bin Laden is dead! (Pay no attention to those crippled children)

I’ll just start right out by saying that my sleep is wholly untroubled by the death of Osama bin Laden.  Neither the fact of his demise nor the proximate details of how it came to pass give me much pause.  If one believes (as I do) that there can be morally justifiable acts of war, then I don’t think it requires much heavy lifting to identify him as a permissible target of same.  I understand that there are legitimate questions about respect for the sovereignty of other nations, and I also respect that others in this online community likely do not agree with me on this issue.  But from my perspective, the killing of bin Laden per se was a morally permissible act by the United States government.

And so perhaps it is nothing more than rank hypocrisy or intellectual incoherence that I am intensely bothered by this:

Shakil Afridi, a doctor who worked with the C.I.A. to collect DNA samples of Osama bin Laden under the guise of a bogus vaccination program, was sentenced last week to 33 years in prison under Pakistan’s tribal justice system. America’s hero is Pakistan’s traitor. And Afridi’s sentence is the latest point of contention in the stalled relations between the United States and Pakistan. Last Friday an affronted U.S. Senate panel cut $33 million in aid — $1 million for every year of Afridi’s sentence.

[snip]

Meanwhile, the far more lasting fallout of Afridi’s activities on health campaigns in Pakistan is going unnoticed. Afridi really is a doctor, but rather than dispense vaccinations against hepatitis B, as he was claiming, he was taking DNA samples in the hope of locating Bin Laden. Yet the diplomatic hullabaloo is drowning out any discussion of his severe breach of medical ethics and the adverse impact his actions will have on vaccination programs, particularly polio eradication drives, in Pakistan.

Many Pakistanis, especially those in the tribal areas and Khyber-Pakhtunkhwa Province, have long been suspicious of polio vaccinations. They fear that these are a ploy to sterilize Muslims even though they are carried out by government health workers and local NGOs (albeit with international funding). Rumors along these lines, coupled with inadequate health care and persistent insecurity, mean that up to 200,000 children in Pakistan have already missed their polio vaccinations in the past two years. Some 198 cases of polio were reported in Pakistan in 2011, the highest number for any country in the world and up from 144 cases in 2010. This year, 16 cases have already been reported, primarily from the tribal areas.

Perhaps it is a moral failing on my part that it takes an issue so close to my heart as vaccinating children to make me question whether the killing of bin Laden was worth the cost.  It certainly does not seem to redound to my credit.

Until I read of this the other day, I had heard nothing of Afridi or his involvement in any of this.  Apparently it’s getting lots of coverage in certain media outlets, albeit for reasons other than those that bother me.  What the US should be doing for Afridi now is a foreign policy question above my pay grade.  What concerns me is not Afridi the spy, but Dr. Afridi the physician.

It is unclear to me if the people who saw Dr. Afridi thought they were getting hepatitis B vaccines and weren’t, instead having their DNA sampled.  If that is indeed the case, as it seems to me, then he is an abject failure as a physician.  I’ve said before that doctors mustn’t lie to their patients, and I don’t see how that basic moral principle changes in any way when one relocates it to Pakistan.  An unspecified number of innocent people apparently have been told they (and to a certain degree their potential children) are protected against a disease that can, in both the short and long term, destroy their livers and end their lives, while they are in fact every bit as susceptible as ever.  I cannot find words to express how morally revolting I find that.  That alone is reason enough for me to recant any support I ever had for killing bin Laden as he was.

And furthermore, this action undermines ongoing efforts to eradicate polio, a disease that nobody in the whole world need ever get again.  Since the cost in lost faith by rightly suspicious Pakistanis can never be quantified, it’s all the more easy for us to ignore it entirely.  As a nation we can barely rouse ourselves to care when the occasional child is inadvertently blown to bits by one of our flying killer robots (thanks for the terribly apt phrase, Jason).  How much less do we even notice that our foreign policy has contributed to the ongoing presence of an infectious disease that should have gone the way of smallpox (and essentially has for those children who made the wise decision to be born in the Western Hemisphere), or that hundred of thousands of children thus remain susceptible to a disease that can render them crippled or dead?  If I had to choose between a world with polio or a world with Osama bin Laden, I’ll choose the latter every time.

I am supremely angry about this.  I am angry that the world must play host to a disease it could well be rid of, and which will likely linger on as a result of policies I previously supported.  I am angry at my naivety that considerations like this never even occurred to me, and at my susceptibility to the same revanchist triumphalism in this one case that I usually find so objectionable otherwise.  I am angry that this very real tragedy hasn’t gotten the merest whisper of the attention it deserves.  I am angry that I am so incredibly powerless over any of this.

This story breaks my heart.