Chris Giannou

DATE February 14, 2002 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Dr. Chris Giannou discusses his experiences in
Afghanistan
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

My guest is Dr. Chris Giannou, a veteran war surgeon who is now the head
surgeon of the International Committee of the Red Cross. He was in
Afghanistan with the Red Cross, making the rounds of hospitals and prisons
from mid-November through the end of the year. Some of the hospitals he
worked in were located in areas controlled by the Taliban, others by the
Northern Alliance. The Red Cross convoy he traveled with made its way across
land mine fields and flooded rivers. The mission was to deliver medical
supplies, evaluate the medical needs at hospitals, train doctors and surgeons
and perform surgery as needed.

Dr. Giannou has worked as a war surgeon in Lebanon, Somalia, Rwanda, Sierra
Leone and many other places. I asked him to describe one of the typical
hospitals he saw in Afghanistan.

Dr. CHRIS GIANNOU (International Committee of the Red Cross): Well, how
typical is any hospital in Afghanistan? Let me give you an example of the
Kunduz hospital, which went through a very, very difficult situation. This is
in a large compound, and everything is one floor. There's no second story.
Most of the Third World, you do not use elevators, so hospitals are a modular
system, several buildings, all ground floor. And this is a large brick and
stone structure that was built about 25, 30 years ago; very high ceilings.
The Kunduz hospital is large. It's about 200, 250 beds. And the hospital had
functioned very, very well. Even under the Taliban regime, the hospital staff
had been there. They were staying.

When the Taliban retreated, and before Northern Alliance troops could enter
the city of Kunduz, there was a gap of about six or eight hours, and during
that period there was looting in the hospital, OK? Uncontrolled soldiers went
in, they took whatever medicines and easy-to-carry equipment that they could
and they threatened the staff. Several days earlier I had been told that one
of the doctors or dentists had been shot dead by some of these uncontrolled
elements.

The staff was truly shocked, and all of the Northern Alliance now controlled
Kunduz; it was quiet. They still refused to go back to the hospital, so the
hospital was quite empty. There were only about 10 or 12 nurses, one or two
doctors ...(unintelligible).

GROSS: They refused to go back because they were afraid?

Mr. GIANNOU: They were afraid. They were afraid that security was still not
guaranteed, that there would still be further looting. We delivered
medicines. The director of the hospital said, `Please don't leave the
medicines. If you leave the medicines, then this will be a target for more
looting.' So we left the medicines in the office of the governor of Kunduz.
We saw the governor, we tried to see the military authorities, and over the
next two or three days we insisted on seeing the military authorities of the
Northern Alliance to get them to assure the security of the hospital.

And I was away in Taloqan, which is only about an hour and a half from
Kunduz--you have to drive through a minefield--and two or three days later
when I then returned, I found the hospital full of staff and they were
cleaning up and starting to operate again. During that first week we had to
evacuate about 10, 12 patients from Kunduz to the still-functioning hospital
in Taloqan. These are wounded patients, mostly; a couple are ill. The
hospital staff was back and I asked and they said, `Now the security's all
right. We are assured that there is no further looting. We have our system
back in place to assure our security and that of the patients.' And the
hospital started functioning again.

GROSS: I know you performed some surgery during your rounds of the hospitals
in Afghanistan. You were there to evaluate their needs, but you also performed
some surgery as well. How did you decide whether you should step in or not?

Dr. GIANNOU: Well, many of the surgeons I had worked with previously, and
therefore they knew me. And there was not a question of my stepping in. It
was usually a question of my Afghan colleagues asking me, `Please, we have
this sort of case. Would you please come and do the case with us?' And this
was great for a couple of bone cases, orthopaedics, one case where there was
an injury of an artery and a vein and it forms a fistula between the artery
and the vein. And these are a little bit more specific types of operations
where they've said, `We've been trying these things before, but would you
please come and work with us?' So those are the sort of cases. It's not a
question of my stepping in, it's really a question of my colleagues saying,
`Please come and do this with us.'

GROSS: Could you describe one of those surgeries and why it was so difficult
for the doctors there to perform it?

Dr. GIANNOU: Well, vascular surgery is a particular specialization, and
there's a big difference between a relatively healthy artery, such as the
femoral in the thigh, that a butcher may cut with a knife and you get a nice
clean cut and it's very easy to find the artery and it's very easy to patch it
together again. When you get a bullet wound, and all of the muscles around it
are damaged as well, it's sometimes difficult to even find the artery, and a
segment of it may be injured, and therefore you have to dissect it off, which
means now the artery is short, and you have to be able to mobilize it for
several inches upstream and down in order to then get the two ends together so
that you do your suture, your anastomosis.

And when you get a very small injury, both in the artery and in the vein,
there is a passage of blood that goes between the two, and some of the blood
clots and it gets larger and larger and larger and then starts pulsating. And
it can very easily infect, and when it does sort of rupture, the patient very
easily bleeds to death, or your grab a hold of the artery and then you're
usually faced with an amputation. And trying to dissect through this fragile
tissue that has been damaged by the bullet, by the shrapnel fragment, can be
difficult. These are the cases that my colleagues asked me to help them with.

GROSS: Was this particular surgery successful?

Dr. GIANNOU: It was, yes. Not always the case, but...

GROSS: Did you have anesthesia for the patient?

Dr. GIANNOU: Pardon?

GROSS: Did you have anesthesia for the patient?

Dr. GIANNOU: Anesthesia? Yes, oh, yes. Oh, yes. I mean, we supplied the
hospitals--they did not run short of anything.

GROSS: And there was antibiotics to prevent infection afterwards.

Dr. GIANNOU: Yes.

GROSS: What can...

Dr. GIANNOU: The best antibiotic is good surgery.

GROSS: What were the conditions you had to perform the surgery under?

Dr. GIANNOU: The operating theater is cold. They do not have central
heating, and in northern Afghanistan especially, it reaches zero and below
zero. To heat the operating theater they use a wooden stove called a
bohare(ph). Some work with diesel fuel, others with wood, and you have to
stoke it. Sometimes it gets a bit smoky. But that is the only way to heat
the operating theater and the wards.

GROSS: Well, what about the smoke or the soot? Does that infect the wound?

Dr. GIANNOU: Well, you try to keep the soot away, but the body also has
mechanisms of defense.

GROSS: And if your fingers get cold it's not a good thing if you're
performing delicate surgery.

Dr. GIANNOU: That's right, that's why they try to heat the room.

GROSS: Right, right, right. Did the hos--yeah.

Dr. GIANNOU: It's also good for the patients. I mean, a patient who has
been bleeding and is in shock, goes into hypothermia, and that hypothermia
will then create problems for blood coagulation. And therefore you have to
keep the room warm as much as for the surgeon's benefit, but also for the
patient's benefit.

GROSS: What was your impressions of how Taliban control had affected the
medical system in terms of women; women doctors, women patients?

Dr. GIANNOU: Well, a great deal has been said about this in the Western
press and a great deal of it is wrong. What is true is that from '96 on, the
health system--what was left of it--truly fell apart, and what remained was
the parallel system that the ICRC, the World Health Organizations, NGOs set
up. We were the ones who were running the health system, certainly not the
Taliban regime. The question of stopping women and going to certain
hospitals, that only concerned Kabul. In Kandahar, which was the capital of
the Taliban, the one central hospital, that's all there was for about two or
three million people in several provinces. Well, there was the women's ward
and there was the men's ward. And you had women nurses and doctors taking
care of the women, and men doctors and nurses taking care of the men.

And one little event that occurred just over a year ago was that in
Kandahar--and they did not consult us--the Taliban authorities took the
initiative themselves to open up a school of nursing. They had 200 students;
100 men and 100 women. So there was the Taliban School of Nursing training
women to be nurses so that there would be female nurses to take care of female
patients. Now that's not to say that, obviously, the Taliban truly considered
the status of women. Women were still refused the possibility to work, apart
from the health professions, and it's very difficult to train somebody to be a
nurse if they are totally illiterate.

But the Taliban were full of such contradictions. They wanted their own wives
and sisters to be treated by female medical staff, and then they thought,
`Well, how are we going to have a female medical staff if we don't train the
women? So let's train the female nurses. But before that, we've got to teach
them how to read and write.' But they'd closed down the schools. So they were
caught up in their own contradictions, their own world view of things, and
that's not the least of their shortcomings. But women did, to a certain
extent, have access to certain things.

What people must also understand is that Afghanistan is a very conservative
traditional society. Today the Taliban are gone; .5 percent of women in the
country have taken off the burqa; 99.5 percent of women continue to wear the
burqa, and it has absolutely nothing to do with the Taliban. It has
everything to do with a patriarchal, socially conservative society. And it's
going to take quite some time for people to even get back to the days of the
old Communist regime where you saw miniskirts in Kabul.

GROSS: Did you treat any women when you were in Afghanistan?

Dr. GIANNOU: Yes.

GROSS: And were they particularly uncomfortable being treated by a male
doctor?

Dr. GIANNOU: Not the ones that I did, but that has been known to occur. And
one of the biggest problems is simply getting the woman to the hospital. That
is why...

GROSS: Why is that so difficult?

Dr. GIANNOU: Well, for these conservative villages to accept that a woman
should have access to medical care. Once she gets to the hospital, then there
is care for her. But if you take a look at the hospital beds, three-quarters
will be for men and only one-quarter for women. Most of the women who need
medical care don't even get to the hospital. That's the problem. And that is
a problem of a socially conservative society, which does not really care much
for the state and status of women. But that predates the Taliban and it
continues to exist today. So that is a totally different societal problem
that Afghan society has to deal with, irrespective of who is in power.

GROSS: Are there any changes in how the government is dealing with health now
in Afghanistan?

Dr. GIANNOU: In Afghanistan today, in the interim government, the new
minister of Health is a woman doctor, a female surgeon by the name of Suhaila
Seddiqi. And Suhaila, for me, epitomizes the contradictions in Afghan
society. She was a former member of the Central Committee of the Afghan
Democratic Communist Party. She was head surgeon of the military hospital.
When there were Soviet surgeons there, she used to tell the Soviets what to
do. She ordered them around. When the mujaheddin took over, this woman had
such a reputation for honesty and integrity that they kept her as the head
surgeon of the military hospital and the armed forces of Afghanistan. It was
only the Taliban in 1996 who removed her as head surgeon. She resisted, and
what she did was she took over a building within the compound of the military
hospital in Kabul and set up a hospital for women and children. We provided
her with instruments and medicines. She continued to work. Suhaila today is
the new minister of Health.

So here is an example of some of the contradictions of Afghan society where
many women do not have access to health care because their menfolks who do not
bring them to a hospital, and at the same time, you have a woman who was chief
surgeon of the Afghan armed forces, and she today is the minister of Health.

GROSS: My guest is Dr. Chris Giannou, head surgeon with the International
Committee of the Red Cross. We'll talk more after a break. This is FRESH
AIR.

(Soundbite of music)

GROSS: My guest is Dr. Chris Giannou. He's the head surgeon for the
International Committee for the Red Cross. In the past couple of years, he's
been in Nepal, Sri Lanka, Chad, Macedonia, the Congo, Somalia, Sierra Leone,
Uganda. From mid-November through the end of 2001, he was in Afghanistan,
and we're talking about what he found there.

During your travels to Afghanistan, you not only visited several hospitals,
you visited several prisons to evaluate the medical needs of prisoners, and I
imagine you performed some surgery there as well. Would you describe, what
are the prisons that you visited?

Dr. GIANNOU: Well, most people when they read in the papers that the Red
Cross is visiting prisoners, they're rather surprised because they don't
understand what's going on. A lot of our work is driven not by needs,
assistance. It is driven by what we call protection issues, and this is the
difference between human rights law and international humanitarian law, which
is the law of war. In human rights law, what counts is the individual, and
individuals, whether at peacetime or wartime, have what are considered to be
inalienable rights.

The laws of war, humanitarian law, deal with categories of people. You have
the civilian population as a category. You have prisoners of war or the
wounded amongst military forces as categories of people who are protected. A
prisoner is somebody who, in a war setting, has decided not to fight until
death, not to lay down his arms and go home, but surrenders, and by
surrendering, takes it upon himself a little bit like a soldier's honor to
say, `I no longer am a combatant.' And at that point, you make him prisoner,
and it's a sort of social contract. You're not supposed to execute him
summarily. You're not supposed to torture him. You are supposed to detain
him under what are considered to be humane conditions of detention. And the
International Committee of the Red Cross, as one of the guarantors of the
Geneva Conventions and their additional protocols--that is to say the rules of
war--we visit the prisons. Now our prison visits include a delegate, plus a
health delegate, and we look at the conditions of detention.

GROSS: So when you visited prisons and assessed the conditions there, did you
see prisoners who seem to have been victims of torture? Were there a lot of
medical problems that you saw? Give us a sense of that.

Dr. GIANNOU: There were a few medical problems. Some of the prisoners had
been wounded. They had been treated. They needed further operations, and we
organized with the hospital that that occur. Now apart from that, I cannot
tell you what I see in a prison. This is supposed to be confidential, and it
is a report that the ICRC makes to the detaining authorities. So we are
visiting prisoners today, for instance, in Guantanamo Bay. What we see, what
recommendations we make to the detaining authorities--in this case, the United
States--will remain confidential. They will be given only to American
authorities of detention, and we will tell them that either `Everything is
fine' or that, `No, this needs to be improved, that,' etc., etc. But that
will remain entirely confidential.

GROSS: Have you personally been in the camp with the detainees in Guantanamo
Bay?

Dr. GIANNOU: No. I personally have not, not in Guantanamo Bay.

GROSS: OK. If you're just joining us, my guest is Dr. Chris Giannou. He's
the head surgeon with the International Committee of the Red Cross.

When I interview a Western woman who has worked in Afghanistan, I always ask
her about how she dresses and how she feels she needs to change her behavior
in order to work there and be accepted with the people that she's working
with. What about you as a Western man? Is there anything you have to take
into account when you're working in Afghanistan with the Red Cross in terms of
your dress, your behavior, the visual cues that you give off to whoever you're
talking with? I don't know, anything that you have really think about.

Dr. GIANNOU: Of course, you always to be culturally sensitive. You are
going into a society, a culture that is not yours, and there are certain
things that are simply not well seen in that particular cultural society and
therefore, you have to take that into consideration. You wear long-sleeve
shirts. You don't go around with your chest naked. There are various other
things in your expressions and so forth. You learn this. At the same time,
you then, as you get to know the society better, you get in with people--I
mean, I go into hospitals and I go into the women's sections and I make jokes,
and people accept it, and they know, and it's not considered bad form. But
you have to know when to do it and how.

In the city of Mazar-e Sharif, back in '98, I was there during Ramadan, OK?
This is before the Taliban took over. Now Ramadan is the month where Muslims
fast from sunrise to sunset. And I would be invited at noon by four generals
of the security services of the four mujaheddin faction, and we would sit down
and eat at noon and drink locally made vodka. And that is in Afghanistan, a
socially conservative society. But that also exists. And like an Afghan
would know when do you do this and drink vodka at noon during Ramadan and when
do you not do it?

GROSS: When is it OK to do it?

Dr. GIANNOU: When everybody else around you is doing it as well.

GROSS: That's a good answer.

Dr. GIANNOU: And I was back in Mazar-e Sharif this last year and so forth,
and after the Taliban, they were back to making their locally made vodka. At
the faculty of medicine in Mazar-e Sharif, you have women students, and they
go around without a burqa, but only in the medical faculty. You do not make
jokes with women out in the streets or this, that, or in certain homes, but in
other homes, you would. In the hospital, you would. And this is simply
getting to know the society and to respect the norms of that society and what
is allowed, what is not allowed, and that's the case for a man, it's the case
for a woman. And those are some of the constraints that you have in
Afghanistan, but you have other sorts of constraints elsewhere.

GROSS: What's a joke that's an appropriate joke to tell to women in a
hospital in Afghanistan?

Dr. GIANNOU: Let's see. Oh. You're smiling radiantly today. Is it because
you got married or got divorced?

GROSS: Is there such a thing as divorce there, though?

Dr. GIANNOU: Oh, yes.

GROSS: Yeah?

Dr. GIANNOU: Oh, yes.

GROSS: And does that usually get a laugh?

Dr. GIANNOU: Well, it depends on the circumstances, of course.

GROSS: Dr. Chris Giannou is head surgeon with the International Committee of
the Red Cross. He'll be back in the second half of the show. I'm Terry
Gross, and this is FRESH AIR.

(Soundbite of music)

(Announcements)

GROSS: Coming up, Father Chris Keenan, Catholic chaplain of the Fire
Department of New York. He replaced Father Mychal Judge, who was killed on
September 11th at the World Trade Center, where he was praying over dying
firefighters. Also, we continue our conversation with war surgeon Dr. Chris
Giannou.

(Soundbite of music)

GROSS: This is FRESH AIR. I'm Terry Gross, back with Dr. Chris Giannou, head
surgeon with the International Committee of the Red Cross. He spent the last
six weeks of 2001 in Afghanistan with a Red Cross convoy making the rounds of
hospitals and prisons. Dr. Giannou has worked as a war surgeon in Lebanon,
Somalia, Sierra Leone, Rwanda and many other places.

But one of the issues that you're particularly concerned about is land mines.
And Afghanistan before the war on terrorism was already near the top of the
list of countries with the most land mines. How has the war added to the
problem?

Dr. GIANNOU: Well, first of all, top of the list, not a question of how many
land mines. That in many respects is irrelevant, although Afghanistan is one
of the most mined countries in the world. The problem is what percentage of
land that is economically productive or potentially productive and is excluded
from the normal production circuit because of the presence of land mines.

Now sometimes you also find land mines in cities. A good deal of Kabul is
still mined. You also have a problem with unexploded ordnance. And for
populations, there's not much difference between a bomb that does not explode
and a land mine. Both then stay in the ground, and if you walk on them, if
you have a vehicle go over them, they explode. Some of them act as sort of
booby traps quite simply because of the way that they have fallen or have been
placed. And Afghanistan is probably the most affected country in terms of
killed and wounded from land mines, anti-personnel, anti-vehicle, as well as
unexploded ordnance.

Now the most recent fighting has simply resulted in large areas being remined.
The front lines between Taliban forces and the United Front Northern Alliance
were mined with a large, large minefield set out in defensive positions. They
were not very useful, which is something we've been trying to tell people for
very many years, and not in terms of the actual outcome of the fighting. And
then, of course, with that fighting, there's quite a lot of ordnance that was
shot and simply did not explode when it hit the ground. And it was a
particular concern when it comes to cluster bombs.

GROSS: What are the problems that the cluster bombs pose?

Dr. GIANNOU: Cluster bombs--let me describe them. First of all, they're like
a large canister. It can be shot from an airplane or from a piece of
artillery. It opens up in midair and it scatters anywhere from 2 to 600
little bomblets. The numbers differ according to the particular type of
cluster bomb being used. And these bomblets are scattered over a radius of
100 yards, 200 yards. And they're supposed to explode when they hit the
ground. Anywhere from 5 to 30 percent do not explode when they hit the
ground. And they sit on the ground, some of them very, very fragile; often
simply a question of walking next to them. You don't even have to touch the
little bomblet for it to explode. And they sit there in the earth and act
exactly like anti-personnel land mines at that point.

GROSS: Did you see a lot of cluster bomb and land mine wounds in Afghanistan
during this trip?

Dr. GIANNOU: I was in the area of Taloqan-Kunduz to begin with and this is up
in the north. And the Taliban forces had been cut off in the Kunduz pocket
and were besieged there for quite a while. And, therefore, the front lines
were around the city and between Taloqan and Kunduz, and some of those front
lines had been bombed by American aviation. Cluster bombs had been used, and
in the succeeding weeks, we saw in the hospital, especially in Taloqan, quite
a number of people--and it varied--three or four a day for several days and
then none and then we get six or seven. And people talked about land mines
and cluster bombs. And this went on for quite some time. It's still going
on.

Now again even Afghan peasants are not stupid and, therefore, once you have
several injuries or deaths in a particular area, the word gets around. People
simply do not return there. And, therefore, the number of victims may drop.
As displaced persons return to their villages, the numbers of killed and
wounded go back up again until people sort of sort out where they can go
safely and where they cannot.

GROSS: One of the things you've had to do in getting to hospitals and prison
camps in Afghanistan was to drive through minefields. Now as a doctor, you're
as aware as anyone is of the dangers of minefields and the horrible wounds
that they inflict, not to mention death. So what's it like for you with all
this knowledge to knowingly drive through a minefield so that you can get to
treat mine victims at the other end?

Dr. GIANNOU: You're scared and you have to be stupid not to be scared. You
don't just drive through a minefield. Usually what has happened is forces
have advanced. They have cleared a breach in the minefield which is so many
yards wide, usually wide enough for one car, maybe two. And they'll then go
back to try to clear up the rest of the mines but they want to advance
quickly. So they clear a road through.

It usually works at least for that small segment, although there was an
example in the central mountainous region of Bunyan where we and a number of
other humanitarian organizations have been bringing food into this very
isolated region and medical supplies. And we were going along the major road,
and after about two or three weeks, somebody hit an anti-tank mine.

Now the anti-tank mine had been there all along. And somehow the trucks had
missed it for a couple of weeks. And then one of the trucks hit it. This is
the sort of thing that happens in a war zone and you accept the risk or else
you simply don't go there. And...

GROSS: Is the part of the road that's been cleared clearly marked?

Dr. GIANNOU: Yes, but there was even a problem at the Bagram air field. This
is the air field that was first secured by American and British forces and the
road from Bagram into Kabul was supposedly cleared. And then I went through
that road once when I arrived in Kabul and, about a week later when I left,
the signs had been changed around because what had been cleared apparently was
not completely clear. And they had also had an incident. And that's the
problem with land mines. And don't forget land mines will move around. Soil
erosion, snow, the melting waters, etc., they will move mines around and,
therefore, you can say, `Oh, yes, this place was clear.' And in the meantime,
it's rained. And the next time you go through, well, a mine has found its way
there because it's simply come down the hillside.

GROSS: Have you had any frightening close calls with land mines?

Dr. GIANNOU: Over the years, a couple of occasions where mines have exploded
near to where I was at the time, but I've also been shot at and bombed. So...

GROSS: Right.

Dr. GIANNOU: ...everything is relative. I've been taken prisoner, I've been
taken hostage. I've been--you know, it's a relative question.

GROSS: Why do you keep doing it? I mean, you've been at this for a long
time. How many years?

Dr. GIANNOU: Over 20.

GROSS: So, I mean, you're constantly putting yourself in jeopardy; plus,
you're seeing some of the best but also a lot of the worst aspects of
humanity, you know, the way people wage war and kill each other. This is what
you're immersed in all the time. So what keeps you going back for more?

Dr. GIANNOU: Well, what keeps me going, of course, is the best of humanity
that I see. I have worked with Afghan surgeons, I've worked with Somali
surgeons. I've worked with surgeons in the Congo and elsewhere. They haven't
received a salary in a year or two years. Their families are there. Their
families are in danger. I mean, I have a Canadian passport. I can get up and
go away. My monthly salary is put into my bank account. I don't even have to
worry about it or think about it.

They are there. They don't have a bank account in Geneva. They don't have a
Canadian passport. They're still taking care of their people. They don't get
paid, and yet they don't run away. Very courageous men and women. And it is
my honor to know them, to know that they are my colleagues, to have worked
with them, to try to support them so that they continue to work to serve the
health needs of their people even in catastrophic situations. It is their
example that keeps me going.

GROSS: My guest is Dr. Chris Giannou, head surgeon with the International
Committee of the Red Cross. We'll talk more after a break. This is FRESH
AIR.

(Announcements)

GROSS: If you're just joining us, my guest is Dr. Chris Giannou and he's the
head surgeon for the International Committee of the Red Cross. He's been
around the world performing surgery. He's been just in the past couple of
years to Sri Lanka, Macedonia, the Congo, Somalia, Sierra Leone and Uganda.
From about mid-November through the end of 2001, he was in Afghanistan.

Often both sides in a conflict recognize the value of the Red Cross and the
difficult work that the Red Cross is trying to do, but sometimes human rights
and medical groups become targets. What was traveling through Afghanistan
like? Did you feel like as a representative of the Red Cross that you were
respected as you were traveling through the country or that you were sometimes
the target?

Dr. GIANNOU: In Afghanistan, the Red Cross is well-known. And our colleagues
of the Afghan Red Crescent are well-known. They're present in the community
and all of the provinces. ICRC has been present for over 20 years. We have a
half dozen prosthetic centers around the country, artificial limbs.

I remember once several years ago arriving in the north in Kunduz where no
foreigner had been for five or six years. And we arrived in our car, and one
fellow came tearing across the road carrying his Kalashnikov. We froze. He
came up to us, broke into a large smile, a grin, pulled up his pant leg and
knocked on his artificial limb saying, `ICRC, ICRC.' And this was his
prosthesis. And then he said, `What do you need? What do you want? I can
show you where to stay and where to eat and where to this and where to that
and so forth and so forth,' quite simply because the ICRC had provided him
with an artificial limb which allowed him to work, which in this case was to
continue to fight. But he could have just as easily been a peasant, but he
was able to run and walk with his artificial limb. And there are thousands of
people like this all over Afghanistan. So we are known, and Afghanistan is
not a problem.

However, just last year in April of 2001, we had two expatriate and four
Congolese colleagues who were killed, assassinated in the Congolese town of
Bunya near the border with Uganda. In many conflicts today, we can really
talk about destructured conflicts, and many of the belligerents do not follow
a chain of command, a real hierarchy. Many of them are local warlords. Some
of them are simply local Mafia, bandits and...

GROSS: So there's no accountability.

Dr. GIANNOU: And there, there's no accountability and basically...

GROSS: And maybe no education, either.

Dr. GIANNOU: ...don't think of what the Red Cross can do for them or their
people because they don't care.

GROSS: Right. Right.

Dr. GIANNOU: And this is where real danger occurs and where we can become
targets. Also, even where there is a chain of command, sometimes you become a
target because people do not want embarrassing witnesses to be around, and
they prefer to have our foreigners leave, whether it's Red Cross or UN or
anybody else. So that also is a consideration in some contexts.

GROSS: You have treated many victims of religious wars, and I'm sure you have
treated many people who are very religious themselves and for whom religion
becomes particularly important when they are facing death. Are you religious
yourself? And I wonder, you must have thought a lot about religion seeing it
up close like that and seeing the best and worst of it as you have.

Dr. GIANNOU: I am a practicing atheist.

GROSS: They say there's no atheists in a foxhole. I guess you're proof that
that's not true.

Dr. GIANNOU: Yes.

GROSS: And has what you've seen from religious wars upheld your atheism?

Dr. GIANNOU: Well, what I've seen from any war, religious or otherwise, has
upheld my atheism.

GROSS: Care to expand on that?

Dr. GIANNOU: When you see what human beings are capable of doing to each
other in the name of noble causes, etc., etc., and people talk of good and
evil and people were talking of good and evil long before President Bush, in
war, you very, very quickly learn that the world is divided not amongst the
good and the bad but amongst the bad and the worse; that even good people in
war do bad things. War obliges them to do evil things. The good person
cannot stay good in war. It is the intrinsic nature of war. That means that
even the good person with good intentions must do things that are evil. And
that is why I've seen it--that, for me, the world is divided, as I say,
between the bad and the worse, not between the good and the bad.

GROSS: Well, do you ever worry you're going to be infected by that?

Dr. GIANNOU: I already have been.

GROSS: You're there as a doctor doing good. You're not there as a combatant,
but still--I'm sorry?

Dr. GIANNOU: Have I always done things the right way? Have I not created
dependencies in certain situations and people would have been better off
without me being there? Those are questions that I continuously ask myself.
I always ask myself those sort of questions.

GROSS: We've been lucky to have you as a guest on FRESH AIR several times
over the years, and it's kind of traditional for me to end our interviews by
me asking you if you've stopped smoking. And I ask that not in any judgmental
way, but just out of curiosity, since you're living in these life-and-death
situations all the time, and so perhaps the risks of smoking don't really seem
all that risky when you're surrounded by land mines and bombs and people who
want to take you hostage and so forth. But I'll ask, are you still smoking?

Dr. GIANNOU: Well, no, I still smoke my Gitan cigarettes. I enjoy them. I
enjoy them especially with a good shot of malt whiskey and the pleasure of
pleasurable company at the same time. That altogether goes very well.

GROSS: And can you enjoy a good smoke with the people of the different
countries that you go to? Do most countries smoke cigarettes without all the
health...

Dr. GIANNOU: With all of the...

GROSS: ...questions that Americans...

Dr. GIANNOU: The health questions...

GROSS: ...especially with the...

Dr. GIANNOU: ...and may I add the puritanical questions as well. Yes, of
course you can. I say puritanical because I've just come back down from
Canada, Ottawa and Toronto, where in Ottawa, you can drink yourself silly but
you cannot have a cigarette with the drink in the bar. And for me, it's very
much of a puritanical--it has nothing to do with health at this point. It's a
fundamentalist sort of sign. But in many countries, yes, you can sit down and
have a smoke with somebody, and offering a cigarette is considered to be a
great sign of generosity and hospitality.

GROSS: Well, Dr. Giannou, I wish you continued health and good luck on your
travels around the world. And thank you for doing the work that you do.

Dr. GIANNOU: Thank you very much, Terry.

GROSS: Dr. Chris Giannou is the head surgeon with the International Committee
of the Red Cross. Coming up, Father Chris Keenan, a chaplain with the New
York Fire Department, where he succeeded Father Mychal Judge, who was killed
on September 11th. This is FRESH AIR.
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.