The September 11, 2001, terrorist attacks prompted a worldwide outpouring of support for the United States. A common refrain was, “We Are All Americans Today.” Two decades later, we are still recovering from the shock and terror of that day.
Russia unleashed its military might against Ukraine on February 24, 2022. This unprovoked assault on a sovereign nation threatens the survival of Ukraine. The deep threat we felt on September 11, 2001, was symbolic. Al Qaeda was never poised to threaten the survival of the U.S. The threat to Ukraine is existential. Ukrainians are fighting for the survival of their country. They are fighting for their liberty, their future, and their freedom to choose their destiny. They are fighting for the fundamental principle of democracy: self-determination.
We are all Ukrainians today.
It is impossible to overstate the brutality of the Russian assault. The assault came from Belarus on the northern border, Russia on the eastern border, and the Black Sea and occupied Crimea on the southern border. The initial assault involved hundreds of missiles directed at Ukrainian military facilities and civilian infrastructure, followed by an invasion of nearly 200,000 soldiers and thousands of tanks and artillery.
Having failed to secure a rapid victory, the Russians have fallen back on their tried and true method of bombing civilian population centers into submission. The Russians defeated the uprising in Chechnya by laying siege to the capital Grozny from 1999 through early 2000. The Russians initially assaulted Grozny with ballistic missiles, cluster bombs, and thermobaric weapons (Figure 1) (asamonitor.pub/3i5AyYj). Shelling continued for two weeks before Russian troops started to advance. It took nearly four months and tens of thousands of soldiers to eventually subdue Grozny. The city was reduced to rubble. The true death count is unknown, but it has been estimated that roughly 8,000 civilians died.
The 2016 siege of Aleppo, Syria, followed the same pattern. In 2016, the Syrian government, supported by Russian air power, began a massive bombing campaign against rebel forces in Aleppo (asamonitor.pub/3w5IDEA). This included the use of barrel bombs and cluster bombs by the Syrian and Russian forces, and “double tap” airstrikes that deliberately bombed rescue workers responding to earlier airstrikes. The airstrikes deliberately targeted hospitals, clinics, schools, and critical infrastructure (asamonitor.pub/36ngvSQ). An estimated 31,000 people were killed by the time Aleppo fell to Syrian forces.
As of today, March 13, Russia's invasion of Ukraine appears to be following the same brutal tactics. The city of Kherson fell to the Russians on March 2 following a thermobaric attack on the main administrative building. The residential areas of Mariupol were shelled relentlessly for days. Last week, Russia bombed a maternity and children's hospital. Efforts to establish a civilian evacuation corridor failed when Russians repeatedly shelled proposed evacuation routes. Mariupol has been without food, water, and electricity for nearly two weeks, and it is estimated that nearly 1,600 civilians in the city have been killed (asamonitor.pub/3InRowx). Russian forces are currently bombing residential areas of Kyiv. Nearly 2.5 million Ukrainians have fled the country.
Rising above the destruction is an unlikely hero: Volodymyr Zelenskyy, the President of Ukraine. In 2019, Zelenskyy transitioned from portraying the president of Ukraine in the sitcom “Servant of the People” to being the actual president. His courage in leading Ukraine's government against the Russian assault has inspired people throughout the world to support Ukrainians' valiant efforts to repel the Russian assault.
Why am I writing about this?
The ASA Monitor is the official news publication of the American Society of Anesthesiologists. We are Americans. We are anesthesiologists. The war in Ukraine calls to both.
As Americans, we cannot take for granted the gift of freedom and liberty won and preserved through generations of sacrifice. We cannot be indifferent to the sacrifice of Ukrainians in defending their freedom.
As anesthesiologists, we are bound not only to our duty to our patients, but to the health and well-being of all in need of medical care. The Latin word for suffering is patientem, from which our word “patient” derives. The Ukrainians are suffering. As physicians, our care for patients is not bounded by the walls of our practice.
What can we do?
The U.S. is standing with the world's democracies to financially undermine Russia's military. This will involve real sacrifice on our part. Cutting off Russia's access to international markets will lower stock prices, increase gas prices, and exacerbate already high inflation rates. The dollar will appreciate against international currencies because greenbacks have always been the safest haven for money in times of uncertainty. Imported goods will fall in price, hurting U.S. manufacturers. Our exports will become more expensive abroad, further hurting U.S. businesses.
It is what it is. Ukrainians are willing to face thermobaric weapons to defend liberty. Paying more for gas seems a small price to pay if it increases the chances that Ukrainians might yet prevail.
I plan to set aside my partisan political views for the greater shared goal of defending democracy. Both extremes of our political spectrum have naively defended Russia's aggression. Paraphrasing Margaret Thatcher, an invasion is an invasion is an invasion. There is no version of reality in which Ukraine posed a threat to Russia. Russia's aggression threatens not only Ukraine but the peace and prosperity that has benefited the world for three-quarters of a century.
I plan to be patient. Russia has been setting the stage to annihilate Ukrainian independence for a decade. After annexing Crimea in 2014, Russia started a war in eastern Ukraine that has killed nearly 15,000 Ukrainians. Russia isn't focused on winning next week, or even next year. We have to be resolute in opposing Russia's aggression.
I have dear friends of Russian descent and academic colleagues in Russia whom I respect greatly. In times of conflict, it is easy to forget that the actions of the Russian state do not reflect on the character of my friends and colleagues. The Russian military acts on the command of Vladimir Putin and a ruling oligarchy. The 144 million Russians will endure economic hardship from this war second only to the suffering of Ukrainians. Our uniquely American multicultural origins, including peoples from Russia, are part of our national heritage. We must hold to that heritage as firmly as we oppose Russian aggression.
I am terrified of Russia's biological, chemical, and nuclear weapons. Ukraine is not part of NATO. We have no obligation to respond to a biological, chemical, or nuclear attack on Ukraine. What are we to do if Russia crosses these unthinkable boundaries in Ukraine?
Such questions are well above my pay grade. I am no expert on national defense. However, I think it is worth contemplating what a rational response would look like. Our government ultimately represents our views, as naive as they may be.
My opinion is that under no circumstances should we respond in kind to a biological, chemical, or nuclear attack on Ukraine. Any attack on Russia, particularly one involving banned weapons, invites escalation to a nuclear war. I think that Putin's repeatedly drawing attention to his nuclear arsenal is a sign of weakness. However, my hypothesis is not worth testing. If Russia crosses any of those thresholds, we can hold them responsible by tightening the financial screws on the country and forcing Putin to surrender whatever banned weapons he deployed in Ukraine. This may take years and cost us dearly. However, economic isolation of Russia will be infinitely less costly than escalating toward nuclear war.
If it is any comfort, the Cold War ended when the Soviet Union collapsed from decades of economic isolation and stagnation. This worked before. History suggests it will work again.
I have taken comfort in the past weeks donating to charities that provide food, shelter, and medical care to Ukrainians and Ukrainian refugees. Donating has become a source of solace, allowing me to believe that I'm not watching helplessly. See the Table for a list of charities that support Ukrainians and Ukrainian refugees.
We are all Ukrainians today.