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When drone footage emerged of New York City’s COVID-19 casualties being buried by inmates in trenches on Hart Island, the images became a key symbol for the pandemic: the suddenly soaring death toll, authorities’ struggle to deal with overwhelming mortality and widespread fear of anonymous, isolated death. The images shocked New Yorkers, most of whom were unaware of Hart Island, though its cemetery operations are largely unchanged since it opened over 150 years ago, and about one million New Yorkers are buried there. How does Hart Island slip in and out of public knowledge for New Yorkers in a cycle of remembering and forgetting – and why is its rediscovery shocking? Perhaps the pandemic, understood as a spectacular event, reveals what has been there, though unrecognised, all along.
Based on the anthropological classification of death into ‘good deaths’, ‘beautiful deaths’ and ‘evil deaths’, and using the methodology of screen ethnography, this article focuses on mourning in Brazil during the COVID-19 pandemic, especially the extreme cases of deaths in Manaus and among the Yanomami people. The article ‘follows the virus’, from its first role in a death in the country, that of a domestic worker, to hurriedly dug mass graveyards. I consider how the treatment of bodies in the epidemiological context sheds light on the meanings of separation by death when mourning rituals are not performed according to prevailing cultural imperatives. Parallels are drawn with other moments of sudden deaths and the absence of bodies, as during the South American dictatorships, when many victims were declared ‘missing’. To conclude, the article focuses on new funerary rituals, such as Zoom funerals and online support groups, created to overcome the impossibility of mourning as had been practised in the pre-pandemic world.
Research into the governance of dead bodies, primarily focused on post-conflict contexts, has often focused on the aspects of the management of dead bodies that involve routinisation, bureaucratisation and order. Less attention has been paid to the governance of the dead in times of relative peace and, in particular, to the aspects of such work that are less bureaucratised and controlled. This article explores the governance of dead bodies in pandemic times – times which although extraordinary, put stress on ordinary systems in ways that are revealing of power and politics. Observations for this article come from over fifteen years of ethnographic research at a medical examiner’s office in Arizona, along with ten focused interviews in 2020 with medico-legal authorities and funeral directors specifically about the COVID-19 pandemic. The author argues that the pandemic revealed the ways in which the deathcare industry in the United States is an unregulated, decentralised and ambiguous space.
This article sets forth a theoretical framework that first argues that necropolitical power and sovereignty should be understood as existing on a spectrum that ultimately produces the phenomenon of surplus death – such as pandemic deaths or those disappeared by the state. We then expound this framework by juxtaposing the necropolitical negligence of the COVID-19 pandemic with the violence of forced disappearances to argue that the surplus dead have the unique capacity to create political change and reckonings, due to their embodied power and agency. Victims of political killings and disappearance may not seem to have much in common with victims of disease, yet focusing on the mistreatment of the dead in both instances reveals uncanny patterns and similarities. We demonstrate that this overlap, which aligns in key ways that are particularly open to use by social actors, provides an entry to comprehend the agency of the dead to incite political reckonings with the violence of state action and inaction.
Chapter 1 explains the initiation of the anthropological research in 2017, when the MSF programme in Amman entered its tenth year. Multiple questions about the patients’ wellbeing both in the hospital and after they returned home required answers. Simultaneously, the concept of a “patient-centred approach” was flourishing at MSF, and the RSP had declared it one of its main preoccupations. The chapter details the qualitative-research methodology used in my research. In-depth interviews with ninety-nine MSF staff members and seventy-four patients from Syria and Iraq were transcribed, coded, and analysed using a thematic-analysis approach. Furthermore, extended observations of participants both inside the MSF hospital and in patients’ homes, and internal MSF documents provided information used in the process of triangulation. I describe how my observations over the six months I spent in the RSP hospital grew out of my integrated position, embedded in the hospital microcosm. My constant presence there facilitated my formal and informal interaction with staff. The chapter concludes with reports from my fieldwork in Jordan and Iraq. My vantage point – inside the home countries and literally inside patients’ homes – gave me the unique opportunity to observe the intimate physical and social environments of my participants.
In Chapter 2, I follow patients and staff through their daily routines in the hospital. I describe the spectrum of emotions experienced by members of hospital staff, ranging from their personal motivation to the emotional impact on them of the daily support they provide to the victims of war. The hospital routine is marked by mutual informal interactions between patients and staff, lending a general sense of informality and friendliness to the institutional relationships. Nevertheless, providing a “healing environment” and remaining steady under the visual impact of deformed limbs carries a certain price. Interviews with staff suggest feelings of sadness, guilt, and generalized emotional distress. These overwhelming emotions are linked to the staff’s perceptions of patients. Patients are predominantly viewed as victims, lacking their own agency, and patronizing attitudes are sometimes imposed to justify the social order in the hospital. An enduring hospital culture of stereotyping is widespread. This became obvious through positive descriptions of Iraqi patients in contrast to derogatory portrayals of Yemeni patients, who are viewed as lacking proper hygiene practices, for example, or not understanding the Jordanian dialect of Arabic. Despite all of this, the hospital appears to be a successful melting pot, where cultures blend and transformation takes place. It becomes a place where a patient’s sense of self is gradually altered.
The Introduction opens with a description of the book’s intent and my position as an anthropologist examining the humanitarian field. I introduce the story of one war victim – Ismael – who presents in microcosm the unique aspects of the patients in the MSF Reconstructive Surgery Programme (RSP). I go on to explore the invisibility of the war-wounded, especially those who have never participated in combat. The Introduction continues with a discussion on the delivery of humanitarian surgery, a specific field in the larger world of humanitarian aid. I touch briefly on the history of MSF surgical programmes and capture some of the history of MSF’s surgical practices, which go back to the very origins of the organization itself. RSP is a programme that reflects the cumulative MSF experience. The Introduction concludes with an in-depth description of MSF’s RSP in Amman, Jordan. Currently, patients in the RSP, who often sustain critical injuries years before they are admitted to the hospital, have various levels of disability or have lived with significant post-surgical complications. The Introduction explores several of the aspects that make the RSP unique. Among them are surgical procedures focused on functional improvements, the months and sometimes years-long rehabilitation undergone by patients away from their home countries, the scale of the programme, and the multi-disciplinary treatment provided.
Chapter 3 examines events related to patients’ injuries and reports on typical incidents in the immediate aftermath of an injury. The chapter shows how patients carry a double burden: that of their injury and of the disruption to their family and social environment. We meet Ali, a Syrian patient. Retelling his personal history, Ali describes the risks taken by the wounded and by those who try to save them. Ali reports multiple losses: his health, social identity, loved ones, material objects, and sense of security and trust. Numerous scenarios experienced by other participants in the study tell of the ways their lives were changed in a matter of seconds. The majority of those injured in Syria were wounded in bombing raids from the air or by gunshot. Iraqis, in contrast, were mainly the victims of explosions. The narration style of each group indicates how they frame, understand, and feel about the injury event. But in all cases, the incidents related to the injuries certainly leave their mark. The subsequent struggle to access healthcare and a safe refuge adds to the toll. The chapter details the long and difficult journeys taken by the wounded leading them eventually to the RSP in Amman. They carry their painful, traumatized past with them.
Chapter 4 looks at patients’ reflections on the care they received in the RSP, told years after being discharged from the hospital. Aside from reporting on programme strengths, particularly in providing a healing environment, patients shed light on the gaps that need to be addressed if the programme is to achieve its goal of delivering patient-centred care. The reader is presented with patients’ expressions of relief and gratitude for the care they received at the hospital. They describe beneficial aspects of the treatment that extend far beyond medical care, encompassing the relationships developed in the hospital setting. Furthermore, the chapter re-examines the notion of “unrealistic” patient expectations. When framed from the patients’ perspective, this notion appears flawed. In contrast to staff perceptions, the vast majority of patients report being fully satisfied with their treatment. For those patients who did express some degree of dissatisfaction with the programme, it was mostly related to a mismatch of priorities they have with the RSP. They spoke primarily about what they perceive as a neglect of the aesthetic dimension of care and the RSP’s emphasis on functional improvements. These perceptions highlighted gaps in the patient-centred approach and questioned the dominant assumption that functional outcomes alone improve patients’ lives.