What Chemical Weapons Feel Like

09/08/2013 08:51 pm 20:51:04 | Updated Nov 08, 2013

I have never treated a victim of a chemical weapons attack. Indeed, there are thankfully few physicians in this world who can say that they have. In my work providing emergency care in rural Rwanda, however, I have treated several children and adults with severe organophosphate poisoning from the potent pesticides still widely available in many poor countries -- the exact same class of chemicals used in the suburbs of Damascus to kill 1500 people on the night of August 21. Like many of you, I watched the video images taken of the victims of this horrific attack that were broadcast to the world through various social media.

Unlike most of you, though, my mind immediately began to fill in the details that were missing from those videos, based on my own experiences treating similar patients. For instance, the high-pitched rasping sound that the children would have been making with every breath they took, as though they had a broken whistle stuck deep in their throat. The thickness of the white foam pouring from their mouth that seems to just keep coming and coming no matter how quickly you work to suction it out. The tiny beads of sweat glistening across their foreheads. The smell of vomit and urine and feces as the chemical causes the intestines and bladder to pour out all their contents, rapidly dehydrating their small bodies in the process. The endless twitching, most noticeable as an incessant fluttering of the eyelids, due to the constant stimulation of nearly every muscle fiber in the body, until they are so weak that they can no longer even breathe. The sinking feeling deep in your own chest that occurs when you run out of atropine, the antidote for the poisoning, because you've used up the entire hospital's supply in treating just one patient (which happened to me on one occasion), and you find yourself forced to sit quietly by the patient's bed, alongside their family, and watch as they die.

The organophosphate poisonings that I've witnessed have been largely accidental, as children and adults consumed water or food unknowingly contaminated with concentrated pesticide. The thought of one human being, or a group of human beings, purposefully unleashing this fate on another group of human beings while they lie sleeping in their beds at night makes me want to vomit. And as an emergency physician who has seen horrific trauma in my life, from gunshot wounds in Soweto, South Africa to blast injuries from exploding mortars near Misurata, Libya, I can attest that almost nothing makes me feel like vomiting. I know that very smart, very rational individuals have argued that the 1500 deaths on August 21 were a drop in the bucket compared to the tens of thousands who have died in Syria over the past two years. These individuals, however, have not heard what I've heard, smelled what I've smelled, and felt what I've felt. Chemical weapons are different, which is why the nations of the world came together nearly a century ago to draw a thick red line around their use and place a large X across the middle.

To be clear, I am not necessarily advocating for unilateral military strikes against targets in Syria. I am sympathetic to the arguments made by so many I respect that such attacks without UN Security Council authorization would be illegal under international law and might even lead to more civilian deaths in Syria. What I cannot stand, however, is the arguments made by those on both the left and the right that Syria is simply "not in our strategic interest." Crimes against humanity are the responsibility of all of humanity. This is precisely why we call them crimes against humanity.

Perhaps no individual understands this better than President Clinton. In April of 1994, as the genocide was beginning in Rwanda, the images beamed back to the world by the handful of television reporters on the ground were shaky and confusing -- they seemed to show Africans killing Africans, without a clear sense of order or intention. The UN rapidly pulled out the vast majority of its peacekeepers, allowing the killing to accelerate, and Clinton himself decided against any unilateral American intervention. After all, America had been burned just the year before by its failed humanitarian intervention in Somalia, culminating in the now infamous Black Hawk Down episode. So, in memory of the 18 fallen U.S. soldiers in Mogadishu, we allowed nearly a million Rwandans to be wiped clean off the face of this earth. Clinton went on to regret his decision deeply, and four years later he became the very first head of state to stand before the Rwandan people and issue an apology for his own inaction in the face of crimes against humanity.

Here is the tough thing about war crimes: at the time they are committed, they are often difficult to distinguish from the seemingly random violence occurring all around them. History, though, rarely forgives us for our lack of clarity or our desire for more details. The question we should be asking today with regards to Syria is not whether to intervene, but how best to intervene. If there are non-military means to put a stop to the use of chemical weapons in Syria, then let us discuss them quickly, and implement them as rapidly as possible, either as a nation or as a community of nations. If we choose to do nothing, however, then four years from now it won't be President Obama standing before the Syrian people, delivering an apology speech for his inaction. It will be all of us instead.

Adam Levine is an Assistant Professor of Emergency Medicine and Co-Director of the Global Emergency Medicine Fellowship at Brown University. He currently serves as the Clinical Advisor for Emergency and Trauma Care for Partners In Health-Rwanda and as a member of the Emergency Response Team for International Medical Corps. His research focuses on improving the delivery of acute care in low-income countries and during humanitarian emergencies. The views expressed in this blog are his alone and do not represent the views of any of the organizations mentioned above.