Voice

Would American Money Have Saved James Foley?

European governments pay millions of dollars in ransoms to free their hostages. The White House needs to decide whether it’s willing to sacrifice principle for people.

The bloodthirsty jihadists of the Islamic State (IS) have murdered James Foley, an American journalist who was kidnapped in Syria in November 2012. They also have threatened the life of Steven Sotloff, another American freelancer, who was seized last August, and who has written for Foreign Policy on three occasions. The executioner in the video warned President Barack Obama that Sotloff would die if the White House continues its bombing campaign in Iraq. I assume that the president has asked intelligence and special forces operatives whether Sotloff could be freed in a raid. I hope he determines that he can be, but it's very unlikely. According to the New York Times, a rescue attempt earlier this summer came to naught when commandos air-dropped into a remote region of Syria failed to find the hostages. The record of rescue attempts has not been good since American helicopters came to grief in the Iranian desert in 1980. And IS could be shuttling Sotloff anywhere in their vast "caliphate."

It is a gut-wrenching moment. And it's impossible not to think about how it could have been otherwise.

Sotloff had been seized a few weeks before I arrived on the Turkish-Syrian border to write a piece for FP about the rampant kidnapping of journalists by IS (at the time, still ISIS) and other Islamist extremists. I never met him, but he was a good friend of Barak Barfi, an Arab scholar and fellow at the New America Foundation who served as my guide and mentor on that article. I talked to many of the people who had advised Sotloff on when and where and how to cross into Syria that last time. (Little of that made its way into my dispatch, since I went to great lengths to protect the identity of journalists then being held.) Some of them thought he had not taken proper precautions; but the situation had deteriorated so rapidly over the summer of 2013 that even a few of the world's most experienced war correspondents had escaped being seized only by a stroke of luck. Sotloff was one of the unlucky ones.

Being kidnapped is not usually a death sentence, whether for diplomats or businessmen or tourists or journalists. Most kidnappers in war zones view their prey as a commodity. The Taliban who kidnapped New York Times correspondent David Rohde in Afghanistan at first sought to trade him for money. In Syria, the nationalist rebels who seized journalists in the first years of the war usually held them briefly and then sold them off. ISIS, however, was different. They asked nothing, and divulged nothing. Their victims simply disappeared. And yet, it seemed, they had not been killed. No one knew what, if anything, they wanted. Perhaps they weren't sure either.

And then, earlier this year, some disappeared journalists began to emerge. Two Spanish journalists were released in March. The following month, four French journalists emerged from captivity. It was widely assumed that ISIS had demanded ransom, and that the European governments had agreed to pay. European governments generally agree to make, or facilitate, ransom payments, which are believed to have run as high as $10 million.

Neither the United States nor Britain makes payments of this sort, and both countries sharply criticize European governments for doing so. But perhaps that's why no American or British journalists have been freed during this period. In August, of course, the United States began bombing IS positions in Iraq, further complicating any official attempts -- if they were made at all -- to free Foley and Sotloff. They were thus available to serve as punishment, and as blackmail.

This raises an agonizing question: Should states pay ransom to kidnappers? If you are a friend or loved one of the victim, the answer is obviously yes. But even a more remote observer could cite the moral argument that the obligation to treat people as ends rather than means -- what Kant calls the "categorical imperative" -- forbids one to place the life of the abductee in a balance with abstract goods, like "sending a message" that kidnapping doesn't pay. In any case, the consequences of capitulation are remote and hypothetical; the life is terribly real. Israel, the most hard-nosed of democracies, has been prepared to pay a terrible price to retrieve its captured soldiers; in 2011, the state handed over 1027 prisoners, a quarter of them serving life terms, in exchange for Gilad Shalit. Israelis understand that by doing so they may encourage further kidnapping, and thus further endanger their own security; it is a price they are prepared to pay.

Journalists are not soldiers, and Americans are not Israelis. And U.S. presidents are clearly not moral philosophers. The president has an obligation to consider the consequences of his decisions, and act accordingly. The consequences of capitulating to terrorist kidnappers are ruinous. As a recent New York Times investigation revealed, "Kidnapping Europeans for ransom has become a global business for Al Qaeda, bankrolling its operations across the globe." That's why no European government will admit to making payments. The thought of Steven Sotloff jammed into a pit, awaiting death, when he might have been freed for nothing more than money, is unbearable. But the thought of rewarding the Islamic State for its savagery is also unbearable. A humane response to a monstrous act engenders more monstrousness.

At the end of the video apparently showing Foley's execution, Sotloff is shown kneeling; the IS executioner says, "The life of this American citizen, Obama, depends on your next decision." The plain implication is that President Obama could save Sotloff's life by calling off the American bombing campaign in northern Iraq. One might say that this represents another stage of the moral dilemma; but here the calculus is unambiguous. To call off the bombing is to endanger thousands of Iraqi civilians now menaced by the jihadists' advance; and there is no guarantee that IS would have even a modicum of compunction to spare their captive's life -- even if they got what they wanted. Nevertheless, you would not want to be in Obama's shoes right now.

The liberal state is awestruck, and often paralyzed, in the face of evil. We shiver when we hear a Taliban or al Qaeda warrior boast, "We worship death and you worship life." To seek death over life is to gain mastery over those who love life. That's why the suicide bomber is such a fearsome weapon. In fact, peace-loving people are prepared to fight, and risk death, to preserve everything that makes life worth living. Yet there is a terrible insight in that death-swagger. When our cherishing of each life leads us to surrender to blackmail, we fortify the death-cult; we abet evil.

One wishes, of course, for some sort of Gotterdammerung out of Inglourious Basterds, in which the former victims rise up to give the monsters a taste of their terrible medicine. That's what the movies are for. In real life, Obama has done what he can do by sending American warplanes to hammer IS positions in Iraq. For the moment, at least, he has saved Kurdistan from being overrun, and driven the jihadists away from the Mosul Dam. That's a very good start. There may be nothing Obama can do to save Steven Sotloff. But there is a great deal he can do to show the criminals of the Islamic State that the West is prepared to defend the values it professes.

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COLUMN

Why Are So Many Women Dying From Ebola?

Studies show that infectious disease often affects one gender more than another -- but that knowledge isn't being put into practice. 

When people started dying from Ebola in West Africa in March, Martha Anker, a former statistician in communicable disease surveillance and response at the World Health Organization (WHO), began watching the news to see whom primarily the terrible disease would strike. Sitting in her house in Massachusetts, Anker had a gut feeling: that Ebola, as it had in the past, would claim women as its primary victims.

As it turns out, Anker was right.

On Aug. 14, the Washington Post reported that across Guinea, Liberia, and Sierra Leone collectively, women have comprised 55 to 60 percent of the dead. In Liberia, the government has reported that 75 percent of victims are women. "I felt very sad when I read that thing from the Washington Post," Anker says. "I'm so sorry to be right."

Back in 2007, Anker wrote in a WHO report, "Differences in exposure between males and females have been shown to be important factors in transmission of EHF [Ebola hemorrhagic fever]. Therefore, it is important to understand the gender roles and responsibilities that affect exposure in the local area."

That entreaty clearly didn't find its way to West Africa when this current outbreak began. Ebola spreads through contact with blood and other bodily fluids, and in Liberia, as in neighboring countries, women are usually the primary caregivers for the sick. They continue to be during the current epidemic -- they stay in their homes and become infected by their children or husbands instead of seeking out doctors and nurses for their loved ones. Rarely are the roles reversed. "If a man is sick, the woman can easily bathe him but the man cannot do so," says Marpue Spear, the executive director of the Women's NGO Secretariat of Liberia (WONGOSOL). "Traditionally, women will take care of the men as compared to them taking care of the women."

It shouldn't take so many deaths -- more than 1,200 at the time of this writing -- to realize how attention to gender dynamics might help save lives (in this case through, among other things, targeted messaging to women about the importance of using protective measures at home or allowing loved ones to be cared for by trained professionals). Indeed, there shouldn't have to be Cassandras like Anker -- for Ebola and other diseases.

Data show that many infectious diseases affect one gender more than another. Sometimes it's men, as with dengue fever. Sometimes it's women generally, as with E. coli, HIV/AIDS (more than half the people living with the virus are female), and Ebola in some previous outbreaks. Sometimes it's pregnant women and mothers, as with H1N1 (an outbreak in Australia is currently infecting women over men by a 25 percent margin).

Yet when women are the primary victims of an epidemic, few are willing to recognize that this is the case, ask why, and build responses accordingly. Indeed, experts say that too little is being done to put even the small amount that is known about gender differences and infectious diseases into practice -- to determine in advance of outbreaks, for instance, how understanding gender roles might help in the development of a containment or prevention strategy. Not only that, but there is too little research being done to understand how infectious diseases affect the sexes differently on a biological level. It's like Groundhog Day each time a disease surges, and people are losing their lives because of it. "We can't get past the 'interesting observation' stage," says Johns Hopkins University professor Sabra Klein. Public health officials generally gather data on age and sex in a crisis, but "nobody goes somewhere with it."

Klein, who studies biology and immunology, explains that going "somewhere" would mean consciously evaluating what happens in an outbreak, or in any health crisis, through a gender lens. It would also mean tackling systemic problems, such as women's unequal access to adequate health care or the finances they might require for treatment. In short, it would mean challenging fundamental and dangerous disparities.

Looking at who dies in an outbreak "shows you who has power and who doesn't," says Columbia University epidemiology professor Wafaa El-Sadr. "In a way, it holds a mirror to society. And it shows societies how they treat each other."

***

As in many spheres, the funding, research, and thinking in public health has long been geared toward white men. As Claudia García-Moreno, lead specialist in gender, reproductive rights, sexual health, and adolescence at the WHO in Geneva, puts it, "When I was in medical school, everything" -- drug dosages, public health scenarios -- "was still defaulted for the '70-kilo white male.'" García-Moreno says that though this has changed somewhat, "it's still not what we would hope it would be."

García-Moreno points to a persistent lack of attention to the "biological components" of disease. There are often basic differences in how men and women respond to infection, Klein echoes, and those can -- and should -- affect medical responses in the short and long terms. Take influenza, for instance; according to Klein, "Inflammation caused by infection is often greater for women than for men." Similarly, Anker noted in a 2011 WHO report, "A frequent mistake is to undercount the relative importance of symptoms that can only occur in one sex, such as vaginal bleeding in dengue."*

"You get these really interesting observations about Ebola, too," Klein adds. "[Yet when] research funding is coming in for Ebola, they will not even consider the role sex might play."

As evidence of this sort of dismissal of gender's importance in public health matters, Klein describes an anonymous note once included in a review of a grant application she wrote. "I wish you'd stop with all this sex stuff and get back to science," it read. "I've been in this field for 20 years and this [biological difference] doesn't matter," another note once stated.

Throughout her career, Anker has been beating back against similar faulty notions, though ones often rooted in social, as opposed to biological, issues. "The general belief has been that since infectious diseases affect both males and females, it is best to focus public health attention during an outbreak on control and treatment, and to leave it to others to address social problems that may exist in society such as gender inequalities after an outbreak has ended," she wrote in the 2011 WHO report. However, addressing these "problems" can be critical to understanding and stemming an epidemic's spread.*

Consider nurses. They are primarily female worldwide, and they are frequently at the forefront of dealing with infectious diseases. Yet very often, they are too low on the social -- and gender -- totem pole for their needs to be heard clearly. "Research has shown that poor nurse-physician relationships are common in hospital settings, pose a potential threat to patient safety -- including the risk of infections [--] and have a negative impact on nurse satisfaction and retention," the 2011 WHO report stated. Moreover, after the 2003 SARS outbreak, Canadian studies found, according to the WHO, that a "lack of power and influence of nurses was linked to infection control deficiencies."

Considering gender more broadly, in one previous Ebola outbreak, an anecdotal report claimed that men dominated informational meetings on the disease, despite the fact that women were already known to be primary caregivers. During H1N1 (avian flu) outbreaks, government officials tended to deal with men because they were thought to be the owners of farms, despite the fact that women often did the majority of work with animals on backyard farms. And some dengue-control programs in Southeast Asia in the early 1990s, according to one report, "met resistance" because health workers "called into question the woman's ability to preserve health by maintaining a household free of disease."

These problems are certainly entrenched. Yet with each new outbreak or uptick of an infectious disease comes a chance to do things differently. "Whether they be acute or chronic epidemics, they tend to show the schisms and the vulnerabilities that exist [in a society]," says Columbia's El-Sadr. "Maybe with Ebola it will bring to the fore the weaknesses in the health system; it will bring to the fore the plight of people who have been disenfranchised."

"Maybe the lessons learned can help prevent the next epidemic," she adds.

With so many dying in West Africa, there is an opportunity to go against the grain, to try to incorporate a much-needed gender lens into medical and social responses. Now is the time to do it -- just like it was in the last crisis.

Correction, Aug. 20, 2014: Two quotes in an earlier version of this article were incorrectly attributed to a 2007 report by the World Health Organization. The report was actually published in 2011.

Photo by John Moore/Getty Images