Chapter 90 Global Crimes, Incarceration, and Quarantine
Hostile Geopolitical Environments and Political Insecurity
Danger by Geography: The World’s Most Dangerous Places
Some regions, in a general sense, are more dangerous than others. In his quirky, entertaining, and occasionally controversial website, The World’s Most Dangerous Places, author Robert Young Pelton offers a list of some of the world’s most difficult destinations.12 Box 90-1 lists these with a four-star grading system that addresses their “dangerousness.” In some instances, I have changed the rankings on the basis of the current political climate.
Reasons for Enhanced Personal Risk in Politically Unstable Regions
Increasing Civilian Nongovernmental Organization Involvement in Unstable Regions
Escalation of ethnic and intrastate conflicts during the early 1990s after the conclusion of the Cold War led to a significant increase in civilian nongovernmental organization involvement in active conflict settings. The number and size of these organizations grew significantly during this period (Figure 90-1). They employed a large number of civilian health professionals in areas of active conflict, including the former Yugoslavia, the Great Lakes region of Africa, Somalia, and West Africa. Civilian medical and public health personnel found themselves working in settings with active combatants, migratory populations, international military forces, and large-scale humanitarian needs.
Targeting Aid Workers
Intentional targeting of civilian aid workers and erosion of neutrality exemplify major changes in the recognition of the neutrality of Western aid organizations. Analysis of 382 aid worker deaths from 1985 to 1998 revealed the alarming fact that most of these deaths (68%) were intentional and the result of aggravated assault and murder as compared with the most commonly accepted risks of motor vehicle accidents, which comprised the second leading cause of death (17%) among these individuals.15 Countries noted to be a significant risk to aid workers include Angola, Sudan, Rwanda, Afghanistan, Democratic Republic of Congo, Somalia, Burundi, the former Yugoslavia, and regions in the Middle East, including Iraq.
Restricted Access in Politically Unstable Regions
Working in settings of active conflict or social disruption caused by political instability creates high-risk situations that require a deep understanding of regional politics and local people of influence. In many of these settings, travelers encounter informal militia, banditry, and obstructed access. It is essential to become familiar with the range of possible threats before encountering them (Figure 90-2).
Weapons
At least some of what defines a hostile environment for travelers and health care workers are places with a variety of weaponry. The most common weapon-related threat to international tourists, health care workers, and explorers is a gun in the possession of someone willing to use it for ill gain. Guns are used to protect and intimidate people and to create a threatening environment. Police, military, local militia, security personnel, and civilian gun owners create a dangerous environment for travelers. In a recent review of the impact of small arms assaults on aid workers, Robert Muggah found that more than 220 United Nations civilian staff have died as a result of malicious acts since 1992, and at least 265 have been taken hostage while serving in United Nations operations. This is added to the thousands of assaults on aid workers and foreign travelers in politically insecure areas, which have resulted in hundreds of deaths.17
The most commonly encountered weapons in most conflict areas are personal assault rifles, primarily variations of the Russian-made AK-47 (the name AK-47 refers to “automatic Kalashnikov, 1947,” which is named after its designer Mikhail Kalashnikov and the first year of its production).13 Because of their simplicity, durability, dependability, and ease of creation, variations of the AK-47 constitute more assault rifles throughout the world than all others combined (Figure 90-3). In some regions of the world, an AK-47 can be purchased for as little as $50 to $100. Handguns are also frequently encountered weapons. They are considered close range or self-defensive weapons, and are commonly found among military and “irregular” militias.
Risk Reduction Strategies for Situations in Which There Are Armed Combatants
Land Mines and Unexploded Ordnance
Travelers to areas that have historically suffered from conflict should be aware of the very real threat of land mines and unexploded ordnance. This is especially the case in regions that are currently stable but have been contested in the recent past. There are 88 nations affected by land mines and unexploded ordnance, and there have been new victims in 71 countries since the turn of the century. Regions notorious for the presence of mines in areas frequented by civilians include Kosovo, Chechnya, China, Jordan, Ukraine, Mozambique, and the Balkans. Eighty-five percent of mine-related casualties occur in Afghanistan, Angola, and Cambodia, although details from Iraq are not accounted for in this figure.7
Mine Types
The biggest producers of the world’s land mines are China, Russia, the United States, Belarus, Ukraine, and Pakistan. Mines are a multibillion-dollar weapons industry. There are more than 350 types of antipersonnel devices produced internationally, from large antitank mines to “toe poppers” and other small devices that are intended to maim rather than kill. In general, mines are designed to injure (not kill), to create terror, and to disrupt military targets by injuring soldiers. They can be detonated by direct pressure, vibration, or trip wires, which results in sending high-velocity projectiles of metal, dirt, and debris into the tissues and bones of victims (Figure 90-4).
FIGURE 90-4 Land mines. From left to right, an M14, a Valmara 69, and a VS-50.
(With permission from Nation Defense Days, Esplanade des Invalides, Paris, France, September 24 and 25, 2005.)
