Scores of men, women and children were killed outside Damascus on Wednesday in an attack marked by the telltale signs of chemical weapons: row after row of corpses without visible injury; hospitals flooded with victims, gasping for breath, trembling and staring ahead languidly; images of a gray cloud bursting over a neighborhood.
But even with videos, witness accounts and testimonies by emergency medics, it was impossible to say for certain how many people had been killed and what exactly had killed them. The rebels blamed the government, the government denied involvement and Russia accused the rebels of staging the attack to implicate President Bashar al-Assad’s government.
Images of death and chaos poured out of Syria after what may be the single deadliest attack in more than two years of civil war. Videos posted online showed dozens of lifeless bodies, men wrapped in burial shrouds and children, some still in diapers. There were hospital scenes of corpses and the stricken sprawled on gurneys and tile floors as medics struggled to resuscitate them.
Getting to the bottom of the assault could well alter the course of the conflict and affect the level of the West’s involvement.
President Obama said almost exactly a year ago that the use of chemical weapons was a red line. But the subsequent conclusion by the White House that the Syrian Army had used chemical weapons did not bring about a marked shift in American engagement.
This latest attack, by far the largest chemical strike yet alleged, could tip that balance — as many foes of Mr. Assad hope it will.
But like so much in Syria, where the government bars most reporters from working and the opposition heavily filters the information it lets out, the truth remains elusive.
The real "Revolution in Military Affairs" has been the readiness of some governments to wage war on their own people. Once upon a time, wars were fought between armies, which suffered most of the casualties. Then some genius realized that killing unarmed civilians was much better for the troops' morale (little chance of return fire), and in theory it sapped the enemy's resources.
The public health consequences of wars like those in Syria, the Democratic Republic of Congo, and southern Sudan have been like a cytokine storm—the immune system that ought to be protecting the body politic has instead attacked it.
As in Vietnam and Cambodia and Iraq, so in Syria and Darfur and the DRC: A generation of crippled survivors, coping with everything from PTSD to the loss of limbs from old land mines to genetic damage unto the third and fourth generation from poisons like Agent Orange. Never mind the loss of social capital, the simple trust between fellow-citizens that civil society relies on. Without it, stress brings its own bitter health consequences.
The "winners" of such suicidal conflicts preside over wastelands. Violence was a winning strategy, and they continue with it in the aftermath. They shrug off the public-health burden they've inflicted. Civilians know their best chance for survival is to bury their dead children and send the surviving kids off to the army.
From the point of view of the healthcare community, this situation is no different from bioterrorism: Deliberate infliction of disease, suffering and death to achieve a political goal. The international healthcare community should raise its voice to demand an end to it.