I am grateful to the engaged and thoughtful responses to my book from Nadje Al-Ali, Harris Solomon, and Michelle Pentecost, and to Alex Nading for proposing the idea of a book review forum. I am also honored by the SMA’s recognition of Ungovernable Life with the New Millennium Book Award ,and I thank the committee for bringing attention to work on the medical anthropology of Iraq and the Middle East. In response, I would like to pick up the flow and reflect on few analytical and methodological themes pointed out by my esteemed colleagues, while trying to provide further contextual clarity to the work.
When I began working on Ungovernable Life, I was driven by what I saw as the obscuring of Iraq’s history in the wake of the 2003 US invasion. Empirical research on Iraq had been scarce and muted for decades in the West, trumped by narrowly conceived frames of state and society, as Nadje Al Ali points out in her diagnostic note. Even in more progressive circles, conversations about Iraq lacked depth, sometimes eager to showcase US neo-imperialism, the illegality of occupation, and the failures of state building under occupation. There seemed also to be less understanding of the impacts of the pre-occupation decade of war and sanctions in fathoming the post 2003 moment and the unfolding of sectarian and communitarian violence Iraq. Challenging these parochial concerns, Ungovernable Life was an attempt to rethink the making and unmaking of the modern Iraqi state and the Iraqi social body through the lens of a central state infrastructure – the public healthcare system.
The title of the book, Ungovernable Life, draws upon a discourse consistently applied to Iraq between the colonial period and the present, through which Iraq’s environment and politics are imagined as uniquely intractable – as beyond governance. I wanted to take “ungovernability” seriously as more than a representational discourse of “otherness.” Rather, I wanted to build on “ungovernability” as a frame to analyze how logics and practices of power are unstable, fragile, and disordered: to draw attention to the “unruliness” at the heart of power, what Mike Taussig has once described as the “tripping of power in its own disorderliness”(Taussig 1986).
Working with and through “ungovernability” as an analytic was useful for thinking “life” in relation to politics in the production of this protracted “war experiment,” as Solomon rightly noted. War experiments are “uncontrolled” and messy. They metabolize, to borrow from his excellent ethnography (Solomon 2016), in the ecologies of care and affliction, leaving behind long-lasting non-healing wounds (Dewachi 2014, Dewachi 2019). To think through ungovernability as an analytic was not to designate life as an object of politics, but rather to pay more attention to the interplay of life at the unstable border of politics: to extend Didier Fassin’s invitation to imagine and think through the possibility of alternative “politics of life” (Fassin 2009). In writing about the various healthcare events that constitute the narrative arc of the book, their trajectories, paradoxes, reach, failures, and contradictions, I tried to highlight how “ungovernability” is imbricated in the intricate movements of historical structures and in the timbre and experiences of healthcare, as well as the imagination of state projects.
Pentecost noted in her generous and close reading that one of the interventions of the book was an attempt to engage with conversations on the decline of healthcare in the context of late modernity. Excellent and vast anthropological and global health scholarship on state medicine and public health has chronicled the transformations of local, regional, and global healthcare landscapes through neoliberal projects and assemblages. The writings on that wall were clear: neoliberal logics and policies were conditioning the corporatization of the public good and the production of extreme inequalities, increasing lived vulnerabilities and pushing societies to rework social, therapeutic and care relations and futures. With the “pulling out” of the state from managing welfare, societies were increasingly being governed by “ungoverning.” What I tried to show in the book was that Iraq’s “ungovernability” was not readily understood through the same analytical and theoretical frames often applied in other settings. Who needs neoliberalism if you are on the frontlines of the US war machine?!
The destruction of Iraq’s healthcare was carried out through decades of military interventions, sanctions, and occupation that systematically unraveled the infrastructure of the state. Iraq’s cities were literally turned into the war zone of a foreign occupying force that thrusted the country into a protracted civil war. The “war experiment” surely continues to reverberate in Iraq and across the region today. From Syria, to Libya, to Yemen, communitarian conflicts have become the mode of expression of the broader geopolitical warmongering, contributing to increasing insecurities and leaving so much suffering and destruction behind. There is a need to capture the historical trajectories of this war machine, where violence has become increasingly dispersed in the face of the decaying political economy of the state and its monopoly over violence (Mbembe 2019). In light of this, I tried to show how state infrastructure is built upon complex forms of life which, when disentangled, cannot easily be stitched back together. Healthcare and doctors have been front and center in this systematic and messy war experiment and its refractions in the biosocial realities of everyday life.
The undoing of infrastructure in Iraq was not merely a matter of destroyed facilities and a brain drain of doctors. It was also the unraveling of longstanding cultures of professionalization reliant upon interwoven transnational connections. One way to understand the breakdown of the state’s architecture of power and the continual shifts and fluctuations of the biopolitical apparatuses in Iraq is to see the doctors themselves as an “infrastructure.” This begins to explain why the loss of so many Iraqi doctors during the period of the 1990s had such a huge impact not only on the material workings of the healthcare system but also on the place medicine would come to hold in post-2003 Iraq. More than highlighting the role of the doctor as a mediator and expert of state architecture, my focus on the figure of the doctor helps to imagine the reach and limits of post-colonial medicine in contemporary global health (Anderson 2014). Doctors in the post-colony were not only important mediators of in situ modernity projects. Iraqi, Indian, and Pakistani doctors, among others, have long been the backbone of Western healthcare systems, such as the British National Health Service (NHS). Following the doctors from Iraq to the UK was a way to show how healthcare networks in the metropole and the post-colony are tethered. I did not want the story of the Iraqi doctor in London to be understood as only a story of an immigrant doctor in the West. In tracing these educational networks and the trajectories of medical training, medical migration was very useful for pointing out the vitality and relevance of the history of colonial medicine. The networks of the post-colonial training of doctors were central to the story of “Western Medicine.” Seen through this lens, one can begin to understand the British NHS as a post-colonial project par excellence, being currently “saved”, as Pentecost notes, by those same doctors whom it forever, reluctantly depended on, yet resisted and marginalized through racial discrimination and unfair professionalization and immigration policies.
Now more than ever, we see the centrality of the “ungovernability” thesis to the current COVID 19 global response and experiment, as Western healthcare systems scramble to deal with “what went wrong” (Caduff 2020). Regimes of power across the world continue to be overwhelmed by decades of the undermining of healthcare organization and public health through senseless economic policies and the waging of war on infrastructure in the global south. This has left global health and environmental landscapes increasingly vulnerable and “ungovernable.” While Iraq has been, so far, miraculously spared from a hard hit of COVID 19, despite all the apparent vulnerabilities of its healthcare system, it is important to put things into perspective. Since October 2019, Iraqis have taken the streets to protest the “disorders” of the post-2003 political establishment. Men and women from different social classes, professions, ages, and cities demand to reclaim the state from the hands of a corrupt political network of war mercenaries. With more than 800 people killed and close to 20,000 injured over the past few months, the “disorder” of the pandemic seems to be dwarfed by that of the uprising and the decades of protract political violence. Nowhere was this clearer than in the street chanting of the Iraqi protestors: “In China they got the Corona disease, while our disease is our corrupt political system.”
As I work on my second book manuscript on the ecologies and trajectories of wounds and wounding in Iraq and the Middle East, I take Ungovernable Life as a building block for a series of methodological and ecological explorations of war, medicine, and displacement. It is an attempt to reimagine an alternate history and future for Iraq in the face of deep experiences of loss, displacement, and survival. It is a story that is lived and told through the personal and collective wounds and care projects that stretch over geographies of cruelty and silence.
References
Anderson, Warwick. 2014. ‘Making Global Health History: The Postcolonial Worldliness of Biomedicine’. Social History of Medicine, February, hkt126. https://doi.org/10.1093/shm/hkt126.
Dewachi, Omar. “When Wounds Travel.” Medicine Anthropology Theory 2, no. 2 (2015): 61–82.
Omar Dewachi. 2019. “Iraqibacter and the Pathologies of Intervention,” Middle East Report 290 (Spring).
Dewachi, Omar. n.d. ‘Iraqibacter and the Pathologies of Intervention | MERIP’. Accessed 22 August 2019. https://merip.org/2019/07/iraqibacter-and-the-pathologies-of-intervention/.
Fassin, Didier. 2009. ‘Another Politics of Life Is Possible’. Theory, Culture & Society 26 (5): 44–60. https://doi.org/10.1177/0263276409106349.
Solomon, Harris. 2016. Metabolic Living: Food, Fat, and the Absorption of Illness in India. 1 edition. Durham: Duke University Press Books.
Taussig, Michael T. 1986. Shamanism, Colonialism, and the Wild Man: A Study in Terror and Healing. Chicago: University of Chicago Press.