Thursday, October 2, 2014

Ebola - A Global Terror Vector

This is a copy of an article submitted to the Yale Global Health Review in February, 2014 for publication.  It was never published.  This paper was a self study project undertaken by my daughter.  With the current emerging global Ebola crisis, this information is too important not to release to the web.  YGHR missed the boat on a critical global health issue. 

Joe Mazzarella 
Global Health Risks of Non-state Transnational Terror
Grace Mazzarella
January, 2014

In September of 2000, the United Nations, through its member states, agreed on Millennium Development Goals (MDGs).  The MDGs are a series of goals aimed at making measurable improvements in alleviating worldwide poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against women within a 15 year period.  Since its adoption, the World Health Organization (WHO) has reported that great strides have been in the intervening years.[1]  These gains are the result of concerted governmental and non-governmental programmatic efforts.   Despite this progress, these gains are vulnerable to being undermined by both well-known and less well-known and understood emerging systemic threats.  One of these less well-known and understood threats is the emerging systemic risks associated with the agents and causes of geopolitical conflict.   In the area of global health, the new paradigm of multinational, non-state sponsored terrorism represents a significant and growing risk factor with unique challenges for the world health community.   

Most state efforts to combat terrorism are motivated by a desire to prevent acts of terrorism and their immediate impacts, namely the indiscriminate loss of life and injury to civilians and noncombatant personnel.   While acts of terrorism catch worldwide media attention, terror groups can have significantly greater far reaching and lasting effects through sustained low intensity conflict.  Terror in itself is not the objective for terrorist groups inasmuch as it is to create conditions of increasing civil instability to achieve various ends.  These ends are often political, ethnic and/or religious in nature.  As a consequence, civilian populations are often targeted based upon on their ethnic and religious composition and political alignments.  For the ideological modern terrorist, the objective is to inflict not only death, but to instigate mass displacement and removal of objectionable segments of the civil population.  This, in turn, creates enclaves of control to stage, assemble and support larger operations with the intent of further challenging incumbent government forces, disrupting national systems of civilian and military support, such as commerce and transportation routes and utility infrastructure, and creating successively greater instability within the state.   These strategies and mass displacement effects have been observed in a variety of conflicts including Iraq, Syria and the Sudan.
Focusing on Syria, one needs to only consider the scale of humanitarian tragedy occurring in Syria to understand the scope and nature of this problem.    As of the writing of this Article, the United Nations High Commissioner Refugees (UNHCR), reports that over 2.3 Million refugees have been displaced from their Syrian homes as a result of ongoing civil war, and it is predicated that the refugee population could reach 4 Million if the conflict continues along it present course.[2]  Despite its political characterization, the greater reality is that the Syrian civil war is being fueled by an influx of multinational Islamic fighters, many of which are aligned with known terror groups such as Al-Qaeda and external state sponsors of terrorism like Iran.[3] Beyond the effects of conventional fighting between insurgents and government forces, civilian populations have been brutalized by numerous reported attacks of barbarity designed to terrorize and incite mass civilian departure.  In one of many similar reported incidents, on January 17, 2014, Al-Qaeda insurgents reportedly overran the western-backed Free Syrian Army held town of Jarabulus located in Northern Syria.  Al-Qaeda fighters then initiated an indiscriminate killing spree, murdering men, woman and children.   Among their heinous acts, over hundred men were rounded up and Al-Qaeda fighters began slaughtering them, including beheading their victims and posting heads on spikes.  As a result of this terror, nearly 1,000 civilians fled for the safety in Turkey.[4]   Syria’s civilians, much like in other recent modern terror infused conflicts, are suffering extreme and indiscriminate brutality which is driving mass population displacement.

But Syria is not unique.  In many of today’s conflicts around the globe, terrorist organizations operate to destabilize government institutions by sowing fear and insecurity among the populace, and eroding the will and capacity of government institutions to carry-out the delivery of basic services.[5]  Whether one begets the other is open for debate, however it is generally recognized that terror groups tend to coalesce and root themselves in places where governments are politically weak and have failing civil institutions.  Cases on point include Iraq, Afghanistan, Pakistan, South Sudan, Somalia, Libya, Algeria, Nigeria, the Palestinian Territories, Lebanon, Indonesia and Yemen, among others.[6]  In fact, the number of displaced person has risen year over year and reached its highest since 1994 with an estimated 45 Million refugees, and the UNHCR reports that vast percentage of refugees are arising within the aforementioned countries.[7] As non-state actors foment civil unrest and spread terror, large civilian displacement becomes a major pandemic disease vector that has broad regional and global implications.
By way of example, the Syrian war has given rise to an outbreak of polio, a disease that has been effectively eradicated from most of the global community, save a few, through decades of vaccination efforts.  Prior to the conflict, the last reported case of polio in Syria was reported in 1995.  In November of 2013, the WHO raised an alarm with an outbreak of up to 37 confirmed cases of polio. [8]    As result, a massive immunization effort has been launched to stem the outbreak.  Nonetheless, this in turn has raised fears that there is high risk of a polio outbreak in Europe given that large numbers of Syrian refuges may begin to migrate from temporary camps in neighboring countries to Europe as they search for better living conditions.[9]
Other places where polio has gained a foothold through disease importation include the African horn nation of Somalia, which is home to a nominally functioning government and numerous terror camps.  Other countries of polio importation, as reported by the WHO, include several African countries with terror based insurgencies such as Niger, Mali and the Congo.[10]  Meanwhile, the countries of Afghanistan, Pakistan and Nigeria remain polio endemic.  All of these locations share another common thread besides polio.  They are each suffering from ongoing conflict spurred by endemic terror groups operating within their borders are main drivers of forcible displacement.
 Overall, the Syrian conflict serves as a powerful example of the role that non-sate terror organizations play in breeding conditions for global health emergencies and potential pandemics.  While the twentieth century was occasioned by state conflicts, the twenty-first century has given rise to a new form of non-state entity conflict that is transnational in nature.  Hallmarked by internal destabilization, these forces operate to sow political instability and fear among the populace and ignite civil strife.   Unlike traditional sovereign conflicts, the ability for world organizations to reach into and operate in these conflict areas to stem global health emergencies is often hampered due to non-existent diplomatic functions and no reliable or formal command and control leadership capable of brokering necessary conditions of security and safety for non-combatant relief workers.   In Syria, the effort to provide humanitarian relief has been thwarted in many cases and nation-states have been unable to provide consistent meaningful humanitarian aid.[11]
In the emerging reality of geopolitical conflicts characterized by non-state terror groups, it is possible that global health emergencies may be exploited as another tactic to create large scale destabilization and fear.  In this vein, while seemingly remote, it is not unreasonable to assume that terror groups could seek to spread highly contagious diseases in target populations through one or more terrorist cells.  In essence, the dynamics of population displacement, nonfunctional health delivery systems, and access to contagious diseases becomes a vehicle for biological warfare, or coined another way its own weapon of mass destruction (WMD).  While polio would be an unlikely candidate due to mass vaccination, infectious diseases such as the hemorrhagic Ebola or Marburg viruses could be used to create a large scale pandemic with a small team of sickly volunteers. Further, proximate access to and vectors for movement by a multinational terror organization are present because they are coincident with terror endemic areas, notably the Sudan, Uganda (bordering South Sudan) and Democratic Republic of Congo.[12]  These viruses can be opportunistically identified in the population and then intentionally passed from a host to willing conspirators. Placing “ground zero” patients inside of highly dense refugee camps along and infecting several disparate international targets has the potential to create global impacts that could overwhelm response systems and resources.  This tactic, albeit crude by today’s standards, has a historical precedent within North America when British forces used infected blankets of small pox to eradicate Native Indians during the French Indian Wars.[13]
More generally, non-state controlled areas with largely collapsed or inoperative healthcare systems and large refugee populations present conditions for pandemic outbreaks that can impact local, regional and global security.   This risk requires collaboration and attention among not only world health authorities but political and policy leaders, security experts and institutions of research and higher learning in order to create the necessary programs to monitor, identify, respond to and mitigate these hazards.    As the world community makes progress towards its MDGs, it is important that it recognize emerging changes in geopolitical dynamics and be prepared to adapt its programs and strategies to counter their associated risks. 

[1] United Nations, The Millennium Development Goals Report 2013, 1 July 2013, ISBN 978-92-1-101284-2, available at:
[2] Syria Regional Refugee Response, UNHCR Interagency Information Sharing Portal –Regional Overview, Web. 20 Jan. 2014 (
[3]  Laub, Zachary, and Masters. "Al-Qaeda in Iraq (a.k.a. Islamic State in Iraq and Greater Syria)." Council on Foreign Relations, March 2013.
[4] Hunter, Isabel, Al-Qaeda slaughters on Syria's killing fields, AL Jazeera Online (January 21, 2014) (
[5] Audrey Cronin, Ending Terrorism – Lessons for Defeating Al Qaeda, International Institute for Strategic Studies (Adelphi Paper 393, 2008), Ch. 1.
[6] National Counter Terrorism Center, Counterterrorism Calendar 2014 – Interactive Map, Web, accessed January 22, 2014 (
[7] UNHCR-Global Trends Report 2012, Displacement-The New 21st Century Challenge, June 19, 2013 (
[8] Global Alert and Response, World Disease News, Polio in the Syrian Arab Republic – update, World Health Organization (November 23, 2013), Web (
[9] Eichner &Brockmann, Polio emergence in Syria and Israel endangers Europe, The Lancet,  Volume 382, Issue 9907, Page 1777, 30 November 2013 (Elsevier Ltd, pub. online November 8, 2013,
[10] Polio Global Eradication Initiative Annual Report 2012, World Health Organization (WHO, Geneva, March 2013). (
[11] Blanchard, Humud & Nikitin, Armed Conflict in Syria: Overview and US Response, Congressional Research Service, Rel. RL33487, January 14, 2014 (avail., 10. “As with humanitarian assistance, U.S. efforts to support local security and service delivery efforts to date have been hindered by a lack of regular access to areas in need. According to Administration officials, border closures, ongoing fighting, and risks from extremist groups have presented unique challenges.”
[12] CDC, Known Cases and Outbreaks of Ebola Hemorrhagic Fever in Chronological Order, Web, accessed January 23, 2014, and CDC, Known Cases and Outbreaks of Marburg Hemorrhagic Fever, in Chronological Order, Web, accessed January 23, 2014. (
[13] F. Fenner et al., The History of Small Pox and its Spread Around the World, (Geneva, WHO, 1988): 239.] See, also, Sheldon J. Watts, Epidemics and History: Disease, Power and Imperialism (Yale University Press, 1999) for a comprehensive exposition on the geopolitical impacts and epidemics in the Western world.

Monday, July 21, 2014

Moving Towards Smarter Immigration and Border Control

Significant political debate swirls around the issue of illegal immigration within the United States. Despite the great divergence of opinion regarding immigration policy, one would believe that controlling border entry is an area of consensus. If nothing else, a porous border presents significant risks of importation of disease, criminality and terrorism. One aspect of the border and immigration problem that has been overlooked is the effective use of systematic information gathering and sharing to begin to discover the source, means and methods being used to exploit our borders. Simply stated, a tremendous amount of intelligence with immense value is being left on the table. Whether intentionally or unintentionally so, we are operating with blinders as we play cat and mouse games at the border.

In large measure, the influx of illegal immigrants into the United States is being facilitated by systemic processes fostered by transnational drug cartels and other organized criminal groups that seek to profit from human smuggling. Successful border exploitation is a result of decades of experience through trial and error associated with drug trafficking. In the evolution path to human smuggling, there is the early experience of the “mule”. These are illegal aliens encouraged to cross borders with contraband. Enterprising criminality quickly recognized that humans themselves are merely another form of contraband form which to profit. Human smuggling is simply a natural outgrowth of a matured and operationalized illegal drug trafficking phenomena.

In this regard, Illegal immigration bears the hallmarks of a large scale, organized criminal enterprise with hierarchal command, divisions of labor and functions, specialization, communication and transportation systems and money laundering infrastructure. The picture of a poor immigrant family picking up roots on their own and making their way to a new way of life is outdated. Illegal immigration is big business. Criminal syndicates operate across borders through untold numbers of “street soldiers” recruited through gangs operating in the United States and abroad. Beneath the surface, a highly adaptive and effective system exists consisting of recruiters, safe houses, look-outs and counter intelligence, document forgers, identity thieves, chop shops and auto-body repairers, transporters, enforcers, money facilitators, and guides. Drug trafficking, human smuggling and gun smuggling all share the same ecosystem of illicit activities. When we fail to gather information that helps to define the nature and extent of this far reaching system and how it operates, we limit our understanding and deprive ourselves of the ability to effectively combat and defeat these activities.

In many ways, we are currently hindering our ability to discover essential information. Currently, efforts to police illegal immigration are effectively segregated from other law enforcement activities that focus on criminal activities. This is further compounded by numerous federal, state and local law enforcement agencies have different jurisdictional and enforcement mandates rendering day to day cooperation and information sharing among agencies challenging. Local law enforcement is the most effective day to day information gathering agency because it is embedded in the local community and has a more intimidate understanding of what is happening on the street. Yet, as a matter of federal policy, local law enforcement is unable to enforce illegal immigration laws and detain illegal aliens. The best local law enforcement can do is refer the matter to Immigration and Customs Enforcement which, in turn, is overwhelmed and allows individuals to remain free on their own recognizance except in the most egregious cases. Being by nature transient and wishing to evade enforcement, most illegal aliens never report back and melt into the landscape. On the other side of the coin, Immigration and Customs Enforcement has no idea where most illegal immigrants are located at any point in time and the data that is available is often stale or erroneous.

Despite these problems, illegal aliens have been given access to public educational and health and welfare programs without any form of verification as to their stay status, and in many cases stolen social security numbers and other false documentation is presented. Public welfare institutions and healthcare facilities are blocked from verifying identity or reporting the presence of illegal aliens to law enforcement. So, at all levels, the ability to gather information about the whereabouts of illegal immigrants, is either nonexistent or exists in silos.

Therefore, one of the first steps to beginning to solve illegal immigration problem is knowing the nature and extent of the problem, and beginning to unravel the means, methods, persons and organizations behind this phenomena. This can occur with a combined effort among federal, state and local agencies to actively track and record the presence of illegal aliens. Law enforcement, schools, hospitals, and public benefits programs must be enlisted to report the identity and presence of illegal immigrants. Further, the use of social security numbers should be required to be reported to a national database to begin to ferret out identify fraud. Assuming there will be policy towards allowing illegal immigrants to stay under a documented worker program, there should be a requirement that illegal immigrants provide key information that can assist authorities in developing a better understanding of the system they are fighting. This information would include where illegal immigrants came from, how they were recruited, who recruited them, who helped them and how they made their trip, where did they stop, etc. Just like an employment application, truthfulness and accuracy should be required as a condition to stay and any inaccuracy should be grounds for deportation.

Over time, a reservoir of data and associated trends and correlations will begin to emerge. Americans have an uncanny ability to tackle complex problems when they put their minds to it. Being able to track, quantify and analyze illegal immigration should be something that stands above immigration policy. Information collection will empower policy makers and those with the responsibility of enforcement. When we begin to recognize that the border does not stop at the border, and illegal immigration effects every community, we will recognize that border protection is an internal matter that is best addressed by all communities working together, and it starts with gathering and sharing information.