Mesopotamian Madness

Thursday, 30 November 2017

Medico-Chirurgical Hall

The winner of this year's President's Medal, Professor John Webster, gave a lecture to mark the occasion of his presentation with the medal.

Graduated in medicine from University of Aberdeen in 1973 and developed an interest in hypertension and clinical pharmacology during postgraduate training with Professor JC Petrie at Aberdeen Royal Infirmary, and as MRC Training Fellow in Sir Colin Dollery’s Unit at The Royal Postgraduate Medical School, Hammersmith Hospital from 1978-1980. He was appointed as University of Aberdeen Senior Lecturer in Medicine & Therapeutics in 1984 and in 1990 as Consultant Physician at Aberdeen Royal Infirmary, where he practised in acute/general medicine and clinical pharmacology, with responsibility for outpatient clinics in Aberdeen & Orkney, and for the Aberdeen Hypertension Clinic. He also contributed to obstetric medicine at Aberdeen Maternity Hospital and to the Acute Stroke Service at Aberdeen Royal Infirmary. He was lead for Acute/General Medicine at ARI and Chaired the Grampian Formulary Committee. A founder member of the Scottish Medicines Consortium, he continues to act as expert adviser for that body. He was Physician to the Queen in Scotland 2008-16. Professor Webster has published over 200 papers on various aspects of hypertension and cardiovascular drug therapy, much relating to multicentre therapeutic drug trials of cardiovascular prevention. He retired from full-time NHS work in 2016, but continues to act as Principal Investigator in some research trials, as examiner of undergraduates and postgraduates, and as occasional Locum Physician with NHS Orkney.


Note of President’s Medal Presentation and Lecture – 30th November, 2017

The President, Dr Andrew Robinson welcomed the company and noted the apologies. He introduced the award of the medal as a rare opportunity to laud the work of local clinicians and presented this year’s medal to Professor John Webster in recognition of his long and diligent service to clinical and academic practice. A photograph of the presentation was captured by Professor Sir Lewis Ritchie. The President then invited Professor Webster to give his talk entitled ‘Mesopotamian Madness’.

Professor Webster began by thanking the Society for awarding the medal which he considers a major honour, especially considering previous recipients. He acknowledged the generosity of Professor Sir Lewis Ritchie whose endowment had established the award. He spoke of his long association with the benefactor and, indeed, showed a picture of both as members of the Med Chi Council in its bicentenary year of 1989. Professor Webster explained that was the same year that he accepted an invitation from a former colleague, Dr Amir Khir, to go to Malaysia the following summer to give some lectures at the Joint Colleges Conference in Kuala Lumpur. It was what happened on this trip that was to be the subject of his talk.

On August 1st 1990, Professor Webster flew to Heathrow to then take flight BA 149 to Malaysia. The flight departure was delayed, apparently due to a problem with the air conditioning on the aeroplane – perhaps slightly ominously named ‘Coniston Water’. Before departure, the news included reports of Iraqi troops gathering on the border with Kuwait, a scheduled fuelling stop for the flight; reassurances were given that this would not be a problem and the flight departed in the early evening. Approximately 3 hours later, the Iraqi invasion forces crossed the border into Kuwait. BA 149 nevertheless landed in Kuwait as scheduled around 4 hours after that – and reportedly 2 hours after the British Prime Minister, then in Colorado, had been informed.

Passengers for Kuwait disembarked and others, including Prof Webster, left the plane to stretch their legs during refuelling. The terminal was deserted and showing ‘flights cancelled’. Shortly afterwards Kuwait airspace was closed, necessitating further delay. At 5.30 local time (a little over an hour after landing), Prof Webster heard the first explosion and looked on as Iraqi jets bombed the runways and fired at perimeter defences.  Fortunately, neither the terminal nor the BA flight was attacked. There was to be long-term controversy about why the plane had landed several hours after a hostile invasion, some of which centred on the incorrect and often-repeated assertion that the invasion began after landing. There seems to have emerged over a number of years compelling evidence that the delayed departure from Heathrow coincided with the late addition to the passenger list of a group of (apparently ex-) members of the SAS, SBS and SIS. Collectively known as ‘the Increment’, they were to be part of a covert reconnaissance operation in Kuwait providing invaluable information to allied troops who would eventually repel the invasion. Such use of a civilian flight to smuggle in Government operatives has never, of course, been officially confirmed nor accepted.

During the later allied campaign to retake Kuwait, the BA plane was destroyed (whether by retreating Iraqi troops, or by allied air strike has never been ascertained) with apparently the only copy of the passenger list left on board – such that nobody has ever confirmed who was on that flight. BA received an insurance payment to cover the loss of their plane. French and US passengers on the flight also received very generous settlements for their unfortunate involvement in this military advance. Professor Webster informed us that he had received about £2000 reimbursement for cost of his ticket and loss of his suitcase and contents, but never an apology from anyone.

Many of the passengers were taken to the Airport Hotel in Kuwait for a few nights and then, having been separated from the aircrew, were moved by bus in around 50 degrees of heat and without air conditioning, to the Sheraton Hotel in Basrah, then on again by train to the Al-Mansour Hotel in Baghdad. There was limited support from the British Embassy and, when pointedly invited to address the hostage group, the British Ambassador is remembered for suggesting it would take some time to resolve matters and perhaps that could be used in learning some Arabic!

On 16th August, some 30 UK hostages were moved to what may have been a chemical plant, and two nights later to a different building, perhaps involved in uranium enrichment, where a day was spent cleaning. That night, armed guards separated out 9 men at gunpoint including Prof Webster, who using astronomical navigation reckoned they were being driven south into the night. At 3am, they were ordered out of their transport by the guards and lined up against a ditch – the most frightening moment of the whole affair – until the guards announced they were allowed to pee. They drove on to their destination, the Hartha Power Station some 10k north of Basrah, where they would spend the remaining months of their detention. Some illustrations were shown of the landscape in the area, and reference made to the extensive marshes around the river Tigris which were later drained by the Iraqis after the allied forces had withdrawn, causing damage to precious wildlife habitats, as Saddam Hussein proceeded to persecute the Shia Arabs residing there. In more recent years, some of the marsh territories have been re-flooded to restore wetland habitats.

Professor Webster described how he established and stuck to a daily timetable –and suggested that this was perhaps simple but one of his most important defences against the anxieties of a protracted hostage situation. He also described his early resignation to a longer-term detention, as included in an early letter written from the Mansour Hotel, as another major factor in enhancing resilience. The daily routine included writing, reading, board games and daily exercise whereby in time allowed (and able!) to run a circuit round the inside of the 3k perimeter fence. He had acquired a short wave radio and this allowed access to news via the BBC World Service. He wrote around 120 letters home, mainly to family, and came in time to know that around 2 in 3 of these were eventually delivered. No letters sent in the opposite direction reached him. He tried to persuade the audience that having a copy of Kaplan’s Clinical Hypertension in his hand luggage meant that he now had the opportunity to study hypertension properly for the first time.

Working from memory of recently gathered results, and without any notes, he was able to write drafts of no fewer than 3 research papers on hypertension which, with detailed results added in back home, went on to be published in the British Journal of Clinical Pharmacology and the Quarterly Medical Journal. Although it seemed unlikely that he could send his manuscripts out directly, he was able to get one out via a Japanese and second via a German hostage when they were released. The third paper was sent directly home – and was delivered. Everything was written in long hand with the only access to gadgetry being permitted after he was allowed to make photocopies of his hand drawn Christmas cards which he designed, and wrote, shortly after arrival at Hartha in August. Many of these were delivered having being sent in November, and some are still known to exist – including a few precious framed copies!

Professor Webster then described some of the consequences and impact on Iraqi civilians of the invasion and what it provoked around the world. The trade sanctions applied in August 1990, which immediately denied Iraq the 85% of its income which came from the sale of oil, had its greatest impact on families, and particularly children. While childhood mortality certainly rose, he noted how the quoted figures have been serially overestimated as considerably worse than the truth – including in Tony Blair’s evidence to the Chilcot enquiry in 2010. When Operation Desert Storm, the allied assault on Saddam’s army was launched early in 1991, the Iraqi tanks were annihilated by greatly superior UK and US counterparts. Around 350 tonnes of depleted uranium – a metal which vaporises on impact – was used in shells in the course of this operation, with considerable potential for causing protracted health and environmental problems. Some images were shown of the mass of burned remains of vehicles destroyed by air raids when many had been slow to leave the Basrah area ahead of the allied attacks in January 1991. An infamous iconic image of the time, the burned remains of a victim, taken by photographer Ken Jarecke working for Time magazine during Desert Storm was shown and said to have contributed to the realisation that the Allied attacks had been extremely severe and it was time to stop.

We were told that, as many historians have noted, there had been a lack of allied planning for what would happen in the region after the Iraqi military forces had been ejected from Kuwait. There was perhaps some respite for the Kurdish peoples in the north, which had been designated an autonomous ‘no-fly’ zone, but the Shia uprising in the south of Iraq was brutally suppressed. Ongoing trade sanctions effectively neutralised Saddam Hussein’s military capacity. Attempts to ameliorate conditions for civilians, for example by the Oil for Food programme, were at best partially successful due to the ongoing potential for any resources to be redirected into unintended coffers and projects. The attacks of 9/11, some 11 years after the invasion of Kuwait, likely had little or nothing to do with the Iraqi regime. Iraq was, however, probably recognised as a soft target for anti-terrorism sentiment. This, and the now notorious claims about “weapons of mass destruction”, eventually led to the invasion of Iraq in 2003 and the overthrow of Saddam. Air attacks, often by remotely launched missiles saw many major buildings in Baghdad systematically destroyed by so-called ‘precision bombing’. Subsequent surveys have established that women and children comprised 67% of fatalities in the year after this invasion. Death rates were particularly high in Fallujah after intensive American attacks following the assassination of 4 US employees of a security company there.

Over all the bombardment by allied forces was extensive and included widespread use of toxic materials probably including white phosphorous, heavy metals and radioactive isotopes. The resulting contamination has led to ongoing high rates of foetal malformation (8% or 2.5x previous background in Fallujah), with extremely high levels of lead and mercury in babies, and their parents. The effects of malnutrition, via folate deficiency, may have contributed to susceptibility to environmental poisoning. There are ongoing health issues in heavily bombed areas, particularly when the wind blows up contaminated dust storms, and there are now reports of increased rates of neoplasia and leukaemia, though it has proved difficult to obtain accurate information from that country.

Professor Webster then returned to the timeline of his own hostage spell following the detention of passengers on BA 149 on 2nd August. By the end of the month, women, children and UN personnel had been allowed home. By mid-September the BBC had set up the Gulf Link radio channel that allowed some exchange of messages. In late October, former Prime Minister Ted Heath, in direct contravention of government policy, visited Baghdad in attempt to persuade the Iraqis to release hostages. In early November, Prof Webster was able to make his first telephone call home. On 22nd November, American Thanksgiving day, Mrs Thatcher resigned and the consequent removal of her consistently belligerent approach to deterring Saddam Hussein, regardless of potential consequences for any hostages, went with her. For example, a letter from Mrs Mary Webster and Prof Jim Petrie to the Prime Minister got a reply from Charles Powell, Private Secretary to Mrs Thatcher, stating that the Government “… would not negotiate for the release of hostages and would discourage others from doing so.” And furthermore that “… if Saddam Hussein does not withdraw [from Kuwait]  voluntarily we must be prepared to force him out.” Eventually, on 6th December, a message came saying that Saddam Hussein was allowing the release of all the remaining hostages, including those at Hartha.

It remains unclear as to exactly why the hostages were released when they were. However, Professor Webster shared a possible contributory factor relating to a friend called Mary Maccaud who at the time was Head of the International School in Geneva. She had been approached by the Iraqi embassy there to see whether she could help stop the bullying to which Iraqi children in the area were being subjected. She agreed to deal with this but, in turn, asked why something couldn’t be done to secure the release of her friend, John Webster. Two weeks later, she was taken to the embassy to meet a senior official who had three folders on his desk containing information, respectively, on her, her husband and Dr John Webster of Aberdeen Royal infirmary. She repeated her request for release of her friend, and followed this up with a letter which received a cordial reply from the official - Saddam’s half-brother, Barzan Al-Tikriti. As previous Head of the Mukhabbarat in Iraq and known to have been involved in various atrocities there, he had been posted as Permanent Representative of the Iraqi Government in Geneva, where he controlled massive Iraqi money deposits. The possibility remains, that this official used his considerable influence with his half-brother to encourage release of the remaining hostages.

Whatever the reason, Professor Webster got back to the UK on 10th December a little over 4 months since he had left for a conference in Malaysia. His experiences had left him unimpressed by the actions of the Foreign Office, the British Embassies and Mrs Thatcher. However, while British Airways should perhaps have never landed in Iraq during the invasion, they had been very supportive thereafter and, indeed, were in the process of supporting Mrs Webster to fly to Iraq via Royal Jordanian Airlines when the release was announced. In sharing his relief at the end of this ordeal, he proceeded to acknowledge those who had been particularly supportive during his exile. He, and his family, had been helped by last year’s medal winner, Prof David Alexander and his expertise in the psychology of conflict and hostage situations. Alick Buchanan-Smith, former MP for Kincardine had been particularly courteous and helpful, despite being rebuffed by Downing Street. Ex-Prime Minister Ted Heath’s wisdom and diplomacy were highly regarded. Dr Anthony Jeffers had looked after all of Professor Webster’s clinical work during his extended absence. Abu Majid, a local chef in the power station had been very helpful and had perhaps put his own security at risk in being so and Dr Alan Milne, then GP to the Webster family, had also been a great help to them over some difficult months. (Drs Jeffers and Milne were in the audience; Prof Alexander had sent his apologies). The late Professor Jim Petrie, mentor, colleague and friend had, as ever, worked assiduously in managing the situation and, finally, Mrs Mary Webster’s fortitude throughout the whole affair was gratefully acknowledged, particularly the way in which she had prepared for a long haul on hearing in the first letter home from her imprisoned husband that he did not expect things would be resolved soon.

After resounding applause, Professor Webster agreed to take questions from the audience. He was asked how much trouble he had subsequently caused for the ineffectual ambassador in Iraq and graciously replied that the answer was none, and that nobody, including the ambassador, had been in such a situation before. On a question about sequelae of the ordeal, he answered that he had noted no discernible problems and suggested that getting control of his situation – as he had done with his regular daily routine, and by resigning himself to a somewhat protracted stay – had been of considerable assistance to his ability to remain relatively calm. He also recounted the story of how he had come across some golf clubs at Hartha and his efforts to persuade the guards to find some golf balls! He wondered whether it had been easier for the hostage than his family, especially in the early weeks when no news was getting out. After 6 weeks of recuperation on returning home, he returned to full time work.

On being asked if his medical expertise had been put to use, he explained how he had been called on to advise in some cases, and helped secure the release of a Japanese hostage with hypertension. He had also been taken to another hostage group in a nearby cement factory after one of their number had died, apparently of a myocardial infarction, his remit being to undertake health checks on the remaining hostages. A further question on how fellow hostages had coped drew the clarification that he had spent most of his time in a group of 9 men, including 2 teenagers who were particularly stressed. He was the only BA 149 passenger in his group, comprising a variety of professionals. He told the audience that he has kept in touch with about half a dozen people and visited one of them in New Zealand at the start of 2017.

On being asked, finally, whether he had attended the conference in Kuala Lumpur the following year, he said that he had been to Malaysia twice since then as a College examiner.

Professor Webster was once again thanked by the President who then reminded the audience of further Society events on the next two Thursdays before the meeting was closed.

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