Doctors at War: Life and Death in a Field Hospital. Mark de Rond, Ithaca, NY: Cornell University Press, 2017, 176 pp.
Good ethnographies of war are hard to come by. They often focus on the perpetrators or the victims, and very few speak to the labor of doctors in confronting the actual wounds of war.
In today’s U.S.-led War on Terror, military medics are faced with major dilemmas: Death rates of soldiers are down, but injuries and disability are on the rise. Advances in medical and body armor technologies at the frontlines have led to a dramatic increase in soldiers’ survivability after injury, and the main casualties have disproportionately been civilians.
Doctors at War: Life and Death in a Field Hospital is an attempt to highlight the complexities of war experiences and to examine the scope and limits of human empathy. It tells the story of the everyday experiences of medics at Camp Bastion, a military field hospital in Afghanistan. Camp Bastion is the chief trauma unit operated by NATO, and it is considered the largest overseas British-run field hospital since World War II. The hospital was originally built in 2006 and scaled up in 2008 to include 50 beds, intensive and ordinary care units, an emergency department, four-theater operation rooms, and two morgues—“one for the Americans and the other for everyone else” (p. 21). Since its inception, the hospital has provided critical surgical care to the wounded from the International Security Assistance Forces, as well as to local Afghanis injured in military operations.
Doctors at War is an exceptionally rich hospital ethnography that focuses on the lived experiences of British surgeons and medics at Camp Bastion. It highlights the medical and social labor—and suffering—that go into “damage-control, resuscitation and early surgical management in a war zone” (p. xvii). Following medics from deployment to their return, the ethnography is based on a six-week “tour of duty” by the author as an anthropologist embedded with British military surgeons deployed in Afghanistan during the summer of 2012. Despite his short-lived fieldwork, de Rond offers a passionate and animated account of Western doctors at war in a foreign land. Over the course of 15 chapters, he pays close attention to the everyday struggle of medics as they try to make sense of the absurdities of war and respond to the everyday realities of surgical care in conflict zones.
Through this ethnography, de Rond invites us to contemplate war as a social condition and to reflect on the lives, bodies, and futures of those implicated in Western-led wars in the Middle East. He shows how, despite advances in medical technologies, war cannot be sanitized. War is, in essence, a meat grinder. With a keen attention to detail, de Rond situates the labor of doctors in modes of professional work ethic, transitory social relations, teamwork and comradery, and in labor. He takes into consideration the institutional, medical, and existential dimensions of doctors’ experiences.
De Rond’s account is further interlaced with reflections from classic Western literature and first-hand accounts of modern war, including Richard Hooker’s 1968 novel-turned-film-turned-TV-series, M*A*S*H*. The central figures in this narrative are the surgeons: conducting triage, debriding wounds, intubating children, and deciding on above- or below-knee amputations. De Rond captures the social and psychological mood of his characters, the perverted sense of humor, the unsettling boredom, and the various individual and collective coping mechanisms. For the surgeon, there is a thin line between being caught up in the role of a god and becoming a complete cynic. In interrogating how surgeons relate to the scale of injury among soldiers and civilians, de Rond shows that empathy is a complex business negotiated by his protagonists through everyday gestures and modes of relations.
While intended for a wider audience, Doctors at War engages with a number of theoretical and methodological conversations in anthropology. I believe that the central contribution of the book is a methodological one. De Rond’s focus on storytelling, existential reflections, character development, attention to details, and an animated attention to interpersonal relations are strong attributes of his ability to engage in the experiences of the doctors he studies. He explains: “Lived experience cannot be plucked from trees and passed around like fruit; rather it is something one approximates using whatever empathy, imagination, and analytical skills required to bring into sharper focus the world as experienced by ‘the other’” (p. xvii). Doctors at War does this very well.
De Rond also presents a polemic that asks us to seriously reflect on what it means to be an engaged anthropologist. Responding to the paralysis of Western academia, and especially the social sciences, in deterring their nations’ wars elsewhere, de Rond asks:
Where are the real problems that should guide our research? We know the world is complex and that our knowledge of it is imprecise and incomplete, and so where is that point beyond which we profess to know and, based on this, to act? When did we ever stop human suffering on such scales as witnessed in Iraq and Afghanistan—or on any scale, for that matter? What did we ever do to stop this or any war?(p. 130)
These are somber questions worth considering.
While the book captures the clinical experiences associated with emergency care, the embedded ethnographic gaze introduces a number of limitations. First, the account does not delve into the complexities of post-operative care and management. There is a clear and seductive focus on the urgency and immediacy of fresh wounds and injuries, rather than on the long-term experiences of the medical and social labor of care. Second, while de Rond makes subtle inferences about the physical and social burdens of this war on society in Afghanistan, we do not get a good sense of the fate of thousands of Afghanis treated at the hospital. Though it seems to be beyond the scope of his study, de Rond acknowledges a wide gap in terms of quality of care between Camp Bastion and the crumbling local health care system that is stunted by the war.
These are increasingly important questions in thinking about the lived experiences of doctors at war, as the current conditions of war across the region seem to be affecting mainly civilian and humanitarian hospitals. In the same breath, one would be interested to know more about how this account of Western military medicine contrasts and refracts through other nonmilitary settings in countries such as Iraq, Afghanistan, and Yemen, where the clinical load of war trauma has become central to the medical experience of doctors and hospitals.
Doctors at War is a significant intervention in medical anthropology. It is a unique ethnography of surgeons and medics at work in times of war that manages to break away from the trappings of avant-garde critiques, heavy-handed theoretical claims, and academic jargon. Doctors at War is accessible and beautifully written and will make an excellent addition to classroom ethnographies for both undergraduate and graduate students in medical anthropology, anthropology of war, and the anthropology of experience. It is also an important account chronicling the human cost of the non-ending War on Terror and its devastating legacies.