back 100 years, the arc of history has bent toward justice. Now, I would say that probably in the last 10, 15 years, we’re seeing a deflection or a plateauing, and there’s certainly been.


But it is important to really understand what an achievement that is and just to say what is a little bit frustrating to me as a human rights lawyer is that we’ve moved right past all of that, and now, people are like, well, why aren’t these people in the Hague? What is the good of the UN, you know? Why aren’t these people being arrested? I mean we’ve gone from 0 to people now being disappointed that there’s no international force that can stop the bad guy.

0:31:23 Michele Bratcher Goodwin:

So, what you’ve drawn out is this tension, and I appreciate the positivity and the hope because I think, at the end of the day, and certainly when we conclude, we want to be thinking about hope because that is so critically important, but you’ve also acknowledged, and certainly, Sima, you have, a sort of question of invisibility, where people endure, right?


To get to that space of hope has often meant so much devastation, and the silencing of so many, and that kind of pain, right? On the other side of the pain is hope, but it also takes recognition that people exist who deserve recognition. I want to engage you, Karen, and build on this question about the role and place of those who are invisible and women in these agendas.

0:32:43 Karen Joy Greenberg:

So, first of all, thank you for hosting this event. I think it’s really important and very helpful to helping us all think together about this. I want to just say something at the very beginning, which is that I started my career as a student of the Holocaust and decided, at a certain point, when I had my children, that I didn’t want a lot of Nazi paraphernalia around my house from my studies and so wasn’t going to do that.


And so, studied the presidency, got my PhD in American history. The point was I wasn’t going down that road, and now, where am I? After 9/11, everything changed in my world, and all of a sudden, I founded, don’t ask me why, this center on basically looking at one atrocity after another.


And so, the takeaway of that is you can’t escape it. This kind of inhumanity just…you can decide you’re not going to do it, but you know what? We’re not in control of it. So, I think that’s the first thing I wanted to say. The second thing I want to say, and I want to address this hope issue because I find it really hard, these days, to have any hope.


I literally, you know, I am a person who edits a news service every morning and has for 20 years on national security, and it’s just…I can’t believe I make people read that, and so, I’m so happy to hear that there’s this, you know, glimmer of hope, but it’s getting harder and harder.

0:34:08 Michele Bratcher Goodwin:

0:34:10 Karen Joy Greenberg:

That’s what I wanted to say, and I’m trying to think about why, and one of the reasons is that we are going backwards in a lot of ways, and I don’t just mean in terms of how our Supreme Court is behaving and taking away rights, but I think that we’re going backward in other ways, which is you ask about international law, you know, human rights, humanitarian concerns, if you look at how narrowly this is now applied, you know?


The amount of exceptions and exemptions that are allowed for humanitarian assistance, for example, when you’re talking about sanctions, and you know, the imposition of sanctions everywhere, and then you see that what sanctions do…sanctions is just another form of warfare.


So, when you first invited me to talk here, you asked me to…you said this was going to be about conflict zones, and now, it’s not about conflict zones. It’s about a global crisis, which includes conflict zones. My point is that everywhere, in some ways, is now a conflict zone when it comes to health.

0:35:08 Michele Bratcher Goodwin:

Including domestically.

0:35:10 Karen Joy Greenberg:
Absolutely domestically, and I had started to compile a paragraph or a page on a number of challenges to healthcare, right now, but it’s not just in this company. It’s around the world, right? And whether it’s by cyberattacks, or by physical attacks, or whatever it is, whether it’s about the lack of access to healthcare.


Whatever it is, it’s diminishing everywhere, and so, I guess what I’m trying to say is that I find that the hope should be let’s get to the other side. The moment for now is what do we do now? And I just wanted to kind of point to one thing I think we can do, which is that let’s start with the battle space.


We, whoever we are, humans, have conflated things that are opposites. For example, we have conflated warzones with the non-war zones. That’s what’s going on in hospitals, in hospitals around the world, oh, it’s part of the warzone, we can attack it, that hospital.


We have conflated civilians and combatants, you know, we once had a policy in this country of signature strikes. If you were in that place, you got attacked. Didn’t matter who you were, right? We continue, as we see now in Gaza and elsewhere, to refuse to distinguish between civilians and combatants.


So, we don’t distinguish between war and non-war. We don’t distinguish between civilians and combatants. We don’t distinguish, in so many ways, things that we need to be distinguishing between, including humanitarian assistance versus, well, that one doesn’t really pass for…you know, you can’t really provide. So, I don’t know if that answers your question.

0:36:55 Michele Bratcher Goodwin:

Well, we certainly are unfolding, unpacking, the tension between hope and also pain, and so, Houssam, thank you, so much, for being here. Thank you, so much, for the incredible work that you do. Both you and Sima have been on front lines as physicians. I think that’s really important to pause on, especially as we’ve seen just how people who are medical providers, which would also include nurses, and it also includes people who give aid.


There’s so much to say in terms of the ecosystem, and we want to recognize that, a broader ecosystem of healthcare providers, right? And they’ve put their lives at risk. Both of you have put your lives at risk. I wonder how you are seeing this moment, now, in the world, where reports are of doctors dying, medical providers dying, while rendering healthcare?

0:38:05 Dr. Houssam al-Nahhas:

Thank you, very much, for this question, actually. That brought me back to when I decided to study medicine, back in 2006. My main intention was to save lives, and this is what I’ve tried to focus on throughout my study, and then when the Syrian uprising started in 2011, I was still an American student.


And I made the decision that I should step in, even with my limited capacity, to save lives, and I just could not imagine how providing healthcare can be a crime, until I experienced it firsthand. This is when a few of my team members, who we were working under fake names, with unregistered phone numbers, and clandestine ____ 0:38:50 and like treating people in shops and in farms and pharmacies.


And three of my team members were detained for providing healthcare, were tortured to death, and then their burned bodies were sent back to us and their families, and that was a clear message, back then, that this is what will happen to those who provide healthcare.


And that continued, and I continued to think about how this can be a crime, until I got myself to detention, and I was, throughout my torture, throughout my interrogation, the only question I was asked was who were you treating, how were you getting your medical supply?


And these were types of questions that shocked me because for five years, I was just being taught that actually saving lives is our first mission, and all of a sudden, I became an enemy to the state, not only this, but more dangerous, and here, I’m quoting the person who was interrogating me, more dangerous than those who are handling weapons and fighting against the country and against the government.


And the reason was we are trying to kill those people, we are trying to kill those who are demonstrating against the government, you are saving them, and this is a crime. And this is what brought me from different like mind…

0:40:18 Michele Bratcher Goodwin:
How in the world did you process that?

0:40:20 Dr. Houssam al-Nahhas:

I couldn’t, and that’s why I’m here. My first ambition was to be a cardiac surgeon. This is when I got into medical school. This is what I was planning for. Now, I find myself away, completely, from the medical field, focusing more on documenting attacks on healthcare, because when I went out of the prison and they forced me to sign the pledge that I will not provide healthcare to anyone who is against the government, the first moment after seeing the sun after 16 days, this is what I’m going to do.


And I need to bring the attention of the world toward what’s happened to me as a healthcare provider and what’s happening to all healthcare providers around the world while we’re focusing solely on saving lives as the most important and the most meaningful work to be done.

0:41:13 Michele Bratcher Goodwin:
Sima, did you ever find yourself in a situation similar or where you felt your life was at risk?

0:41:22 Dr. Sima Samar:

Yes. I think I was a student when the Russian invaded Afghanistan, and then when I became a medical doctor, I was still resisting but not really taking a gun. I mean I was helping the people who were against the government and also distributing some pamphlet and night letters to give awareness to the people that why the Russian invasion in Afghanistan is a serious issue.


Then I was in danger. That’s why I flee Kabul, and I went to the area where it was not under control of the government. So, I send people over there when I saw the terrible, terrible situation that women were going through because of that, and I was forced to leave even that area because the mujahideen became more politicized.


They were not anymore the simple freedom fighter to fight against the USSR. They were politicized and bought by different countries, including by the US, and then I was in Pakistan, working in the…

0:42:35 Michele Bratcher Goodwin:
So, from place to place to place.

0:42:37 Dr. Sima Samar:
Yes. Exactly. Then I was providing healthcare, and I started a hospital for women and children, and also training midwives and female nurses, and I was under attack by the political parties, the mujahideen political parties, Islamic political parties, because I was providing healthcare to women.

0:43:02 Michele Bratcher Goodwin:

I think that that’s something that most people, perhaps, don’t know, exactly the stories that both of you have just told, how providing healthcare itself can be perceived as a crime, how that can lead to punishment, both in terms of criminal punishment and even torture, and also in the civil side, that you must promise to never practice again or practice with people who may not like torture.


Larry, I want to come back to you because it seems that even as clear as our panelists may be and the cause of preserving healthcare and health institutions may be, in this time, there are people who still respond negatively to that, and I’ll just share with our audience, again, with the piece that we’ve recently written that was published in the Journal of the American Medical Association.

0:44:37 Lawrence Gostin:
Yeah. I mean and I didn’t even send you some of the really nasty comments.

0:44:40 Michele Bratcher Goodwin:
You kept them back.

0:44:44 Lawrence Gostin:
That we got. You know, I think it’s been really very moving and appropriate that we actually focused on ____ 0:44:54, and they were, and it is just…it shocks the conscience, the idea that you’re trying to go and save people and being subjected to torture, but I’ll pick up on some of the things that Sam mentioned.


As I understand, and you know this much better, both of you, much better than I do, that international law and international humanitarian law, it’s designed to say that even in conflict, even in war, that there are certain rules. There are certain things we shouldn’t cause, certain things we should not do.


And as I said before, we all know it’s far from perfect. The compliance is miserable. As you said, it’s riddled with exceptions, but there are rules, and to me, the singular rule, at least for ____ 0:46:08, is to protect civilians and health infrastructure but also the human beings that are providing care. I mean, do you remember during COVID-19 where we started applauding the healthcare workers, you know? They were the ones that were going into harm’s way.

0:46:34 Michele Bratcher Goodwin:
They were considered essential.

0:46:35 Lawrence Gostin:
Yeah. They were the essential workers. We sang to them in Italy, we clapped them in New York, and yet we treat them so shabbily, and it’s not just in conflict. I mean even, you know, post-COVID, we started to attack public health officials that were trying to help us.

in our article, Michele, we suggest a number of concrete ways to try to get greater adherence to this one sacred norm, which is the norm of, you know, the brave nurse, the brave doctor, the brave ambulance worker, the child or the mother that’s giving birth in a hospital, to protect them. Why can’t we?

0:48:46 Michele Bratcher Goodwin:

Well, let’s pick that up with Sam. Sam, you’ve been our beacon of hope, and I think that that actually is really important, while, at the same time, Karen, I completely understand the point that you’re coming from. So, Sam, what have been the impediments?

0:49:21 Saman Zia-Zarifi:

I’m not comfortable with being the beacon of hope.

0:49:22 Michele Bratcher Goodwin:


0:49:23 Saman Zia-Zarifi:
But let me tell you what was hopeful. Let me tell you why I think there was an impediment and then potentially what we can do. Those norms did hold. They’re new. They did hold, and even today, even today, one of the most hopeful things to me is that both Hamas and the IDF vociferously say that they are abiding by the norms.


They deny that they violated the norms. The Russians deny that they’re violating them. So, the norms have some normative value. Now, there is backsliding, and some of the backsliding started with 9/11, where the US just kind of let…well, I think Karen can tell us all about that.


But a clear…I mean, not to get too abstract. I’m just a small country lawyer. The stuff that I saw in my own direct work had to do with accountability, and I can take this particular moment back to 2009 and Sri Lanka, where the Sri Lankan government was fighting the Tamil Tigers in a brutal war, and it pushed the Tigers, along with about 40, 50 thousand people, into a smaller and smaller corridor.


And the Sri Lankan government said to hell with the rules of war, we’re going to defeat these guys, and they did, and the Tigers had no friends, and so, people just said, oh, and that moment of lack of accountability was watched very closely by the Pakistanis, by the Russians, by the Israelis, and they all said look at that, you can actually defeat what is called a terrorist organization.


None of this stuff about, oh, you can’t do it, you can’t defeat terrorism with force. You can, if you don’t care about the norms. Then, Syria happened, and Assad, and then with Russian assistance, they all said, you know what, we are going to use the Sri Lanka model. 


If you don’t care about the rules, and you just kill everyone, and in particular the strategic value of attacking healthcare, the original norm, it’s the original norm because once you start attacking healthcare, then all the people who’ve been killed or injured are gone. So, then Ukraine happened, and so, we had the Russians were now saying, oh, you know what we can do?

0:51:53 Michele Bratcher Goodwin:
And Ukraine is still happening.

0:51:55 Saman Zia-Zarifi:
Right. Now, we’ve, in terms of documenting healthcare, attacks on healthcare, we’ve seen increasing attacks, 2019, ’20, ’22, until this year. Before October 7, this year was already the worst in terms of attacks on healthcare. I think we had documented around 16 hundred attacks, globally, on healthcare. That’s record.

0:52:15 Michele Bratcher Goodwin:

They’ve been escalating.

0:52:16 Saman Zia-Zarifi:

Escalating. So, but after October 7, what is really alarming, then, is that the exceptions suddenly started swallowing the rule. Militarization of healthcare is against the law. It’s a war crime. A militarized healthcare facility can be attacked, can be attacked.


The norm is gone. It’s militarized. But this used to be such an exceptional thing. The US attacked one hospital in Iraq that had ISIS in it, and my god, the lawyers ripped their hair out, oh my god, we’re going to attack this one hospital, even though ISIS is firing from it.


What’s happened in the last few months, and unfortunately, supported by the US, is the notion that, you know what, we think that this is militarized, and therefore, we’re going to attack this hospital, and that’s the scary moment that we find ourselves in is that the exception, what was supposed to be exceptional, what was supposed to be done with great reluctance, has now become, well, we think all of these hospitals are militarized.


Now, the way forward, it’s not just international humanitarian law, and one of the things that Larry has worked on and is absolutely clear is that we also now know that international human rights still apply, even during a conflict, even during a conflict.

0:53:44 Michele Bratcher Goodwin:

How do we get to the space of enforcement, where it’s not just having the norm, but we actually have real respect for law, humanitarian law, international law, and we enforce?

0:54:32 Karen Joy Greenberg:
That’s a hard one. However…

0:54:35 Michele Bratcher Goodwin:

All of these questions, I think, are hard.

0:54:36 Karen Joy Greenberg:

Yes. Okay. So, there’s a couple of things. One of the things about the erosion of norms has been the erosion of accountability. This is not something new that all of a sudden…it’s just too complicated, too disruptive of things that we care about, like our military force, our intelligence force, etcetera, to go down the path of accountability.


That’s what we saw in the War on Terror. That’s what we’re seeing now. There’s always a, yeah, that’d be great if we lived in a perfect world, but we don’t, and so, we have to focus on what we’re doing now. That’s number 1. Number 2, the global order of 1945 and thereafter is not the global order of now.


And we, as humans, have not come to grapple with that. The polycrisis that political scientists talk about is real. You can’t separate climate from healthcare. You can’t separate war, from climate, from healthcare. They all pile onto each other in a way that they’re inseparable.


And so, trying to take one piece of it is actually not going to work. There needs to be a new sense of how to deal with this beyond the post-’45 framework. We all know it. The international organizations that are supposed to be there for accountability, starting with the UN, know that they can’t do other than set out the norms and the principles.


Another thing, and this is something, as humans, we’re grappling with that kind of just riffs off of what you were saying is that we have all these great institutions that we want to protect, we want to nurture, we want to grow and expand, but it’s not about the institutions or the laws.


It’s about the human beings that run these places, and this does get to the accountability. We are relying on each other as humans to do the right thing, and it’s not just more laws. It’s people who want to take care of the world. It’s people who want to do this the right way.


And so, what we need to do is to nurture the generations that are coming up in the right way, and instead, we’re depriving them of healthcare, we’re depriving them of food, we’re depriving them of water, we’re depriving them of a sense of security, all around the globe. Sorry. I didn’t mean to rain on your hope thing.

0:56:54 Michele Bratcher Goodwin:
No. It’s important to level set.

0:56:55 Karen Joy Greenberg:
But you get what I’m saying? And so, what I’m really saying is that we need to be…I know we have crisis right here and now. We need to be really future-oriented in a way that we aren’t. The reasons we aren’t are totally understandable, but that’s what we need to do. We need to grapple with polycrisis. We need to grapple with what we’re doing to our children all over the world and step up to the challenge now and not in 10 years.

0:57:18 Michele Bratcher Goodwin:
So, Houssam, What’s needed?

0:57:52 Dr. Houssam al-Nahhas:

I think we need to recognize, first, that, actually, attacks on healthcare are happening as part of a war tactic. It’s not just accidental, unintentional side damage. It’s something that’s happening systematically.

0:58:04 Michele Bratcher Goodwin:

Very specific.

0:58:05 Dr. Houssam al-Nahhas:
Depriving people of one of their important needs, one of their foundational needs, which is the need to health, is a strategy, also, to break people’s resilience. When I saw this happening in Syria, in front of my eyes, and I was targeted personally, when the war in Ukraine started with Russia, I ____ 0:58:27 now, we will start seeing attacks on healthcare as part of their war tactics. When attacks on healthcare started in Gaza…this is going to continue. This is how you break the communities.

0:58:37 Michele Bratcher Goodwin:

It’s how you break spirit.

0:58:39 Dr. Houssam al-Nahhas:

When you know that you won’t find someone to heal your child if it’s sick, or when you know that if you are pregnant, no one will be able to help you deliver your baby, you will leave. This will break you. Then when healthcare facilities become targets, and this is what we have seen in Syria, you, as a part of the affected population, you start being afraid of getting into this facility, and we have seen this in Syria. Now, healthcare facilities are being targeted.

0:59:11 Michele Bratcher Goodwin:

Are the places that you don’t want to go, even if you need to go.

0:59:12 Dr. Houssam al-Nahhas:
Exactly. Exactly.

1:22:23 Michele Bratcher Goodwin:

Sam, I’m going to leave the final question to you. I know that you said you didn’t necessarily want to carry the torch for hope for this panel, but you did mention that, and I do think that it’s incredibly important. 


So, I’m wondering, Sam, with this final question, what do you see as a silver lining in a time in which there is so much devastation, at a time in which we have seen the decimation of the facilities and clinics where healthcare used to be provided, where we’ve seen the destruction of universities, of schools, cultural symbols, historical symbols, artworks.


All of those things that are so fundamental, the places where people could rely on to go and eat, to be able to get water, and all of that, which Karen has framed for us, leaves one feeling so deeply wounded. How does one figure a sign of hope out of that, or a silver lining?

1:23:34 Saman Zia-Zarifi:

All of the advances that we’ve seen came after horrific moments of brutality, and I think it’s a really important moment, right now, to understand, and we’re sitting here in Washington, and I think the US still plays a crucial role, crucial role, to be able to say that this norm, protecting healthcare facilities in conflict, is one that deserves to be protected.


The US attacked the MSF hospital in Afghanistan in 2015, terrible, lawyerly investigation of it. The US was very much interested in defending this norm when the Russians were attacking Ukraine and Syria, and now, it is not, and now is the time, in this town, to really look at it and say, if we don’t protect this norm, now, the guardrails are off.


And it’ll be American troops, and it’ll be people around the world who will suffer. It’s hypocritical, but hypocrisy is the space that we live in. Hypocrisy, the distance between what people promise and what they do is the space for advancement, and that’s what we have to work on.

1:24:48 Michele Bratcher Goodwin:
Let me say, that in December, I was in Ukraine. I was in Lviv with a group of American lawyers who came together with Ukrainian lawyers and were in diplomatic spaces and healthcare spaces to think about this moment, and I want to lift up something that has become part of a mantra amongst people there.


And I think it relates to so much that this panel lifted up, and that is unbroken. This is a sign that you see going into the hospitals, it is a narrative that is said by government officials, and I think it really touches upon that psychological component that’s necessary to keep people going, that they will be unbroken. I want to thank you, all. 

Guests and listeners, that’s it for today’s episode of on the issues with Michele Goodwin at Ms. Magazine. I want to thank each of you for tuning in for the full story and engaging with us. We hope you’ll join us again for our next episode where you know, we’ll be reporting, rebelling, and telling it just like it is. 

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This has been your host, Michele Goodwin, reporting, rebelling and telling it just like it is. On the Issues with Michele Goodwin is a Ms. Magazine joint production. Michele Goodwin and Kathy Spillar are our executive producers. Our producers for this episode are Roxy Szal, Oliver Haug, and also Allison Whelan. Our social media content producer is Sophia Panigrahi, the creative vision behind our work includes art and design by Brandy Phipps, editing by Natalie Holland, and music by Chris J Lee. 

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