Contras’ Dirty War Infects Innocents Far From the Fighting

A great deal of the American public’s disagreement over U.S. aid to the contras has involved the character of the insurgents: Are the contras “freedom fighters” and the “moral equivalent of our Founding Fathers,” as President Reagan has said, or are they terrorists who commit brutal crimes against the civilian population of Nicaragua? Because the contras have been supported by U.S. tax dollars and trained by U.S. advisers, and because the Reagan Administration supports expansion of their efforts, the answer to this question has both political and moral implications for the United States.

I have visited Nicaragua several times in the last three years as a physician and epidemiologist involved in international health programs. During these visits, I and numerous colleagues were able to examine both the accomplishments and shortcomings of the Nicaraguan health system. We toured hospitals, neighborhood clinics and rehabilitation and psychiatric facilities. We attended scientific presentations by the Nicaraguans at international colloquiums. We had frank discussions with a variety of health workers and members of the Ministry of Health, as well as with members of the International Red Cross, the Pan American Health Organization and numerous North American health professionals working in Nicaragua.

There have been major public-health improvements in Nicaragua in the seven years since the Somoza regime was replaced by the present government. A unified health-care system provides free medical care throughout the country. Vaccination programs have led to a decreased incidence of measles, tetanus and whooping cough. No new cases of polio have been reported since 1982. Oral rehydration programs have led to reductions in morbidity and mortality from childhood diarrhea. Infant mortality has decreased from an estimated 120-140 per 1,000 live births during the Somoza years to 72 per 1,000 in 1985. In 1982 the World Health Organization gave special recognition to Nicaragua as a model country for its progress in primary health care.

This progress is now undermined by the war. There is a serious shortage of medicine, vaccine and equipment; while deplorable, that is to be expected. What we found unacceptable was the insurgents’ targeting of health personnel and facilities. By early this year, the latest figures I’ve seen reported 38 health workers killed by the contras, and 28 kidnapped, almost all while carrying out medical duties, and 61 health institutions completely or partially destroyed and 37 more temporarily closed due to contra activity.

Reportedly, the contras consider health programs to be part of the Sandinista government, and thus fair game. Yet under the Geneva Conventions of warfare, even military medical units are considered off-limits to direct attack.

Last fall, members of our investigating team visited the sites of contra activity to confirm the losses reported in Managua. We went to La Trinidad Health Center, which was attacked by 300 contra troops in August, 1985. We visited the former site of La Pradera health post north of Jinotega, close to the Honduran border. Although it was far from any possible military target, it had been reduced to rubble by the contras. We visited La Colonia health post, also destroyed by the contras last year. In each place we interviewed eye witnesses.

We learned of the kidnaping by the contras on Sept. 11, 1985, of six health workers, including three International Red Cross nurses, at the north edge of Pearl Lagoon near Bluefields; their Red Cross boat was clearly marked.

Dr. Gustavo Sequierra, associate dean of the national medical school branch in Managua, told us how he was kidnaped while he was conducting a vaccination program on the Atlantic coast. He was wounded and was released only after several months of intensive international pressure.

Peter Stocker, head of the International Red Cross in Nicaragua, told us that his organization has the cooperation of the Nicaraguan government in visiting prisoners to determine their medical status. He said that the Red Cross could not visit Nicaraguan prisoners held by the contras in Honduras and Costa Rica.

Juan Guillermo Orozco, a sanitary engineer working with the Pan American Health Organization, reported to us the destruction of a water treatment plant near Puerto Cabezas.

Myriam Ruiz, a Colombian nutritionist with that organization, told us of contra attacks on health workers attempting to carry out nutritional programs.

Economically, the war has had far-reaching effects on the health of the Nicaraguan people. Dr. Rene Melendez, of Oscar Danilo Rosales Hospital, told us of a decrease in civilian health service, including availability of hospital beds, because of the need to transfer these resources to the military. Pablo Coca Ruiz, vice minister of health, told us of difficulty in getting medicine and equipment from the United States, primarily because most U.S. suppliers demand advance payment in dollars. Only 42 of 80 X-ray machines in the country were working, he said; many needed only an inexpensive spare part.

Dr. Miguel Marquez, head of the Pan American Health Organization in Nicaragua, told us that the inability to buy insecticides, due to lack of funds and the trade embargo, had resulted in an increase in aedes Aegypti, the mosquito vector that spreads dengue fever. In one severe epidemic of this disease, more than 600,000 Nicaraguans were affected.

Article 9 of the Geneva Convention of 1949 states, “Medical and religious personnel shall be granted all available help for the performance of their duties,” and Article 11 states, “Medical units and transports shall be respected and protected at all times and shall not be the object of attack.”

These principles have been repeatedly and intentionally violated by the contras in Nicaragua. As party to the Geneva Conventions, the United States government is compelled to oppose such actions. Nonetheless financial and material support for contra forces continues to flow. This can be seen as nothing but complicity in the contras’ violations of medical neutrality.

The paradox of “humanitarian aid” being used to inflict death and disease on noncombatants reflects on moral as well as political goals of the people and government of the United States. The damage that this will do to our interests in Latin America is incalculable.