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MICHAEL HOLMES, HOST: Hello, everyone, and welcome to AMANPOUR AND COMPANY.
Here’s what’s coming up on the program.
(BEGIN VIDEOTAPE)
UNIDENTIFIED FEMALE (through translator): I can’t believe it. Two months of darkness. We did not see any sunlight.
HOLMES (voice-over): Escape from Mariupol. Some trapped civilians finally see the light of day, as Putin presses on with his brutal invasion. I speak
to Russian propaganda expert Peter Pomerantsev about Kremlin strategy and how best to counter it them.
Then: Afghans mark the end of Ramadan with caution, as bloody attacks rattle the country. Habib Khan from Afghan Peace Watch breaks down the
outbreak of violence and what’s behind it.
Plus:
DR. THOMAS FISHER, AUTHOR, “THE EMERGENCY”: It’s an incredible moral conundrum where, when you are the one deciding, well, who should come back
next, how do you choose amongst all of these people who have so much need?
HOLMES: Dr. Thomas Fisher joins Michel Martin with troubling lessons on race and resources from a Chicago emergency room.
(END VIDEOTAPE)
HOLMES: And welcome to the program, everyone. I’m Michael Holmes in Atlanta, sitting in for Christiane. She will be back tomorrow.
Well, weeks underground and now finally free evacuations under way from the besieged city of Mariupol. Dozens of civilians who were holed up in and
around the Azovstal steel plant, the last Ukrainian pocket of resistance, well, they have emerged now, although hundreds more remain. And they are
running out of food, water and medicine.
A larger evacuation of the general population is also ongoing, but it is slow-moving. Mariupol’s mayor says the Russian forces are creating
obstacles and making progress difficult.
Listen now to some of the Ukrainians who have managed to escape.
(BEGIN VIDEO CLIP)
UNIDENTIFIED FEMALE (through translator): The shelling was so strong, and it kept hitting near us. At the exit of the bomb shelter on the top few
steps, one could breathe, as there was not enough oxygen. I was afraid to even walk out and breathe some fresh air.
I was afraid to stick my nose out, so to say. I can’t believe it. Two months of darkness. When we were in the bus, I told my husband, we won’t
have to go to the toilet with a flashlight and not use a bag. I have been with a flashlight. We did not see any sunlight. We were scared.
UNIDENTIFIED FEMALE (through translator): We lived in the basement starting from the 27th of February. We didn’t leave because our house is in
close proximity to Azovstal. The whole time, we were shelled with mines and then airstrikes started. Our house is completely destroyed.
We have a two-story building. It’s not there anymore. It burned to the ground.
UNIDENTIFIED FEMALE (through translator): The scariest part is when they are shelling, when you see a shell exploding and people dying. This is the
scariest part.
(END VIDEO CLIP)
HOLMES: Writer Peter Pomerantsev is an expert on Russian propaganda who just recently spoke with the Ukrainian president, Volodymyr Zelenskyy.
And welcome to the program, Peter, coming to us from Vilnius in Lithuania.
And, firstly, that interview with Mr. Zelenskyy, what was your read of his mind-set and his view of where this war might be headed?
PETER POMERANTSEV, AUTHOR, “THIS IS NOT PROPAGANDA”: Well, the interviews conducted by myself and my colleagues at “The Atlantic,” Jeff Goldberg and
Anne Applebaum.
I mean, I think the great worry for Zelenskyy is really about making sure no one relaxes. Yes, Ukraine has made amazing gains in retaking the areas
around Kyiv, but the big, big scary battle is just starting in the east.
And his main concern was that nobody had some sort of sense of false victory.
HOLMES: You have also been touring the country, talking to Ukrainians about how they feel about the war, engaging opinion towards Russia. You
wrote an amazing piece in “The Atlantic” about the horrors that one particular family faced and describe their experiences, I think, as a
microcosm of the war’s propaganda front.
Briefly explain that to us.
POMERANTSEV: Sure.
I mean, I have to say that this story was first discovered by my colleague Andrii Bashtovy, a Ukrainian journalist and he brought me to Lukashivka
which is a village near Chernihiv in the north of Ukraine that had been held for several weeks by the Russian army.
And there was one story there that really struck both of us about a family, the Horbonoses, who essentially spent three weeks in their cellar living
with Russian soldiers there. They were all hiding from the kind of artillery exchanges above themselves.
And I have got to say, these Russian soldiers were not sadistic in any way. They allowed — well, they took over the Horbonoses’ cellar, but then they
allowed the Horbonoses to live with them. And over several weeks, they kind of developed a sort of relationship.
And the Horbonoses started questioning them. Like, what are you doing here? What is this war for? And the answers that the soldiers gave and I suppose
their changes over time were indicative of many things in Russian society. Only one of the soldiers was like a true believer in the cause, a real
believer this was a war against Nazis or against NATO.
The other soldiers were pretty cynical. They were there because it was their job, because of money, because they had mortgages to pay off. And,
like I suspect, most Russians are actually very grounded in their everyday reality.
And over the three weeks, the Horbonoses sort of ground them down. I mean, by the end of soldiers all admitted that this was a senseless war.
HOLMES: That was the extraordinary thing, that glimpse into how those Russian soldiers felt initially, and then how their thoughts changed over
time with that family.
I wanted to ask you, how is the family now? And how do they look back on that experience?
POMERANTSEV: Well, listen, the family have lost their homes. I mean, the invasion has meant that their homes — their home and their garden and all
their property has been completely destroyed. It’s just complete rubble.
So, they’re thinking about how they rebuild their lives. But they’re also, I think, quite grateful that their village and they themselves did not
undergo the kind of atrocities that thousands of Ukrainians have been subjected to, hundreds of thousands. We just heard about Mariupol from your
from your reporters.
So, in a weird way, they feel they have been spared the very worst of what could have happened.
HOLMES: What an extraordinary experience.
Now, of course, inside Russia, the disinformation, the propaganda continues relentlessly. And you write in your “Atlantic” article — and I want to
quote from it now, if I can — we can put it up on the screen.
You say: “Putin’s feigned propaganda system has always been less about ginning up enthusiasm and more about spreading doubt and uncertainty,
proliferating so many versions of the truth that people feel lost and turn to an authoritarian leader to guide them through the murkiness.”
To that point, how long can Putin and the system, for that matter, sustain the lie? I mean, you also write that his propaganda strategy is more
vulnerable than it might seem.
POMERANTSEV: So, yes, my first book about Russia was called “Nothing Is True and Everything Is Possible,” which was an attempt to catch the kind of
the — sort of the underlying message of Putin’s propaganda.
This can go on for a long time. I mean, there’s lots of science that shows, if you keep on giving people confusing different types of evidence, that
will sort of destabilize them, that will make them feel uncertain and passive.
But this propaganda system has a weakness, which is getting people motivated. So the question, I suppose becomes, like, at what point is
making people passive not enough? I mean, we still have a lot of qualitative research, so interviews and focus groups, coming out of Russia
done by Russian sociologists, which is — which are published. These results are published.
And in them, you hear people. They’re like, well, we don’t really know what’s going on. We hear about Russian atrocities, but maybe they’re
Ukrainian atrocities, and who was behind the murders in Bucha, for example, and who was really bombing Mariupol?
So, a lot of people, they don’t live in a big lie. They live in a big uncertainty. But the question is, how long is that passivity enough?
Because now Putin wants his country to be motivated to get through these tough sanctions and economic hardships ahead. And is passivity enough for
that?
I don’t know.
HOLMES: Yes. Yes. It’s a fascinating aspect of this.
Now, many people, of course, believe that Putin’s aim goes further than Ukraine, that he wants to reconstitute a greater Russia. He laments the
loss of the Soviet Union. He’s living in history, not the present, in many ways.
How then does that make fighting him more difficult, when his aims aren’t necessarily rational or traditional for a war, but more ideological? Does
that make him a tougher enemy?
POMERANTSEV: Yes, I — no, I think this makes him very, very vulnerable.
I mean, the Russian system under Putin, which has survived a couple of decades now under him, is really built on a pyramid of corrupt mutual
interests. So, yes, you sort of doffed your heart and said Putin is a great guy, and I want Russia to be great, and Putin’s making Russia great again.
But, really, you got to with your own life afterwards, and you had ways to enrich yourself through fair means or often, because the system is so
rigged, through corrupt means. But you motivated yourself through those — that desire to survive and feed your family and build a future.
Now, that is all going to start to disappear. The pie is going to get smaller and smaller and smaller. And Putin is trying to do a Stalin 2.0, a
mix of fear and inspiration. And it’s unclear whether really he really has the mechanisms to do fear the way Stalin did. Is he going to build gulags
again? Is he going to incarcerate millions of people?
He doesn’t actually have the prisons to do that. And it’s unclear whether the ideological high will last for very long. So we really have to start
engaging the Russian people about their future. Putin talks about history a lot and nostalgia and The past. But most Russians do think about their
future and the future of their families and their children.
So we need to start a dialogue with them about that.
The sad thing is, we’re not really trying. So far, we have had Arnold Schwarzenegger doing an incredibly successful video address to the Russian
people, which got maybe over 10 million views. It’s hard to tell. But there has to be a lot more of that, statesmen talking to the Russian people,
celebrities talking to the Russian people, and so on and so forth.
HOLMES: And, to that point, I mean, in the Western alliance response to Ukraine, and you talk about seeing the embryo of something more strategic,
I think you said.
In other words, you would like to see more of a formal structure among democratic countries to counter Russia and, for that matter, China’s
ambitions. What sort of structure? What would it do and how would it work?
POMERANTSEV: That’s a superb question.
I mean, I suppose there are a lot of countries now like Ukraine, so Australia, Japan, Taiwan, obviously, who look at China in the same way that
Ukraine, Moldova, Georgia, look at Russia. These are big, scary nuclear states. I mean, it’s highly unlikely the West will ever take them on like
we did, I don’t know, Serbia under Slobodan Milosevic.
But it would be good to know that the minute there’s an illegal war of aggression, the minute there are human rights abuses, humanitarian abuses,
war crimes, a set of sanctions just kick in automatically. I mean, the fact that we’re having a debate in Europe about whether Germany should or
shouldn’t use and buy Russian gas, I think that should be automatic.
After a war of aggression, certain sanctions which are very serious kick in. There’s guaranteed support in terms of military and armed support, not
boots on the ground, but armed support. So what we’re seeing now around Ukraine could well be a way to support countries that feel under threat
from China.
And then the Russias and the Chinas of this world will understand there’s going to be a huge cost to this kind of war of aggression. And is it really
worth it? And maybe we then reach a balancing point, where the costs become so clear that no one dares.
I mean, Putin has done this because, for decades now, he’s got away with horrible wars at home in Chechnya here and abroad in Syria with absolutely
no cost or no serious cost attached. That should change. We need some sort of system of deterrence that matches a globalized world.
It won’t be like the Cold War. It’ll be something new that matches a world of economic interdependence.
HOLMES: And it’s interesting to talk more about, I think, the cost of this.
I mean, the sanctions are in place. Russia is — it’s an international pariah, the economy devastated. That’s going to get worse. His military
failings have been exposed for all to see. NATO is strengthened, not weakened.
At what point are the costs too high for him, or perhaps, crucially, too high for those around him or Russians on the street?
POMERANTSEV: So look, firstly, the economy has not collapsed at all in any serious way. Just for these sanctions to kick in will take — people say —
people give different dates, but definitely several months, if not years.
As long as he can keep on selling oil and gas, he can do whatever every dictator needs, which is pay off his military and his security services.
So, what, sadly, will probably happen if we don’t scale up the sanctions and don’t do an oil and gas embargo is that he will increase investment and
funding of the repressive mechanisms.
Now, at what point do ordinary Russians and enough elite Russians say no, no, no, we don’t want this, this is not the future we want for our country?
I don’t know. We can certainly do right to make it clear to the Russian people that this is serious.
One of the really interesting things coming out of sort of sociological analysis in Russia at the moment is that many Russians don’t take this
seriously. They think this is going to blow over tomorrow, that it’s not a big deal.
I think we have, as a start, to start communicating this fact that this is serious, the sanctions are going to be here for a long time, we are in the
new reality, this is not a joke.
HOLMES: Right.
I want to ask you this before we run out of time.
You’re working on a project to document war crimes inside Ukraine, looking for potential legal evidence of atrocities and compiling, crucially, an
archive of multimedia material.
Briefly, tell us a little bit more about the project and how you would like that material to be utilized.
POMERANTSEV: So, this project is all about bringing sort of culture and the law together.
So I’m working with the great war reporter Janine di Giovanni, done similar projects in Syria and Bosnia. I’m coming much more from the culture side.
We have got to understand what Putin’s trying to do is wipe out Ukraine as a sovereign state.
Sorry. There’s a biker gang right beside me. It’s an exciting night in Vilnius. Sorry about that.
So he’s trying to commit war crimes to show that he can attack Ukraine with impunity and destroy it as a sovereign state. But he’s also trying to wipe
out memory, identity. So we’re going to put these things together, document the war crimes, let’s say, the attack on the — the horrific attack of the
theater in Mariupol, but also record the culture of that place, the lives of the people there, so that we get to preserve all the things that Putin
is trying to destroy, both the legal side and the cultural side.
If you go back to some of the old ideas about what genocide is, it’s all about cultural genocide and sort of the murder of people. So, our project
is unique in putting those things together, and then connecting them to Putin’s other crimes. We’re going to connect it to things that happened in
Syria, in Chechnya, to really make it clear that this is now a pattern of behavior that the Kremlin is executing, and it really has to stop.
HOLMES: It’s an amazing project. Wish you well on that. I have worked with Janine in the Middle East before, so you’re in good company there.
Peter Pomerantsev, thank you so much. Really, really good discussion.
All right, turning now to another country ravaged by war, this time Afghanistan. This was the first Ramadan there since the Taliban regained
control of the country last summer. And even though the Taliban said it would bring security to the country, a series of brutal attacks have
rattled several Afghan cities in recent weeks.
Arwa Damon reports for us.
(BEGIN VIDEOTAPE)
ARWA DAMON, SENIOR CORRESPONDENT (voice-over): At this packed marketplace in Kabul, shoppers wander through the stalls of dried
fruits, nuts and sweets.
They’re preparing for the Eid al-Fitr,holiday. But despite the bustling scene, the anticipation of laughter and love-filled gatherings with friends
and family, there is an inescapable sense of caution, unease. This is a crowded public space. And in Afghanistan, that means potential danger.
UNIDENTIFIED MALE (through translator): The security situation is still not good. There is some security, but the kind of security people were
expecting is still not there.
DAMON: This was the first Ramadan in Afghanistan since the Taliban regained control of the country last summer. And even though the Taliban
said it would bring security to the country and protect its often targeted minorities, like Shia communities, a series of brutal attacks have rattled
several Afghan cities in recent weeks.
Mosques have been targeted, especially during Friday prayers. On Friday, a blast broke through a mosque in Kabul. Witnesses say there were so many
wounded, it took hours to transport the victims to hospitals.
There was a similar attack the previous week at a mosque in Kunduz province in the north of the country, killing at least 33 people. The fear so
pervasive, worshipers say it’s never far from their minds.
UNIDENTIFIED MALE (through translator): I was very much preoccupied with thoughts and fear. I was thinking a suicide attacker explosion will happen
at any moment now, or the mosque will be attacked. Not only me, but every Afghan has this fear in his heart.
DAMON: The Taliban condemned the attacks on the two mosques, and also targeted recently, a school and a learning facility in a Shia neighborhood
in Kabul, where at least six people died nearly two weeks ago.
The ISIS affiliate in Afghanistan, which often targets Shias and its rival, the Taliban, has claimed responsibility for several attacks during the
Ramadan period.
UNIDENTIFIED MALE (through translator): How long will such incidents continue? Afghanistan situation is so bad. We have no secure place to live.
DAMON: Many are questioning if the Taliban government can actually live up to its promises to bring stability to the country.
And so, as Afghans celebrate Eid this year, that sense of apprehension they have lived with for so long, it just continues.
(END VIDEOTAPE)
HOLMES: Arwa Damon reporting there for us.
Well, let’s take a closer look at the issue with Habib Khan. He’s the co founder of Afghan Peace Watch. That’s an organization that is closely
tracking security developments in Afghanistan.
It’s great to have your voice on this.
Now, the Taliban, of course, said it would not tolerate terror groups on Afghanistan soil. A, have they broken that promise and — or, given the
number of recent attacks, can they stop terror groups if they wanted to?
HABIB KHAN, CO-FOUNDER, AFGHAN PEACE WATCH: Good afternoon, Michael. Thank you. Thank you for having me.
So according, to our organization, we have documented and reported 20 bombings that include site bombings, IED attacks, grenade and mortar
attacks only in the month of Ramadan. So that shows that the Taliban obviously are not capable of maintaining the security that they promised to
deliver to Afghanistan.
And as far as the foreign terrorist groups are concerned in Afghanistan, we had reports from Northern Baghlan province that the Chechen, Uzbekistani
and other Central Asian nationals, militants are living under the Taliban, with the Taliban support in the northern province of Afghanistan.
And there have been continuous attack by the Islamic State all over Afghanistan. That includes the major bombings on some mosques, Shia mosques
in particular, and — in Kabul, and also in other provinces of Afghanistan.
HOLMES: And to that point, what do you make of the targets so far, mosques, but also schools?
There are many groups operating in Afghanistan. What do you make of the rationale and the motivation when it comes to the targeting?
KHAN: Yes, they’re bombing public places, mosques, weddings, schools, universities.
This is the legacy of the Taliban. We have seen in the past insurgencies have been continuously bombing public places in Afghanistan. This really
shows that the Taliban are not capable of providing security for the people, because, back in the ’90s, when they were in power, the only thing
the Taliban promised — the Taliban brought to Afghanistan was security.
And this time, they are not even capable of delivering on that promise.
HOLMES: Yes.
There were, of course, plenty of warnings before the Western withdrawal that a Taliban returned to power could reignite the very terrorist threat
that led to September 11. Those warnings, of course, were, by and large, ignored.
How then has the Western withdrawal impacted the level of terrorism in the country today, and would staying any longer have made any difference?
KHAN: Yes, obviously, after the collapse of Afghanistan and the withdrawal of the U.S. troops, the Islamist groups, other than the Taliban, they have
been motivated, in the sense that they could — if they could defeat the U.S. in Afghanistan, obviously, they could defeat other governments.
And they could stage attacks like the 9/11 in Western capitals and Western cities. So that has really given a moral boost to the emergent groups all
over the world to be recognized and to take over governments and stage high-profile attacks.
HOLMES: How has some of the — you touched on some of the international aspects of this, those in the north and so on. But how are some of these
terror groups acting or might they act in a regional sense?
I’m talking about against Pakistan, Uzbekistan, we have seen attacks, or perhaps even act against China in support of the Muslim Uyghur minority
there. What impact could any cross-border terror have regionally?
KHAN: Yes.
So, right up to the fall of Kabul, we have seen surge, a significant surge in the Pakistani Taliban, also known as TTP, attacks in Pakistan.
There have been — like, only in the month of Ramadan, there have been more than 60 attacks claimed by the Pakistani Parliament. And they also
announced the first ever spring offensive, just like the Taliban used to do in Afghanistan, just before Ramadan. The Pakistani Taliban say that they
will attack and target Pakistani troops, Pakistani military.
And there have been so many attacks claimed by these groups. And the Taliban in Afghanistan, they have not been able to conduct any operation
against the TTP, because they worry that, if they go against TTP, they will lose their foot soldiers, because their narrative is based, their whole
ideology is based on Islamic Sharia.
And the TTP has been fighting along with the Afghan Taliban. And now if they go against the TTP, the Pakistani Taliban in Afghanistan, the foot
soldiers are going to turn either to Da’esh or TTP, and that would be a huge loss for the Taliban.
But the Taliban have indeed agreed with the Pakistani military that they cannot go after the TTP. But they have allowed them to conduct, target TTP
in Afghanistan. And we have had a couple of examples in Khost, that the Pakistani (INAUDIBLE). They bombarded Gurbuz and — Gurbuz district and,
before that, another district in Khost province that killed more than 40 civilians.
HOLMES: Now, you wrote recently that the Taliban is pushing for international jihad. Explain that to us.
And is the West still on the target list for either the Taliban or any of these other groups?
KHAN: I think it would be very delusional statement to say that the Taliban have changed, that they have given up on international jihad or the
global jihadist agenda, because, if you closely follow the Taliban’s leader’s statement and the statements — and also from their commanders,
field commanders, they are — obviously, their whole ideology is based on international jihad.
And there was — as a matter of fact, there was a recent major — recently, there was a major gathering in the northern province of Baghlan in — in
Baghlan (INAUDIBLE) district by Hizb ut Tahrir, which is a pandemic- Islamist movement that also want the reestablishment of the Islamic caliphate.
And it was attended by senior Taliban commanders. And they did call for international jihad, saying that, since we have reinforced Islam and Sharia
in Afghanistan, now it’s the turn to expand this jihad to the neighboring countries and to the rest of the region, and as well as to the West,
because the Taliban have already seen, the Taliban and their allies have already seen the West as their main enemy.
HOLMES: Now, we touched on this, and let’s revisit for a moment. The Taliban’s claim, as you said, was always to deliver law and order, even
brutally, and that did earn it local support.
Winning power, of course, is different to having an ability to govern. Does what is happening now, in terms of these attacks, suggest the Taliban is
losing or could lose control of the country, and what might that look like?
KHAN: I think it’s really easy to be an insurgency group.
And we have seen example at that in — all throughout the history, but it’s really hard to go and to provide services. And Taliban are not — their
nature is that they’re a war machine. They’re not made for governance. And they’re not (INAUDIBLE) at that.
And they are obviously conducting and perpetrating a lot of crimes against civilians in Afghanistan and also against members of former government, the
members of (INAUDIBLE).
And we — as a part of our recent study, jointly between my organization and ACLED data, which is a U.S. organization, we have identified five
different trends. That is violence against women, violence against journalists, violence against minorities, and the infighting among the
Taliban, and also the emergence of new anti-Taliban fronts.
That means — and also, in addition, the Islamic State. So, that means that there will be — the war will get bloodier. The conflict has never ended.
The U.S. engagement in Afghanistan, the military intervention, it has ended in Afghanistan, but that doesn’t mean that the war has ended.
So, there has been a lot of attacks, a lot of security incidents all across the country. And this will even grow bloodier, I think.
HOLMES: It’s a country that’s been at war for decades and decades.
Now, you mentioned women. At the end of March, the Taliban reversed its decision to allow Afghan girls to return to high school, saying that a
ruling is still to be made on uniforms they must wear. Or that’s what they said anyway.
Schools were set to open nation after a bunch of restrictions. Do you see girls returning to school anytime soon in Afghanistan, or is the Taliban
just going to back on all of those promises they’ve made?
KHAN: You know, we’re seeing the Taliban, even in the ’90s when the Taliban are in power, they never said that they will not allow girls to go
to school. They have always been saying that they need an environment that is in accordance to with Sharia and then they will allow women and girls to
go to school and to work. And the Taliban, they’re very good when it comes to lying and just making fabricated facts.
And I think that is just an excuse. And the Taliban have been repeating these lines since many, many years, that they will allow, they will create
an environment that is according to Sharia and the women can work and they can go to schools, too. But I don’t think that’s going to happen anytime
soon.
HOLMES: Yes, very good at going back on their word. I wanted to ask you this, too, because it’s another potential front in what’s going on.
Lieutenant General Sami D. Said, he’s an ex-general in the Afghan army, he said that he and many other former soldiers and politicians are preparing
to launch a new war against the Taliban. He said, you know, eight months of Taliban rule convinced many Afghans that military action is the only way
forward. Does that movement have support in your view or a chance of posing a threat to Taliban rule?
KHAN: Yes, definitely. There are a lot of people in Afghanistan who want to fight the Taliban right now. But they’ve been left alone. So, the
soldiers — the ANSF soldiers, they didn’t lose this war to the Taliban. They were sold out by the — that’s an obvious fact, they were sold out by
the leaders and by their sponsors.
So, there is a lot of — there are a lot of Afghans who would want to pick guns and fight up the Taliban. If they, you know, conditions that there
are, like — if there is support for them and there is good leadership to lead them. Because we’ve seen the Taliban that they’ve monopolized the
power in Afghanistan. And they’re not allowing anybody else to hold positions within the government. And they’ve appointed only (INAUDIBLE) and
only people who are affiliated with the Taliban to all senior positions.
And they’ve — at the beginning when the Taliban came to power, the people thought that they’ve changed. They’ll allow women to work and they’ll allow
free media, they will allow girls to go to school. But we’ve seen that they’ve cracked down on journalists. There’ve been so many, so many
instances that the journalists have been tortured, beaten, and jailed. And they’ve cracked down on activists and free speech. And also, people are
starving. And there’s no source of —
HOLMES: Yes.
KHAN: — there is no sort of services to the people as they were expecting. And there is no security either. So, people are frustrated with
the Taliban. And there’s a chance that the — the — a lot of people will believe, resistance. And on top of that, there had only been (INAUDIBLE)
resistance fronts, apart from the NRF. There have been many more anti- terrorism NRFs all around Afghanistan.
HOLMES: And as you pointed out, on top of all of that, massive problems with food and security, the very basics. That’s a worrying picture that you
painted of Afghanistan. We’re going to leave it there. Habib Khan, Co- founder of the Afghan Peace Watch, I really appreciate you taking the time.
Now, the U.S. is being warned to prepare for a summer surge in COVID-19 cases across Southern States. Our next guest has witnessed the pressures of
the pandemic firsthand as an emergency physician. Dr. Thomas Fisher is sharing his experiences in his new book, “The Emergency: A Year of Healing
and Heartbreak in a Chicago ER.” Here he is speaking to Michel Martin about the book and the state of American health care.
(BEGIN VIDEOTAPE)
MICHEL MARTIN, CONTRIBUTOR: Dr. Thomas Fisher, thank you so much for talking with us.
DR. THOMAS FISHER, AUTHOR, “THE EMERGENCY”: It is a pleasure being here. Thank you for having me on.
MARTIN: The title of your book is, “A Year of Healing and Heartbreak in the Chicago ER.” This book chronicles kind of the before, during, and sort
of after of the COVID crisis.
DR. FISHER: Uh-huh.
MARTIN: Is it the COVID crisis that kind of motivated your thinking. Because it’s obvious that you’ve been thinking about these things very
deeply for a very long time. I might argue for the entirety of your career because you kind of had a front-row seat to these issues.
DR. FISHER: Yes.
MARTIN: So, why this book? Why now?
DR. FISHER: I actually started writing the book before COVID. And there’s a chapter where I described what the emergency department was like when we
were overburdened with the chronically ill and the acutely injured, the old and the young, and how we were constrained in our capacity to manage them
effectively by time and resources.
But then COVID happened. And it condensed the time it took for society to protect some and harm others and have that manifest in their health.
Normally, it takes 30 or 40 years for food deserts and violent communities, and jobs that injure them to lead people to the emergency department. That
burden of illness that society creates takes time.
But COVID condensed that into a matter of weeks. Where, depending on your job, you either were able to shelter at home and continue to work from a
screen. Many people got much wealthier during the pandemic. While others were stocking shelves and driving Ubers, and working in warehouses or
slaughterhouses where they were exposed to COVID not because of anything intrinsically biological about them, but because of the way society
protects or exposes them to illness and disease. And they fell ill in droves and came to my emergency department.
And so, it was a perfect opportunity to describe the societal variables that shaped our bodies. And the inequities that now distribute our health
in a very concise timeframe. And it was unlucky for society but a perfect opportunity to continue to write this arc. And so, in many ways, what I was
writing was reshaped by the pandemic.
MARTIN: For people who still don’t get the degree to which race and income — a race or access to wealth, maybe we should put it that way, were
determinants of how people fare during COVID. I mean, Chicago in journal, your emergency room in particular, are a perfect case study of that. The
death rate for African-Americans was far greater than that for white people living just a few miles away.
DR. FISHER: Yes.
MARTIN: And that manifested very early on. I mean, a news organization did a deep study of the first 100 people to die of COVID in Chicago. And I
think 70 percent of them were black, even though black folks are only 30 percent of the population of Chicago now.
DR. FISHER: Uh-huh.
MARTIN: And obviously, you know, why is that?
DR. FISHER: Look, Chicago is densely segregated by race and has been for a very long time. This segregation in Chicago leads the Southside which is
largely black to not only fall ill from chronic diseases but also from acute illnesses. I’m just looking at a couple of statistics so that I — so
that I don’t get it wrong.
MARTIN: Uh-huh.
DR. FISHER: In Chicago, in our predominantly black communities, the highest lead levels are amongst black folks. In Washington Park, a
neighborhood not far from the hospital that I practice in and the neighborhood I grew up in on the Southside, 15 percent of adults are
disabled compared to four percent in the predominantly white loop. Black women in that neighborhood deliver dangerously low birth weight babies, 3.5
percent of the time compared to only one percent of the time in Lincoln Park.
The evidence is clear and consistent. You know, Black folks live shorter and more painful lives not because of any biological or genetic difference,
but because of the way we’ve distributed our healthy food resources. Our good jobs. The clean air that we breathe. The sorts of protections that
allow for us to be free of violence in the community. The wealth that protects us from these swings in job attainment or loss. All of these
things become part of our bodies.
And then when we fall ill, these same societal distributions lead us to have better or worse access to the health care resources that help us get
well. And so, for example, black folks are much less likely than white folks to have the desirable private health insurance that hospitals and
doctors prefer. And in fact, they’re 50 percent more likely than white folks to be uninsured entirely.
And so, if you look at a map of Chicago’s racial segregation, you will see that black folks are crowded into these communities where they are
uninsured and on Medicaid. And if you are to overlay where our health care resources, these health care resources that prefer private pay insurance,
you’ll see those are similarly distributed towards those on the wider Northside where more people are insured.
And so, we have redistributed our health resources and our health care resources along the lines of racial cast. And ultimately based on who can
pay and who cannot. Creating winners and losers. The challenge then is that when you lose, you paying not only with your wallet, you’re paying with
your life.
MARTIN: I was talking about the emergency room. One of the revelations of your book is that you have an average of three minutes to spend with each
patient. How is that possible?
DR. FISHER: So, let me give you a big overview. The emergency department that I work in is massive. There are about 70 something beds that we cover
and each area has different resources available in order to care for specific sorts of interventions. I was working right at the front of the
house where I’m trying to sort through the sickest people in the waiting room and launch them through their care trajectory by early diagnosis and
testing.
And the ability to go through a waiting room where there might be 40, 50 people waiting. Many of whom have been there five or more hours means that
I don’t have a whole lot of time to spend with them. My goal is to identify exactly what is the critical issue that brought them to the emergency
department. Step in, and see if I can diagnose it or relieve some suffering in the meantime. So that by the time they finally get to a room, we’ve
already begun their care process.
It’s frustrating sometimes because — look, I trained for a lot of years in order to have a broad skill set. I’ve got even more experience treating
both simple and complex illnesses. And the ability — and not being able to deploy all of those resources in the service of somebody who so clearly
needs it leads us, and me in particular, with a moral conundrum that I described in the book.
MARTIN: Well, in fact — I mean, some of the stories that really stand out in your book are the stories where you really aren’t sure you got it right.
One of the ones that really stuck with me, in part, because it wasn’t so dramatic. It was the girl who had been jumped at school —
DR. FISHER: Yes.
MARTIN: — and came in with facial injuries. Tell me that story of how you treated her and why this was so frustrating?
DR. FISHER: Yes, part of why that story was important for me is because so much of what we do isn’t, like, made for TV whiz-bang like drama. It’s the
mundane lives of everyday people that we become intimately exposed to.
And here’s a woman who is 18, in her senior year of high school in the book. And was jumped and injured by a group of other people. And in my
brief encounter with her, my job was to make sure she wasn’t seriously injured. That she maintained her eyesight and her physical functions. And
that there were no injuries that we missed and everything that we found we could treat. But that doesn’t speak to whether or not she was bullied at
school. And that this was an ongoing problem, or that maybe there was some misdirection and this was actually an injury that happened at home. And
maybe she didn’t have a safe place to be. Maybe there was more going on with her emotional life. Was she depressed or anxious?
Without the time to address all of these other variables, many of which are the variables that actually lead us here and the physical injuries were
just the end result of a longer-term process. I felt frustrated that I couldn’t ensure that she wouldn’t return in just a little while.
MARTIN: Then there was the woman who had been in the emergency department for, like, hours —
DR. FISHER: Yes.
MARTIN: — with a critical illness. She wasn’t feeling well. And the lab suggested kidney failure.
DR. FISHER: That’s right.
MARTIN: And the family were like, you know what, we’ve just been here too long. Let’s go. Let’s just go.
DR. FISHER: So, in that interaction, I’m sorting through all of these patients one after the next, three minutes at a time. And here comes a
family member saying, look, we’ve been waiting for five hours. Can I take my mom home? We’ll come back later but we’re about to leave. And here when
I look at her chart in the computer, I realized that she actually has a critical illness. Something that needed to be — that needs to be managed
immediately. That probably requires an admission and maybe a number of medications and potentially a surgical intervention to improve. And I don’t
have anything to offer.
I don’t have a medication that would relieve her suffering right now. I don’t have a timeframe to say that, oh, she’ll be in the next bed in a
moment. And in fact, when I reviewed the list of all of the patients in the emergency department waiting, not only has she been there for five hours,
others have been there longer and she might not be the sickest one out there.
It’s an incredible moral conundrum where — when you are the one deciding who should come back next. How do you choose amongst all of these people
who have so much need? And when you are the one making choices and there are no good answers, what kind of burden is that to give people whose job
it is to do no harm? Whose job it is to cure and make people better?
We all carried that weight really very heavily over time. And I think one of the ways that we’ve, over time, manage that is some doctors just look
away and do their best not to confront these moral challenges or the recognition that there’s so much suffering that goes on that goes
untreated. Justifies that suffering as a part of humanity and maybe it’s — in some ways reasonable for people to have to struggle.
And I think that I have gone through those periods. And now I’m at a point where I’m willing to just look at it and be uncomfortable. And I think
that’s part of what makes this book somewhat challenging to read is that I want the reader to look at it and know that sometimes there isn’t a
solution. Sometimes there’s just suffering. And then it becomes an incumbent on all of us to figure out, is this OK? And what do we do about
it?
MARTIN: In the book, you write letters to patients and colleagues that you would have liked to have sent.
DR. FISHER: Yes.
MARTIN: Will you tell us about that?
DR. FISHER: Absolutely. So, the book structure is alternating chapters. One chapter is recounting an experience, a night or a day in the emergency
department where I’m taking care of sick people. And doing so in a sort of detail that brings people very, very close to the interaction that we share
as teams in the emergency department. And then the chapter just after that is a letter to somebody I worked with or took care of in the emergency
department.
The goal of those letters is to, over the arc of the book, described the way we’ve organized our health resources in society. To explain to a
patient, why are you sick before your time? Why did you wait for five hours in the emergency department, or to explain to one of my colleagues, a
training, what happened with that VIP care? Why did that individual get exactly what they need while this other individual didn’t get anything that
was required for their care?
I took the approach of writing a letter to these individuals because I didn’t want it to be a wonky policy book. I wanted my residents and, more
importantly, my patients to understand what’s going on with them? Why is it that the health care system is structured the way they — the way that it
is? And do so in a way that is really accessible.
MARTIN: But you know, I have to notice — I couldn’t help but notice how many of them really were apologies.
DR. FISHER: Yes.
MARTIN: You were saying, I’m sorry, I couldn’t do better by you. It just – – it feels painful. It feels really painful to me.
DR. FISHER: It is very challenging. And I think there’s a component of this where my patients don’t know me when I walk into the room. And as soon
as I have the badge that is — identifies me as a hospital employee, I’m a part of that big system that has the potential to harm them. And even
though I am from the same community as they are, I grew up on the Southside, I’m taking care of people I know, either literally. And that
I’ve cared for old school teachers and the parents of my friends or figuratively. And that we have the same sort of cultural touchstones, they
don’t know any of that.
And in some ways, I’m apologizing on behalf of the system. And in other ways, I’m apologizing on behalf of myself, when I am still human and I get
frustrated and short-tempered, and I have to run off to the next room to do something because I don’t have enough time or resources to give everybody
what they need. And I think that when people are sick, which we all are sick at times, what they deserve is grace and compassion, and care and
mercy. And when I don’t have the capacity or didn’t deliver that, an apology is what they deserve because they didn’t get what they came for.
MARTIN: Why do we tolerate this? This is a wealthy country, why do we tolerate this?
DR. FISHER: I think there are couple reasons. One is, I think that we’ve justified a society that creates winners and losers. That creates
competition and thinks that if you are on winning — if you’re winning, it is something meritorious in your character or your effort. And doesn’t
earnestly recognize that the competition is rigged, and so much of that is rigged by racial cast so that so much of your opportunity to win is defined
by the luck of the birth order and location.
And so, when you see people who are ill earlier, we blame the victims. Well, they should’ve taken better care of themselves. They should have not
smoked. They should have made better decisions without the recognition that it is context that shapes all of us for the good and bad.
And it is not anything biological that creates that 30-year life difference between the Southside and the Northside. I think another reason is so much
of this is pushed out of sight.
I wonder if more of the world saw the wild eyes and gasping for breath of those people who came in in the early days of COVID. And it wasn’t
abstracted into statistics and numbers that we might have had more empathy for, not only the people who had fallen ill but those who were trying to
deliver their care. As a result of it becoming simply a million people dead, which is where the number we are nearing now, it was mothers and
fathers, people who died in ways that were terrifying and suffocating. That might help to cut through this idea that there are winners and losers. That
the racial caste system is somehow justified and helps us to understand that we have this shared humanity when we can see ourselves suffering in
that way. That would force us to think about how do we solve these problems that create our health and these problems that create this in a poor — an
unjustified and unjust health care system?
MARTIN: Dr. Thomas Fisher, thanks so much for talking with us.
DR. FISHER: Thanks for having me.
(END VIDEOTAPE)
HOLMES: And finally, here on the program, a little beauty returned to the Western Ukrainian city of Lviv over the weekend. As ballerinas, once more,
left across the stage of the National Opera House. The theater was close to its doors on February 24th when Russia launched the invasion at its grand
reopening. Correspondent Isa Soares went backstage to capture the grace and the grit of Ukraine’s elite dancers.
(BEGIN VIDEOTAPE)
ISA SOARES, CORRESPONDENT AND ANCHOR (voiceover): Away from the front lines, an army of artists began the process of mending this
nation’s grief, gently repairing the hurt brought on by war. At Lviv’s National Opera everyone has a part to play.
Tonight’s Giselle ballet will be the first full performance since the theater closed its doors almost two months ago. As musicians dust off their
instruments and as the audience starts to trickle in —
For us, coming to the theater is returning to a small part of our life which was there before the war. We are internally displaced from Kyiv, says
Julia Dmitriyeva (ph). We had to come to Kyiv, while there are hostilities.
The artistic director tells me why they decided to open now.
We understand that light must defeat darkness. That life must defeat death. And the mission of the theater is to assert this.
But the reminders of war are never too far away.
UNIDENTIFIED FEMALE: Dear guests, our round in case of an air raid —
SOARES (voiceover): Only 300 seats were allowed to be sold tonight. The capacity of the opera’s bomb shelter. Still, it’s sold out.
SOARES (on camera): It’s only minutes now until that curtain opens. And you can feel the tension because this performance is extra special.
SOARES (voiceover): For a few hours, nothing else matters. As the audience and I are transported to a world of love and beauty. Playing Giselle
tonight is 21-year-old Daryna.
It feels great, she tells me back in her dressing room, because dancing helps to distract from what’s happening.
Like many here, her life has been shaken by war. And the horrors of Bucha where mass graves were recently found.
My mom and my grandmother and her sister survived occupation in Bucha, she tells me. Now, she’s in safety in Poland restoring her nerves.
Daryna finds solace in this stage. Throwing herself behind her character.
All the negative emotions which accumulate for a long-time flow out, she tells me.
A cathartic performance for both those on and offstage. Offering comfort to those who need it most. In the hope that they can lift, if only just
briefly, this nation’s aching soul.
(END VIDEOTAPE)
HOLMES: Isa Soares reporting there from Lviv in Ukraine. I’m Michael Holmes, thanks for watching and goodbye from Atlanta.