Blunt instruments

The law is a funny thing sometimes. A friend in the Sociology department once told me that its a very blunt instrument. It often has the effect you want, but either too little of it, or way too much, causing lots of other unintended effects.

I went to a lecture with a friend yesterday about the legal situation around humanitarian law, given by Naz Modirzadeh, a legal fellow at Harvard (ironic that I have to come to Amman to hear a Harvard Law talk). If what I heard is true, it turns out I can be prosecuted in the US for the aid that I'm giving to refugees and possibly have my assets frozen by the Treasury.

We went to Za'atari today, Dr. B and I. Worked in the General Med clinic, seeing ~35 urgent-care cases. Patients come in with a 2x2 card with their name, their waiting list number, and what kind of doctor they want to see. The nurse records their name and age. We take a brief history, focused physical exam, and write for a medication (even if we give saline drops, the cultural expectation is that patients will walk away with a script for something). The nurse writes down the diagnosis. Simple patients can be seen in 5 minutes.

You can tell what's common by what's missing in the pharmacy. There's no cough medicine - no syrup, no pills. Few antihistimines. There used to be some, but demand outstripped supply. There are few choices of antibiotics and no data on antibiotic resistance to guide our prescription choices.

You'd think everyone in the camp had an upper respiratory infection based on what we saw today. Everyone has a cough. Even walking around the camp, you hear coughing. Wet, dry, yellow phlegm. One woman with 11 kids said everyone in the house has a cough. Only a select few decide to show up at the clinic.

So I helped teach a 60 year old Bedouin woman how to use an asthma inhaler, convinced a number of kids to let us look in their ears, and looked in what felt like innumerable throats.

All that's probably kosher. All the patients I saw could have been part of Jabhat al Nusrah (on the US terrorism list), and I wouldn't know or care. You treat the patient. Same goes in the US - gang member or murderer, everyone deserves to be treated.

But at the end of the day we drove to a tent on the outskirts of the camp. We were greeted by an elderly lady who emerged from her tent, in her black flowing dress and matching hijab, inviting us inside to meet her son, who I'll call Abu Hurriya. He's lying down in the dark tent, his temples hollowed and eyes sunken from days or weeks of poor nutrition. We're told he's a hero, having fought for the Free Syrian Army (FSA). He arrived 5 days ago from Syria, where he was shot three times. They asked us to look at his wounds. The bullet hole in his left hip was still bleeding.

According to US law, I should stop there. It is against US law (the Patriot Act, to be specific) to provide "material support" to terrorists. This includes direct support or indirect support. "Material support" is so vague that it applies in a number of cases. It of course applies in direct assistance or funding. But it also applies in providing things like food or medical aid, on the principle that doing so allows the organization to divert more funds to terrorism. And these clauses reach through, meaning that if funds come from US organizations (USAID, etc.), your organization must ensure that any downstream benefits from your funding do not materially support terrorist organizations. If they do, you are also liable.

Surely there must be an exception for providing medical services? There isn't.

The currently applicable exemption for ‘medicine’ does not appear to encompass anything other than medicine itself and therefore seems to exclude all other activities (such as medical treatment or technical training) and resources (such as medical supplies or equipment) associated with the provision of medical assistance.

It makes sense. A law that prevents people from providing material support to terrorists seems natural. Who would want to support terrorists? But the law was written in such a broad way that humanitarian agencies are jittery. They are at risk of losing funds or being prosecuted if they somehow, even indirectly, provide material support to a group deemed to be a terrorist organization by the US government. This means trying to provide medical aid in Southern Lebanon where you would be required to coordinate with Hezbollah. This means a delay in getting food aid to Somalia during a famine because humanitarian aid agencies needed a waiver from the law in order to provide food in Shabaab-controlled areas. This meant some Muslim charities aiding Palestinians in Gaza after the 2008 Israeli bombings and invasion were prosecuted for coordinating with Hamas on recovery and reconstruction.

Even providing education on how to resolve conflicts peacefully is not protected by the first amendment and considered illegal according to a Supreme Court ruling. Such terrorist groups are "so tainted" by their terrorist actions that support of any kind is against the law.

The FSA is known to coordinate with Jabhat al Nusra. That makes providing any medical services or education to Abu Hurriya is technically against US law (there is an extraterritorial component to the law where any actions committed abroad can be prosecuted upon arrival in the US). Technically, once back on US soil, I could be fined or imprisoned up to 15 years. There is no statue of limitations. International law is moving in the same direction.

I won't say what I did. Abu Hurriya had already been injured by blunt instruments. We didn't allow another blunt instrument to keep him from getting help.

Photo credit: Adriana Reyes