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Key Challenges in Geography
EUROGEO Book Series

Gerry O'Reilly

Aligning Geopolitics,
Humanitarian Action
and Geography in
Times of Conflict
Key Challenges in Geography

EUROGEO Book Series

Series editors
Kostis Koutsopoulos, European Association of Geographers, National Technical
University of Athens, Pikermi, Greece
Rafael de Miguel González, Faculty of Education, University of Zaragoza,
Zaragoza, Spain
Daniela Schmeinck, Institut Didaktik des Sachunterrichts, University of Cologne,
Köln, Nordrhein-Westfalen, Germany
This book series addresses relevant topics in the wide field of geography, which
connects the physical, human and technological sciences to enhance teaching,
research, and decision making. Geography provides answers to how aspects of these
sciences are interconnected and are forming spatial patterns and processes that
impact on global, regional and local issues and thus affecting present and future
generations. Moreover, Geography by dealing with places, people and cultures,
explores international issues ranging from physical, urban and rural environments
and their evolution, to climate, pollution, development and political-economy.
Key Challenges in Geography is an initiative of the European Association of
Geographers (EUROGEO), an organization dealing with examining geographical
issues from a European perspective, representing European Geographers working in
different professional activities and at all levels of education. EUROGEO’s goal and
the core part of its statutory activities is to make European Geography a worldwide
reference and standard. The book series serves as a platform for members of
EUROGEO as well as affiliated national Geographical Associations in Europe but is
equally open to contributions from non-members.
The book series has a global scope and includes contributions from a wide range
of theoretical and applied geographical disciplines.

Key Challenges in Geography aims to:

• present collections of chapters on topics that reflect the significance of
Geography as a discipline.
• provide disciplinary and interdisciplinary titles related to geographical, envi-
ronmental, cultural, economic, political, urban and technological research with a
European dimension, but not exclusive.
• deliver thought-provoking contributions related to cross-disciplinary approaches
and interconnected works that explore the complex interactions among
geography, technology, politics, environment and human conditions.
• publish volumes tackling urgent topics to geographers and policy makers alike.
• publish comprehensive monographs, edited volumes and textbooks refereed by
European and worldwide experts specialized in the subjects and themes of the
books.
• provide a forum for geographers worldwide to communicate on all aspects of
research and applications of geography, with a European dimension, but not
exclusive.

More information about this series at http://www.springer.com/series/15694

Gerry O’Reilly

Aligning Geopolitics,
Humanitarian Action
and Geography in Times
of Conflict

123
Gerry O’Reilly
School of History and Geography
St. Patrick’s Campus
Dublin City University
Dublin, Ireland

ISSN 2522-8420 ISSN 2522-8439 (electronic)

Key Challenges in Geography
ISBN 978-3-030-11397-1 ISBN 978-3-030-11398-8 (eBook)
https://doi.org/10.1007/978-3-030-11398-8

Library of Congress Control Number: 2018966851

© Springer Nature Switzerland AG 2019

This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part
of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations,
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or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar
methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are exempt from
the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this
book are believed to be true and accurate at the date of publication. Neither the publisher nor the
authors or the editors give a warranty, express or implied, with respect to the material contained herein or
for any errors or omissions that may have been made. The publisher remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.

This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Evil comes from a failure to think. It defies
thought for as soon as thought tries to engage
itself with evil and examine the premises
and principles from which it originates,
it is frustrated because it finds nothing there.
That is the banality of evil.
Hannah Arendt, Eichmann in Jerusalem:
A Report on the Banality of Evil (1963)

All that is necessary for the triumph of evil

is that good men do nothing.
Edmund Burke, Thoughts on the Cause
of the Present Discontents 82–83 (1770)
Preface

Aligning Geopolitics, Humanitarian Action and Geography in Times of Conflict

poses a major challenge for individuals, practitioners, organizations, institutions,
policy-makers, the public and electorates alike, but above all, those people directly
affected by crises and disasters. If there were simple answers, solutions and tool kits
to fix this, then there would be far fewer disasters including war and famine. Like
donor fatigue in many instances, people may get tired of the humanitarian chal-
lenges facing ‘the others’ and their suffering being somewhat banalized by the
constant media flow of images. Nonetheless, other people including NGOs and
humanitarian practitioner continue the struggle to create a better world for every-
one. As one aid worker put it: ‘When you start out, you’re enthusiastic and have
hope and many answers. However, anger creeps in at the way things are done,
institutional sclerosis and inaction and the politics and all that. Over the years in the
sector and especially in the field in places like Syria, Sudan, Yemen, and with the
Rohingya, mostly what kept me going was the direct “contact” with the people on
the ground’.
This book aims to offer insights into the interrelationships between geopolitics,
geography and humanitarian action. Concepts regarding conflict and power are
interpreted, as are the roles of the state, and international community in mitigating
and preventing violence and war. Here the material, as well as the non-material—
existential or imagined—reasons for conflict are deconstructed, ranging from land
and resource grab to Utopian ideals that can degenerate into dystopias as with
Daesh’s so-called Calafat in Syria and Iraq (2014–). A range of conflict issues and
locations are geographically scaled from local to wider national and global levels,
as are resolution mechanisms.
As the impact of any humanitarian disaster is proportional to the level of
development of the area affected, concepts and categories of humanitarian action
are explored along with basic development issues at the core. Broadly, humani-
tarian disasters fall into natural, human-made, technological or complex categories.
Here emphasis is laid on the human-made crises. Attempts at greater regulation, and
national and international organization to prevent violent conflict and enhance
responses to humanitarian emergencies need to be reinforced. Besides the

vii
viii Preface

humanitarian imperative regarding people caught up in the disaster, such events

often spiral impacting on people beyond the specific geographical region in which
the emergency takes place as witnessed during the Syrian War (2011–).
Key ideas presented explore the nexus between geography, humanitarian action,
development, geopolitics and political economy. The issues appraised are largely
based on frequently asked questions (FAQs) and discussions that I have had over
many years with students taking courses and researching humanitarian action and
geopolitics, geography and allied subjects, but also from practitioners in the field
ranging from European and African countries to Iraq, Iran, India, Bhutan, Korea,
Japan, Burma, Australia, Colombia, Venezuela, Canada and the USA.
Firstly, questions were categorized into thematic and subgroups, with the aim of
brainstorming the reader, building on his or her existing active and latent knowl-
edge of humanitarian issues and accompanying the reader to make linkages
between concepts and themes. Answers to questions are sometimes short, but with
related websites and references given, where the reader can go deeper into issues,
getting access to information, data, maps and updates, as with the United Nations
Development Program, Human Development Index, and similarly with OCHA—
UN Office for the Coordination of Humanitarian Affairs for the constantly updated
maps and infographs.1 Besides themes and recommended reading, websites and
YouTube material, independent and autonomous research is suggested at the end
of the book. The challenge here is to encourage reflection on humanitarian chal-
lenges and responses, contributing to a holistic overview.
Part I focuses on concepts of Conflict and Power, and in Part II emphasis is
placed on humanitarian action, development, vulnerability and geopolitics. Part III
stresses the role of international organizations, globalizations and quest for regu-
lation to attenuate the effects of violence and to support populations in crises and
disaster along with the evolving norms of the UN Responsibility to Protect (R2P).
This is followed by looking at peacebuilding and post-conflict recovery. Following
on, there is a section on autonomous learning encouraging the reader to reflect on
ideas and themes. As with the book itself, the reader can dip in and out of the
different activities suggested.

Dublin, Ireland Gerry O’Reilly

1
OCHA—UN Office for the Coordination of Humanitarian Affairs. Maps and Infographs. https://
www.unocha.org/media-centre/maps-infographics.
Acknowledgements

This book is dedicated to all those who work in development, emergency and
humanitarian-related activities and environments.
I would particularly like to thank past and present students and colleagues who
have debated and given insights from many perspectives on humanitarian action
issues, including those people working in the field, and NGO and GO staff who
have been generous with their time and camaraderie. Here must be mentioned
ECHO (European Commission Civil Protection and Humanitarian Aid Operations)
that funds several graduate education and training initiatives through the NOHA
(Network on Humanitarian Action)—the association of 12 European and global
partner universities, and NGOs including the International Federation of Red Cross
(IFRC) and Oxfam, with over 3500 graduates working worldwide.2 A special word
of thanks to Sam Taylor, Director MSF—Ireland (Médecins Sans Frontières), and
Dónal Gorman, Communications Manager; and also Amnesty International—
Ireland, as well as Irish Aid, Department of Foreign Affairs, who have been gen-
erous with time and in providing workshops for students.
A lot of encouragement and support in completing this book has come from
Dr. Michael Leuchner, Publishing Editor—Earth Sciences and Geography, Springer
Publishing, and Karl Donert, President, EUROGEO (European Association of
Geographers), and Vice President, Council of Europe, INGO Conference,
Commission on Education and Culture.3
My wife Valérie, daughters Aisling and Alannah, and son Shane survived the
research and writing up process, supplying me with much appreciated good humour
and coffee.

2
NOHA—Network on Humanitarian Action. https://www.nohanet.org/.
3
EUROGEO—European Association of Geographers. http://www.eurogeography.eu/.
Council of Europe, INGO Conference. https://www.coe.int/en/web/tirana/ingos-conference.

ix
Contents

1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Part I Conflict and Power

2 Geopolitics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.2 Frameworks for Understanding Geopolitics and Conflict . . . . . . 10
2.2.1 Geopolitics: Earth, Territory and Power . . . . . . . . . . . . 10
2.3 Time, Place and Space . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2.3.1 A Few Square Meters, or Thousands of Square
Kilometres . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2.3.2 Walls and Boundaries . . . . . . . . . . . . . . . . . . . . . . . . . 19
2.3.3 Symbolic Spaces . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
2.3.4 Historical Time Scales . . . . . . . . . . . . . . . . . . . . . . . . 21
2.4 Physical and Human Geographies . . . . . . . . . . . . . . . . . . . . . . 23
2.5 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
3 Territoriality: Identity, State and Nation Revisited . . . . . . . . . . . . . 29
3.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
3.2 Constructing the State . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
3.3 Territory and the State . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
3.3.1 The State, Political Economy and Geopolitics . . . . . . . 35
3.4 Nations, States and Nationalisms . . . . . . . . . . . . . . . . . . . . . . . 39
3.4.1 Patriotism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
3.4.2 Patriotism and Nationalism . . . . . . . . . . . . . . . . . . . . . 43
3.5 Defining Nationalisms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

xi
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xii Contents

3.6 Continuing Territorialisation and Outer Space . . . . . . . . . . . . . . 51

3.7 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
4 The Causes of Conflict . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
4.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
4.2 Material: Economic and Power Factors . . . . . . . . . . . . . . . . . . 60
4.2.1 Energy and Mineral Resources . . . . . . . . . . . . . . . . . . 60
4.2.2 Competition for Fertile Land . . . . . . . . . . . . . . . . . . . . 62
4.2.3 Geostrategic Competition . . . . . . . . . . . . . . . . . . . . . . 63
4.2.4 Zones of Influence . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
4.3 Non-material—Existential: Imagination and Utopia . . . . . . . . . . 65
4.3.1 Utopias, Ideals and Re-Imagined Golden Ages . . . . . . . 65
4.3.2 Paradise and the God-Contract . . . . . . . . . . . . . . . . . . 66
4.3.3 Golden Ages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
4.3.4 Anger and Grievance . . . . . . . . . . . . . . . . . . . . . . . . . 70
4.4 The Genocide Project: Getting Rid of the Others . . . . . . . . . . . 75
4.5 Democracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
4.5.1 Misinformation and Fake News . . . . . . . . . . . . . . . . . . 77
4.5.2 Democracy: A Continuous Process Based on Ideals . . . 78
4.6 Development and Political Economy . . . . . . . . . . . . . . . . . . . . 82
4.6.1 The Democracy Index . . . . . . . . . . . . . . . . . . . . . . . . 83
4.6.2 Democracy and Development . . . . . . . . . . . . . . . . . . . 84
4.6.3 Transparency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
4.6.4 Endowment and Entitlement Mapping . . . . . . . . . . . . . 84
4.6.5 Action, Context, Structure, and Power in
Humanitarian Spaces . . . . . . . . . . . . . . . . . . . . . . . . . 85
4.7 Human Rights and Democratisation . . . . . . . . . . . . . . . . . . . . . 87
4.8 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
5 Can Democracy Be All Things to All People? . . . . . . . . . . . . . . . . . 91
5.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
5.1.1 The Pillars and Organs of Ideology . . . . . . . . . . . . . . . 92
5.1.2 Ideological Competition . . . . . . . . . . . . . . . . . . . . . . . 95
5.1.3 Religion and Fundamentalism . . . . . . . . . . . . . . . . . . . 96
5.1.4 Democracies and Conflict . . . . . . . . . . . . . . . . . . . . . . 98
5.1.5 Inherent Contradictions . . . . . . . . . . . . . . . . . . . . . . . . 98
5.1.6 States Attempting Moves Towards Democracy . . . . . . . 99
5.2 War Between Democracies . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
5.2.1 Regional Nationalisms . . . . . . . . . . . . . . . . . . . . . . . . 104
5.2.2 Multiple Causes for Regional Conflicts . . . . . . . . . . . . 105
5.2.3 Radicalization: Regionalist and Nationalist
Campaigns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Contents xiii

5.2.4 Regional Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

5.2.5 Good Governance, Good Citizenship
and Competing Voices . . . . . . . . . . . . . . . . . . . . . . . . 108
5.2.6 Interconnecting Central and Local Government . . . . . . 109
5.3 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

Part II Humanitarian Action: Development Concepts

6 Aligning Humanitarian Actions and Development . . . . . . . . . . . . . 119
6.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
6.1.1 Defining Humanitarism . . . . . . . . . . . . . . . . . . . . . . . . 121
6.1.2 Humanitarian Action: Past and Present . . . . . . . . . . . . 122
6.1.3 Geographical Contexts and Development Levels . . . . . 127
6.2 The Major Categories of Humanitarian Disasters . . . . . . . . . . . 128
6.3 Defining Hazards, Vulnerability and Risk . . . . . . . . . . . . . . . . . 132
6.4 Poverty, Vulnerability and Humanitarian Crises . . . . . . . . . . . . 133
6.5 Responses to Humanitarian Disasters . . . . . . . . . . . . . . . . . . . . 135
6.6 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
7 Sustainable Development: Vulnerability and Crises . . . . . . . . . . . . 141
7.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
7.2 Sustainable Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
7.2.1 Food, Power and Hunger . . . . . . . . . . . . . . . . . . . . . . 145
7.2.2 Sustainable Development: Famine and Learning
from the Past . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
7.3 Case Study: The Great Irish Famine/an Gorta Mór
(1845–49) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
7.3.1 Patterns of Global Malnourishment . . . . . . . . . . . . . . . 150
7.3.2 Women Play a Major Role in Food Production
in the NICs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
7.3.3 Political-Economy and Poverty . . . . . . . . . . . . . . . . . . 151
7.3.4 Human Vulnerability and Risk of Disaster
in Post-colonial Countries . . . . . . . . . . . . . . . . . . . . . . 154
7.3.5 Imperialism and Colonialism . . . . . . . . . . . . . . . . . . . . 154
7.4 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
8 Development: Ideal and Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
8.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
8.2 The Struggle for Development . . . . . . . . . . . . . . . . . . . . . . . . . 161
8.3 The MDGs (Millennium Development Goals) and SDGs
(Sustainable Development Goals) . . . . . . . . . . . . . . . . . . . . . . . 163
xiv Contents

8.3.1 Goal 1: Eradicate Extreme Poverty and Hunger . . . . . . 163

8.3.2 Goal 2: Achieve Universal Primary Education . . . . . . . 164
8.3.3 Goal 3: Promote Gender Equality and Empower
Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
8.3.4 Goal 4: Reduce Child Mortality . . . . . . . . . . . . . . . . . 166
8.3.5 Goal 5: Improve Maternal Health . . . . . . . . . . . . . . . . 166
8.3.6 Goal 6: Combat HIV/AIDS, Malaria and Other
Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
8.3.7 Goal 7: Ensure Environmental Sustainability . . . . . . . . 167
8.3.8 Goal 8: Develop a Global Partnership for
Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
8.4 Human Rights Approach to Development . . . . . . . . . . . . . . . . . 169
8.4.1 Rights Guaranteed to All Human Beings Under
International Treaties . . . . . . . . . . . . . . . . . . . . . . . . . 170
8.5 Development Discourses: Basic Concepts Revisited . . . . . . . . . 170
8.5.1 Key Concepts in the Development Discourse . . . . . . . . 171
8.5.2 Under-Development . . . . . . . . . . . . . . . . . . . . . . . . . . 171
8.5.3 Food and Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
8.5.4 Money and Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
8.5.5 The Overpopulation Debate . . . . . . . . . . . . . . . . . . . . 178
8.6 Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
8.7 The Big Economic Institutions . . . . . . . . . . . . . . . . . . . . . . . . . 181
8.7.1 The IMF (International Monetary Fund) . . . . . . . . . . . 181
8.7.2 The World Bank . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
8.7.3 The WTO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
8.7.4 The G20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
8.8 Economic Governance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
8.9 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187

Part III Geopolitics and Global Governance

9 Geopolitics and International Organization . . . . . . . . . . . . . . . . . . . 191
9.1 Introduction: Historical Perspectives . . . . . . . . . . . . . . . . . . . . . 191
9.2 The Quest for Regulation: International Organizations . . . . . . . . 194
9.2.1 The United Nations Organization . . . . . . . . . . . . . . . . 195
9.3 Regional Inter-governmental Organization . . . . . . . . . . . . . . . . 196
9.3.1 The Council of Europe . . . . . . . . . . . . . . . . . . . . . . . . 196
9.3.2 European Union . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
9.3.3 The Organization for Economic Cooperation
and Development (OECD) . . . . . . . . . . . . . . . . . . . . . 198
9.3.4 The North American Free Trade Agreement
(NAFTA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Contents xv

9.3.5 Other Major Regional Organizations . . . . . . . . . . . . . . 199

9.4 International Humanitarian Law . . . . . . . . . . . . . . . . . . . . . . . . 202
9.4.1 The Geneva Conventions . . . . . . . . . . . . . . . . . . . . . . 202
9.4.2 The International Criminal Court (ICC) . . . . . . . . . . . . 207
9.5 The Responsibility to Protect (R2P) . . . . . . . . . . . . . . . . . . . . . 208
9.5.1 The R2P: To Prevent, to React, and to Rebuild . . . . . . 211
9.5.2 The Threshold for Military Interventions . . . . . . . . . . . 211
9.6 Arguments Supporting the R2P . . . . . . . . . . . . . . . . . . . . . . . . 212
9.6.1 Humanitarian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
9.6.2 A Major Reason for the Creation of the United
Nations Organization . . . . . . . . . . . . . . . . . . . . . . . . . 213
9.6.3 Deterrent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
9.6.4 Economic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
9.7 Criticisms of the R2P . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
9.7.1 Violation of National Sovereignty . . . . . . . . . . . . . . . . 214
9.7.2 Double Standards in the Implementation of the R2P . . . 215
9.7.3 New or Neo-imperialism and Neo-colonialism . . . . . . . 217
9.7.4 Abuse of Interpretation . . . . . . . . . . . . . . . . . . . . . . . . 217
9.7.5 Independence, Neutrality, and Impartiality . . . . . . . . . . 218
9.7.6 Structure of the UN . . . . . . . . . . . . . . . . . . . . . . . . . . 218
9.7.7 Not Realistic, Too Utopian . . . . . . . . . . . . . . . . . . . . . 219
9.7.8 Remarks on the UN and Multilateralism . . . . . . . . . . . 219
9.8 Peacebuilding and Post-conflict Recovery . . . . . . . . . . . . . . . . . 222
9.9 Peace Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
9.9.1 Truth and Reconciliation . . . . . . . . . . . . . . . . . . . . . . . 224
9.10 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226

Part IV Conclusions and Further Learning

10 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
11 Reflection: Autonomous Learning, Activities and Questions . . . . . . 235
11.1 Part 1 Conflict and Power . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
11.1.1 Theme: Geopolitics . . . . . . . . . . . . . . . . . . . . . . . . . . 235
11.1.2 Thematic Revision Questions . . . . . . . . . . . . . . . . . . . 237
11.1.3 Theme: The Causes of Conflict . . . . . . . . . . . . . . . . . . 237
11.2 Revision Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
11.3 Part 2 Humanitarian Action: Development Concepts . . . . . . . . . 239
11.3.1 Theme: Development and the UN Human
Development Index (HDI) . . . . . . . . . . . . . . . . . . . . . 239
11.3.2 Theme: Humanitarian Narratives—What’s
the Big Story? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
xvi Contents

11.4 Revision Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249

11.4.1 Theme: Development—Ideals and the Basics . . . . . . . . 250
11.5 Revision Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
11.6 Part 3 Geopolitics and International Organization . . . . . . . . . . . 251
11.6.1 Writing Reports and Recommendations . . . . . . . . . . . . 251
11.7 Revision Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
About the Author

Gerry O’Reilly is an Associate Professor of Geography

at Dublin City University (DCU), with research interests
in geopolitics, development, and political economic and
cultural geography. His teaching focuses on Geopolitics
and Humanitarian Action, the Middle East and North
Africa (MENA) and Spaces of Memory. Before joining
the DCU in 1997, he held lectureship and research posts
at University College Dublin and the Universities of
Durham, Tunis and Annaba, Algeria, and served as a
Visiting Professor at Ohio State University, Columbus.
Regarding Humanitarian Action and Geopolitics and as a
Faculty Member of ECHO (EU Humanitarian Office)—
NOHA (Network on Humanitarian Action), he was an
Erasmus Mundus Visiting Fellow at Western Cape
University, RSA (2009), Toronto York University
(2008) and Columbia University, NY (2007). Gerry
is currently Vice President of EUROGEO—EAG
(European Association of Geographers).

xvii
Chapter 1
Introduction

Abstract Due to live news and social media, people are constantly called to witness
evolving power struggles alongside minor and major conflict, in all sorts of places
worldwide. Conflict is often multi-dimensional and people ask what are the conse-
quences and whose responsible for what. While it is a truism that the first casualty of
war is often truth, now Internet, Facebook, Twitter or WhatsApp can be used to reach
local and global audiences and hence the dangers posed by fake news. Getting checks
and balances between freedom of speech, and abuses of that democratic principle,
ranging from perverse lies, to incitement to hatred, denialism, interference of outside
agencies and individuals in domestic politics and electoral processes pose dangers,
and of course the dark web offers a platform for extremism as illustrated by Jihadi
groups like Daesh. Nonetheless, in this context, communications and media remain
central to all aspects of analyses of geopolitics and humanitarian emergencies.

Keywords Information · Fake-news · Social media · Power · Conflict ·

Geographical scales

In an era of live and continuous news updates without borders, through mass and
social media, iPhones, apps and so forth, people around the world are constantly
called to witness evolving power struggles and conflict, both non-violent and vio-
lent, in all sorts of places and at various geographical scales, local to national and
international. Defining what the conflict is can be multi-dimensional, as is its evolu-
tion and varying intensity of struggle or clash between opposing forces—opposition
between ideas and ideals, contested interests and disagreement or controversy. Often
the word conflict is used, a euphemism like ‘troubles’, so as to avoid using the term
war, which became restricted by legal usage after 1945. Conflict is a more general
term and can be used to describe a struggle between actors of equal or unequal
power, including state or non-state players at any territorial or geographical scale;
it does not necessarily refer to open warfare with military action and leaves greater
room for negotiation.

© Springer Nature Switzerland AG 2019 1

G. O’Reilly, Aligning Geopolitics, Humanitarian Action and Geography
in Times of Conflict, Key Challenges in Geography,
https://doi.org/10.1007/978-3-030-11398-8_1
2 1 Introduction

When information is received via the internet, mass or social media, or is broadcast
or in print, regarding a conflict or emergency, the individual reaction is often to ask:
What, where, who, when, how, why?—Who are the victims, or who are villains and
the good guys. What can be done to fix the problem, or to help if necessary!—Whose
responsible? Does this affect me, my family, my community, my budget! Of course,
the distance factor between the place of the emergency or conflict, and person who
receives the information is important in shaping reactions, but if the conflict, or
emergency may cause regional or global repercussions, this heightens the reactions
of the news consumers and consequently media outlets.
While it is often quoted as a truism that the first casualty of war is truth, now Inter-
net, Facebook, Twitter or WhatsApp can be used to reach local and global audiences
with information about the conflict. Despite the many advantages of the Internet,
foremost dangers for ordinary people are fake news, and also its use by governments
for citizen-surveillance purposes, and for cyber-warfare reasons.1 Fake news is essen-
tially lies and usually sensationalistic information created to gain attention, mislead,
deceive or damage a reputation or the truth about events and people. Hence, inde-
pendent thinking and analyses becomes an even greater challenge. Getting checks
and balances between freedom of speech, and abuses of that democratic principle,
ranging from perverse lies, to incitement to hatred, denialism, interference of outside
agencies and individuals in domestic politics and electoral processes of other states,
and of course the dark-web offering a platform for extremism as illustrated by Jihadi
groups and foremost Daesh (Islamic State).2
According to Pew Research (2016), it was found that 64% of US adults believed
completely made-up news had caused “a great deal of confusion” about the basic
facts of current events, while 24% claimed it had caused “some confusion” and 11%
said it had caused “not much or no confusion”. While 23% of those polled admitted
they had personally shared fake news, whether knowingly or not.3
Efforts to reduce effects of fake and ‘dangerous news’ are being made by fact-
checking websites, which have posted guides to spotting and avoiding fake news
websites.4 Social media sites and search engines, such as Facebook and Google
have received criticism for facilitating the spread of fake news. In reaction to this,
both corporations have stated that they have taken measures to prevent the spread
of fake-news, but critics believe more action is needed. In 2017, Facebook targeted
30,000 accounts related to the spread of misinformation regarding the French pres-
idential elections. In 2018, a 37-page indictment was issued by Robert Mueller,

1 Mike Wendling. BBC Trending. The (almost) complete history of ‘fake news’. 22 Jan. 2018. http://

www.bbc.com/news/blogs-trending-42724320.
Fake News. https://en.wikipedia.org/wiki/Fake_news.
2 Counter Extremism Project—CEP’s Eye on Extremism https://www.counterextremism.com/.
3 Barthel, Michael; Mitchell, Amy; Holcomb, Jesse (2016-12-15). “Many Americans Believe Fake

News Is Sowing Confusion”. Pew Research Centre’s Journalism Project. Retrieved 2017-04-20.
4 LaCapria, Kim (2 March 2017). “Snopes’ Field Guide to Fake News Sites and Hoax Purveyors”.

www.Snopes.com.
Kiely, Eugene; Robertson, Lori (18 November 2016). “How To Spot Fake News”. www.
FactCheck.org.
1 Introduction 3

Special Counsel for the US Department of Justice, against Russia’s Internet Research
Agency providing detail on Russian information warfare targeting the American pub-
lic during the 2016 US electoral campaign. The Facebook–Cambridge Analytica data
scandal connected to the 2015–16 US election campaigns, and the 2016 Brexit ref-
erendum has caused much concern for the integrity of electoral processes in the
so-called mature democracies. The Cambridge Analytica data scandal has incited
much public discussion on ethical standards for social media companies, political
consulting organizations and politicians. Consumer advocates and politicians have
called for greater protection in online media and right to privacy as well as curbs
on misinformation and propaganda.5 Hence the threat to truth and democratic pro-
cesses. The ignorant, extremists, spinners, propagandists and those wanting to make
easy money can hit global audiences with so called ‘alternative facts’ offering counter
truths, solace, over-simplified unconventional narratives, or substitute imagined ‘we’
communities and a whole range of existentialist or imaginary substitutes in the face
of perceived elite and establishment narratives.
Regarding social media platforms and the net, arguments promoting free
speech, democratic usage and tech-company self-regulation, bolstered by the creation
of profits are being seriously challenged by the realities of its misuse, as witnessed by
Daesh activities. The technology giants are being called to account by governments.
While Google, Twitter and Facebook have taken steps to expunge Daesh propaganda
and other terrorist content from their platforms, it could be argued that the approach
has been more reactive than proactive. Have such tech companies become lost
in their Faustian game and who exactly is profiting financially, now that it is
proving ever more difficult to bring Frankenstein back under control.
Governments in authoritarian and hybrid political regime countries have tried
to tackle the problem with direct censorship, in as far as this is possible, while
many governments in the flawed and full democracies are grappling with the state-
regulation versus self-regulation legislation dilemma. In 2018, the European Union
was preparing new legislation threatening internet platforms, big and small, with
fines if they fail to take down terrorist material. Europol stated that cooperation with
big internet platforms on taking down terror content that they flag is “excellent.”
The agency works with over 70 internet and media companies and on average they
remove over 90% of the content that’s flagged to them within two to three hours.
Twitter says it has suspended over one million accounts, with 74% of accounts
suspended before their first tweet. Such arguments pale into insignificance for the
victims and families of terrorist attacks and conflict, where the terrorists have used
the net as a major support in their activities. Critics argue the big internet giants need
to do more. The non-profit organization Counter Extremism Project that aims to
combat the threat of extremist ideologies, states that gaps remained in Facebook and
other companies’ approaches to combating extremism. They contend that Facebook

5 ABC News (2017).

Cambridge Analytica, the political consultancy at the centre of the Facebook data-sharing scan-
dal, is shutting down. 2 May 2018 https://www.bbc.com/news/business-43983958.
Molly McKew. Did Russia affect the 2016 election? It’s now undeniable. Wired. https://www.
wired.com/story/did-russia-affect-the-2016-election-its-now-undeniable/.
4 1 Introduction

has only emphasized the removal of Islamic State and al-Qaeda content and has
provided insufficient transparency about its progress in removing content from other
extremist groups.6 Nonetheless, in this context, communications and media remain
central to all aspects of humanitarian emergencies and geopolitics.

Reference

ABC News (2017) http://abcnews.go.com/Technology/wireStory/facebook-targets-30000-fake-

france-accounts-election-46793944

6 TechGiants Face New Terror Law in EU Crackdown on Internet Hate. 30 July 2018. https://mail.
google.com/mail/u/0/#inbox/164eb4df7a619bf8.
Visit https://textbookfull.com
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 Part I
Conflict and Power

Part I of this book explores concepts of conflict and frameworks for under-
standing geopolitics regarding the earth, territory and power. These ideas are
deconstructed in time, place and space settings with a focus on physical and
human geographies, and the geopolitical aspects found in humanitarian crises
and disasters. Among these are territoriality, identity, ethnicity, nation and the
state. Despite immense changes brought about by globalisation, technological and
digital revolutions especially since the 1990s, the state remains the basic territorial
unit of internal and international organisation. The state is continuously strug-
gling to create equilibria so as to avoid self-destruction, violent conflict and
war. The challenge here for the state and international community remains to
establish a dynamic equilibrium. This essentially entails continuously balancing
the evolving centripetal forces that draw people together, so as to counteract the
centrifugal forces that are pulling people, societies and states apart. By its very
nature, these forces are never, and will never be completely stable. However, when
centrifugal forces outbalance the established norm, this leads to conflict that
may be resolved by democratic means, or degenerate into violence and war at
national and international scales. Top-down and interstate responses and actions
are being persistently challenged to provide answers and policies, and most of all
delivering on ‘better and more’ regarding citizens demands for an improved life
embedded in bottom-up power.
State construction, its territorial-base and political economy, is interpreted here
alongside concepts of the nation, nation state and nationalism. Like territoriality,
nationalism has many iterations and syncretic interconnections with other ideolo-
gies, as well as contested interpretations ranging from the ethnic, civic and
expansionist to the romantic, liberation, post-colonial, socialist, liberal, national
conservative and anarchist. The God concept is sometimes closely interwoven with
organised religion and narratives of the nation or state; therefore, the idea of reli-
gious nationalism must be included here. Similarly, the more abstract, but very real
concepts of pan-nationalism and diaspora nationalism are reviewed.
6 Part I: Conflict and Power

While there are myriad causes of conflict, here they are interpreted as
essentially falling into two categories with the material, tangible or quantifiable
including territory, resources, energy, power and control alongside geostrategic
competition and zones of hard and soft influence. The second category is more
abstract and harder to elucidate; this entails the non-material or existential. Here
the human condition struggling for answers to life—both the philosophical and
material come into play here, with imagination, emotions, Utopian ideals and social
constructs, while hopes, anger and grievance have to be encompassed also. While
few observers would disagree that genuine spirituality, values and meanings form
part of the human condition, the socially constructed organised manifestation of this
in religion is often contested. Although many religions have contributed much to
civilizational projects with the force and power that religion engenders and this is
physically manifest in the vestiges of golden eras, unfortunately the centrifugal
aspects have left history replete with examples of wars of religion, clashing
god-constructs and genocide projects—separating ‘the others from us’. These range
from narratives of paradise, hell and apocalypses to that of reincarnation, and
especially how society and the world should be organised. The concept of secular
democracy and law, especially since the eighteenth century, has endeavoured to
promote the ideal of the separation of organised religion and state powers, guar-
anteeing freedom of religious beliefs or none, for all citizens in civil society.
The democracy ideal can be interpreted as part of the Utopian quest for the
construction of a better life for all and in a secure functioning society; an ideal
which is a constant work in progress and is fragile. This is closely linked to tangible
ideals of development and hence political economy. It is premised on such concepts
as empowerment, entitlements and human rights. This is facilitated or not,
depending on action, context, structures and especially power in society and
humanitarian spaces that are intrinsically linked to transparency, security and good
governance. Hence, the challenge for sustaining credible democracy models
remains as witnessed currently in the USA and EU, being closely observed by the
regimes in the so-called flawed and hybrid regime system countries, but especially
in states with authoritarian governments. Observing political events and processes
within the mature democracies, and more especially from outside, many regimes
and citizens alike in Asia, Africa and Latin America are seriously questioning
whether the Western-style democracy model can be all things to all people. This is
reinforced with media coverage of events in the USA and UK particularly since
2016.
Whatever the official ideology or combinations thereof within countries, these
are buttressed by state pillars and organs—bureaucracies, military, law and
judiciary, educational system, and sometimes or not religion. Ideological
competition in the largest sense of the word whether explicit or covert targets
power, including control of ‘hearts and minds’ as is overtly evident with religious
fundamentalisms and right-wing extremism in many societies, challenging demo-
cratic ideals and hence how this is being managed in North America and EU in
contrast to many MENA and central Asian countries for instance. A major dilemma
exists for states attempting moves towards democracy such as Kenya and Uganda,
Part I: Conflict and Power 7

and such shifts have been greatly supported by the international community.
However, when the electorate votes parties and government into power that have
highly questionable democratic agenda, as witnessed in Algeria, Egypt and Turkey
over the past two decades, this challenges the Western democracy mantra. While
democratic countries have cooperated in military actions or war against other
countries, they do not engage in war between themselves, but resolve dispute
through diplomatic and multilateral institutions.
Nevertheless, regarding regional nationalisms within democratic and
non-democratic countries alike, states have pursued a myriad of integration policies
including military force to prevent them breaking away. The multiple causes for
regional conflicts can become radicalised into regionalist and nationalist cam-
paigns within and outside the mature democracies. In this context, regional
planning is all important in line with good governance and good citizenship
principles, and so the significance of interconnecting them in a sustainable
manner linking central and local governments.
Chapter 2
Geopolitics

Abstract This chapter assesses the geography and politics nexus as embodied in
geopolitics and appraises conflict and its resolution, war and peace. The place, space
and time geopolitical frameworks for analyses, geographical scales and places and
their interconnections are reviewed. Geopolitical approaches spanning the range from
traditional schools of thought to critical geopolitics are referenced. Territory disputed
can range from a few square meters regarding areas on Jerusalem’s Temple Mount,
to thousands of square kilometres as with power standoffs in the South China Sea.
Borders, boundaries and polity are expressed in multi-faceted ways as exemplified
by walls, public squares and symbolic places. Analyses of interactions between
territory and people in place and time contexts is imperative for sustainable planning
and positive action to take place. Territoriality and territorialisation are fundamental
concepts linked to location—indicated by natural, human and political geographical
coordinates. The plotting of maps, GIS and Big Data are vital for the humanitarian
community, as is awareness of the sources, selection of data types, and intended
images.

Keywords Geopolitics · War · Conflict resolution · Time · Space · Territory

2.1 Introduction

This chapter explores frameworks for researching geopolitics and conflict, and its
resolution, regarding territory and power, and the core concepts of time, place and
space. An understanding of the physical and human geographies of any conflict area
is central in developing policies and solutions, and mitigating or preventing further
conflict, or situations degenerating into human-made crises and disasters. The key
concepts of territoriality and identity are explored as are issues regarding concepts of
the state and nation, political-economy and nationalisms. Figure 2.1 helps to illustrate
the world without the human construct of political boundaries.

© Springer Nature Switzerland AG 2019 9

G. O’Reilly, Aligning Geopolitics, Humanitarian Action and Geography
in Times of Conflict, Key Challenges in Geography,
https://doi.org/10.1007/978-3-030-11398-8_2
10 2 Geopolitics

Fig. 2.1 Gall- Peters projection: an equal area map projection of the world. Image by user:
Strebe—Own work, CC BY-SA 3.0, Wikimedia Commons, version 15-Aug-2011. 15° graticule.
Imagery is a derivative of NASA’s Blue Marble summer month composite with oceans lightened to
enhance legibility and contrast. Image created with the Geocart map projection software

2.2 Frameworks for Understanding Geopolitics

and Conflict

2.2.1 Geopolitics: Earth, Territory and Power

Geopolitics, with geo—meaning earth or territory, and politics signifying power—-

can be defined as the study of inter-relationships between physical and human geog-
raphy and political-economy, and its impact on people, organization within states
and between them, and how this impacts on international politics and transnational
relations. Like nuclear and medical research that can be used to improve the quality
of life for humanity, as with radioisotopes and radiation that have many applications
in medicine, agriculture and industry, rather than the negative use of such science
regarding nuclear weapons and chemical warfare, geopolitical research can be used
to create peace, security and development in contrast to destruction and war.1 Sim-
ilarly, with AI (Artificial Intelligence) and Biotech that can bring great advantages
to humanity when used with ethical consideration, as opposed to the unethical drive
for power, control and profit that can disempower or enslave people, and the dangers
of creating a Frankenstein-syndrome.

1 Spencer (1988).
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tissues. Most of the acute infections of the jaw bones are propagated
from the teeth or the tooth sockets. There may be periostitis and
osteomyelitis, and these may be followed by a sclerosing process or
acute suppuration. The jaws are prone to be thus affected in
consequence of the acute exanthems and the infectious fevers,
while the effects of mercury and phosphorus have been mentioned.
The treatment of the inflammatory affections here is the same as
elsewhere, i. e., early incision and complete evacuation of pus, with
removal of necrotic bone or other tissue. Many sequestra may be
removed from within the mouth in such a manner as to avoid
disfiguring scars. When external sinuses complicate the case,
incisions through the skin should be made. These may be so
planned as to coincide with the natural wrinkles or folds of the face.
The temporomaxillary joint is a locality of considerable interest.
Dislocations take place here in consequence of blows or of violent
muscular effort, and are easily recognized because of the fixation
and displacement which they produce. Ordinarily they are easy of
replacement. These luxations may be unilateral or bilateral. As the
result of violence the condyle has been driven upward through the
base of the skull, the violence producing such injury usually being
fatal. Aside from these injuries to the grosser structures the
temporomaxillary joint is not infrequently the site of acute synovitis,
or more extensive inflammation, usually propagated from
surrounding tissues, but sometimes the result of distant infection. In
phlegmons of this region the structures of the joint rarely escape a
sympathetic participation, while parotid abscess and similar
collections of pus may penetrate the joint and destroy it. Again it is
occasionally the site of a postgonorrheal arthritis, or it may suffer as
do other joints after the exanthems and acute fevers. It also
occasionally becomes involved in the disturbances accompanying
irregular eruption of the last molar, i. e., the wisdom tooth; in other
words, it may suffer just as may any other joint in the body, and from
similar causes.
Ankylosis of the temporomaxillary joint is an infrequent result of its
involvement in serious disease, or may result from lesions of the
adjoining tissues, as from the cicatricial deformity following noma,
burns, and the like. Thus we may have either a true or a spurious
ankylosis of this joint, in either case the resulting condition being
intractable and exceedingly difficult to manage. When it can be
foreseen as a consequence of extrinsic disease it may be prevented
by the insertion of a mouth-gag, and more or less frequent and
forcible stretching, or by wearing some suitable apparatus between
the teeth which shall keep the jaws apart, and which may be used at
night. A pseudo-ankylosis produced by cicatricial bands, and long
neglected, will become genuine, and require as radical an operation
as though it had been interosseous from the outset.
For the relief of such conditions various operations have been
devised, in each of which the formation of a false joint is
contemplated, it depending upon the exigencies of the case whether
this shall be produced by the division of the horizontal ramus in front
of the masseter, or of the ascending ramus behind the masseter, or
whether there shall be actual resection of the temporomaxillary joint,
with division of the neck and removal of the condyle. The latter
procedure is the more ideal, at the same time the more difficult, and
the more likely to permit injury to the branches of the facial nerve,
with consequent paralysis of the orbicularis and the facial muscles.
I have elsewhere described a peculiar condition of relaxation of
the temporomaxillary ligaments, by which there is a recurring
subluxation of the joint, noticed most often during eating and
accompanied by a snapping sound. This is usually unnoticed by the
patient, but is often observed by others. It is painless, harmless, and
not ordinarily amenable to treatment. (See p. 528.)
Tumors of the jaws proper include mainly cysts, which are often
connected with odontomas, benign tumors, such as fibroma,
chondroma, and osteoma, most often of mixed type, and the
malignant tumors, i. e., sarcoma, carcinoma, and endothelioma.
Malignant tumors primary to the bone are usually of sarcomatous
type, though these may include the endotheliomas. Carcinoma and
epithelioma do not originate in bone texture, but may easily spread
to and involve it. Thus many cases of advanced epithelioma of the lip
involve the bone as well as the other neighboring tissues.
Epulis is a somewhat vague term, which has been applied to
tumors which spring from and mainly involve the fibrous texture of
the gum and the periosteum covering the alveolar process. The term
itself simply implies a tumor upon the gum. Microscopically these
tumors are usually of the giant-cell type of fibrosarcoma, and are
among its least malignant varieties. They pursue a slow course,
gradually loosening one tooth after another as they invade the tooth
sockets, show very little tendency to spread rapidly, and are usually
sharply circumscribed growths, tending to ulceration. They seem to
be products of irritation. When removed they rarely recur. The
surgeon should excise involved tissue in order to be on the safe
side, sacrificing teeth, gum, and alveolar process as widely as
necessary for the purpose. Formerly the epulides were made to
include different expressions of fibroma and sarcoma involving the
gum, but the name is so vague that it would be better to speak of
each of these cases as its histological characteristics may indicate.
Benign tumors involving the entire bone may necessitate its
removal, but most of the dentigerous bone cysts may be laid open,
their contents evacuated, their size reduced, and the remaining
cavity allowed to fill with granulation tissue; while malignant tumors
call for sacrifice of every portion of tissue involved, often including
the skin, and in the upper jaw much of the complicated structure of
the nasal cavity, or in the lower jaw the loss of the tongue or a large
portion of the floor of the mouth. A cancer of the lower jaw may be
removed, with permanent good result, but a true cancer of the upper
jaw should be seen early and mercilessly extirpated if the result is to
be more than temporary.

OPERATIONS UPON THE JAWS.

Aside from those already mentioned the principal operations upon
the jaws consist of partial or complete excision.
Removal of the upper jaw is a rather formidable procedure,
frequently made so by extent of the disease which requires its
performance. The presence of an extensive and ulcerating tumor, by
which normal anatomical outlines are obliterated, will cause
mechanical difficulties as well as unusual liability to hemorrhage.
During some portion of its performance a temporary control of the
vessels of the neck may be of assistance. This can be usually
afforded by external digital pressure. In serious cases a ligation of
the external or the common carotid may be of assistance. If soft,
vascular tumors protrude into the nasopharynx a preliminary
tracheotomy should be performed, tamponing the pharynx in order to
prevent escape of blood down the throat. The position of the patient
with the down-hanging head may be also of assistance in these
cases. Of the various incisions employed one should be selected
according to the nature of the case. Most of the operations include a
splitting of the upper lip near the middle, with continuation of the
incision along the margin of the nose, upward toward the orbit and
outward along the orbital border, as originally suggested by
Fergusson. This permits of completely raising the cheek from the
underlying bone in one extensive flap and turning it backward, with
complete exposure of the anterior surface of the superior maxillary.
The operator next proceeds according to the desired extent of
removal. If the roof of the mouth is to be sacrificed the
osteoperiosteal and soft tissues composing the palate should be
divided as far from the middle line as may be permitted, then
reflected, and the bone divided with chisel or with cutting forceps. It
may be necessary to remove one of the incisor teeth to permit the
insertion of the chisel for division of the anterior part of the jaw. Bone
forceps or a chain or wire saw will serve for division of the zygoma
and the external or lower wall of the orbit, while with chisel or forceps
the nasomaxillary region is divided. The loosened bone can now be
seized with strong lion-jaw forceps and wrenched from its
attachments, which may then be divided with scissors or knife as
they are encountered (Fig. 474).
 Fig. 474

Resection of superior maxilla. (Farabeuf.)

Hemorrhage will be profuse at this juncture, when the internal

maxillary artery is, with many of its branches, thus torn across or
severed. The surgeon should be ready with tampons and forceps to
check the bleeding and secure the vessels. The complete Fergusson
operation includes removal of the entire upper maxilla, but
oftentimes much less than this will suffice. On the other hand it is
necessary sometimes to go still farther and remove more bone from
the orbit or the nasal cavity, or perhaps to clean out the orbit entirely.
A case which necessitates one of the more formidable operations is
too unpromising to make it often judicious to perform it.
When the tumor involves the overlying skin this should also be
sacrificed, and a plastic operation should be made to cover the
defect. The skin flaps required for this purpose may be taken from
the temple, the forehead, the neck, or adjoining parts of the face.
Bardenheuer has suggested the raising of osteoplastic flaps for
removal of tumors lying within the jaw, and their replacement at the
conclusion of the operation. He has also devised ingenious methods
of making immediate plastic repair which are worthy of study, but
which are so seldom required as to not justify description in this
place.
After operation the bleeding should be checked by torsion, by
ligation, by sutures en masse, by application of hot water, and by
securely tamponing with antiseptic gauze, by whose pressure oozing
is checked and protection from infection afforded. The patient is
allowed to sit up as early as possible, meanwhile being made to lie
upon the affected side in order to avoid danger of aspiration
pneumonia, and using an antiseptic mouth-wash with relative
frequency.
It is sometimes possible to perfect an artificial substitute for tissues
removed, which can be inserted after the operation. The loss of
tissue will cause more or less disfigurement by sinking in of the
cheek and side of the face. After the parts are healed an apparatus
made of gutta-percha or metal, and adapted to each case, by which
most of the lost symmetry may be restored, should be worn, in the
same manner as an artificial denture.
The lower jaw seldom requires complete removal. It is rarely
necessary to go so high as the joint or the coronoid process,
although occasionally the condyle must be avulsed and the coronoid
either cut away or its temporal tendon detached. Most of the
exsections in this location are confined to some portion of the
horizontal ramus. Except in rare instances it is not possible to make
a complete excision of the lower jaw through the mouth, and nearly
all operations are practised through external incision, carried along
the lower border for a sufficient length, and extended upward along
the posterior border beyond the angle, if necessary. In most
instances the facial vessels are directly exposed and should be
secured before division. Masseteric attachments are separated and
the instruments are kept as near to the bone as the circumstances of
the case will justify. In well-marked ulcerating cancer, however, the
surgeon should go nearly an inch beyond its apparent border and
remove still more if it be visible, taking everything which seems
involved. Here the bone is usually divided with a chain saw, although
stout cutting forceps may suffice. It may be necessary to remove a
tooth in order to clear a place for the action of the chain saw.
Growths involving the skin necessitate not merely linear incisions,
but extensive oval excisions of the overlying tissues. All the involved
structures should be removed in one mass; if it be necessary to
remove the floor of the mouth the divided bone section is seldom cut
away until it can be removed with the rest of the tumor. The healthy
mucous membrane should be preserved and brought together with
catgut sutures at the conclusion of the operation, as the more
carefully the cavity of the mouth can be shut off from the balance of
the wound the more prompt and satisfactory the healing (Fig. 475).
Fig. 475
 Resection of inferior maxilla. (Farabeuf.)

In a few cases it may be possible by the use of stout silver wire, or

some other substitute, inserted between bone ends to keep them
apart and thus nearly preserve the contour of the lower part of the
face; but this can be expected to succeed only when the cavity of the
mouth can be completely closed, so that the wire or other material
may be quickly incorporated in granulation tissue, where it is
expected to remain.
When it is necessary to remove the joint end of the bone the
operator should work carefully along the bone toward the joint in
such a way as not to injure the facial nerve, the external maxillary
artery, or Stenson’s duct. With a sharp separator it is possible to thus
expose the joint, and after opening it to avulse the articular surface.
In operating for necrosis the healthy periosteum should be
preserved, while in the removal of cancer it should be sacrificed to
the same extent as the bone itself.
The same rules apply here as above with reference to the closure
of the wound and the construction of flaps; an extensive plastic
operation being sometimes necessitated, as when a large portion of
the lower lip, the chin and the bone are removed for extensive
epithelioma. Dead spaces should be avoided, any cavity should be
packed sufficiently, opportunity for drainage afforded, and the mouth
cavity closed. Mouth-washes should be frequently used.
These cases should be prepared for operation by a careful
cleansing of the mouth and the local use of antiseptics. During any of
these operations, diseased teeth which may require it should be
removed, whether they occupy the site of the operation or some
other portion of the jaws. The cleaner the mouth the more prompt will
be the healing process.
 CHAPTER XLI.
THE RESPIRATORY PASSAGES PROPER.

MALFORMATIONS OF THE RESPIRATORY PASSAGES.

The congenital malformations of the upper respiratory passages
pertain mainly to the nasal septum and the interior of the
complicated nasal cavities, which are rarely symmetrically arranged,
and which often differ considerably. The nasal septum is frequently
deviated or warped to one side, often to an extent making one nostril
too restricted for easy breathing purposes. The nostrils are
occasionally seen to be abnormally retracted. Malformations of the
pharynx are of rare occurrence. The soft palate is occasionally found
to be more of a diaphragm than is natural, and imperforation is
sometimes seen. Pharyngeal fistulas have been mentioned in
connection with incomplete closure of branchial clefts. They occur
more commonly on the right than on the left side, and are usually
incomplete. A fistula placed in the middle line and opening into the
larynx or trachea is also occasionally seen, its inner opening being
generally found on the side of the pharynx and just below the tonsil.
This is not necessarily a persistent remains of the thyroglossal duct,
but may have a different origin. Cystic distentions not infrequently
occur along these fistulous tracts. Malformations of the larynx are
rare and consist mainly of narrowings or stricture formations.
Acquired malformations of the respiratory passages are common
and are the result usually of previous disease or injury. They may
assume the obstructive type, as when the tonsils or the other
adenoid or lymphoid tissues of the nasopharynx become
hypertrophied, or they may assume the constrictive type, as when
strictures result from ulceration, produced either by disease or by
caustics. Such diseases as diphtheria cause not only paralyses,
through the nervous system, but cicatricial deformity in consequence
of ulceration. The latter is also true of burns, while fractures may
permanently displace parts, this being particularly true of the nose,
but holding good also for the hyoid, and even for the larynx. Nearly
all these malformations permit of more or less surgical improvement
by operations, some of which are simple and easy of performance,
while some will need the highest degree of trained skill.
Ozena.—Ozena is a general term applied to ulcerative lesions,
especially involving the Schneiderian membrane in the
nose, and causing more or less discharge of mucus, pus, and crusts,
nearly always offensive, and accompanied by evidences of deeper
ulceration, involving the fragile nasal bones or the nasal septum, and
constituting expressions of caries or necrosis in this region. Ozena
may be the consequence of a milder catarrhal inflammation,
occurring in patients of vitiated constitution and bad habits of life,
with insufficient attention or no care whatever. Another type of ozena
is from the beginning of syphilitic origin, and it is especially the
syphilitic cases which present the most offensive types of lesions,
yet which are the most satisfactory to treat, because of the relative
certainty with which they yield to properly directed treatment. Any
case characterized by profuse and offensive nasal discharge, in
which by suitable illumination and examination ulcerations can be
detected, should be considered ozena.
Treatment.—The treatment for all these cases should consist of
local cleanliness, alkaline solutions in spray or by
irrigation being especially indicated because of their cleansing
properties. Warm sterilized salt solution may also be used for the
same purpose. All visible ulcerations should be treated by local
applications of mild silver nitrate solutions, or some other combined
antiseptic and stimulant; or these may be alternated with local
applications of an ointment of the yellow oxide of mercury in strength
of 0.5 to 1 per cent. Local treatment, however, is but a part of that
which should be instituted. In every case where the syphilitic element
can be recognized, or where there is good reason for even
suspecting it, vigorous antisyphilitic treatment should be begun and
prosecuted. While these cases nearly always need one of the
iodides, administered internally, there is no way of so quickly
bringing them under the desired influence as by inunction with the
ordinary mercurial ointment. Both measures should be carried along
simultaneously until the combination proves to be too active, when
the inunction may be discontinued.
In addition to these measures such cases need improvement of
elimination and of nutrition, and the best restorative tonics may be
combined to advantage with any other special medication which may
seem to be indicated.

FOREIGN BODIES IN THE RESPIRATORY PASSAGES.

Nowhere, except perhaps in the ear, are foreign bodies more likely
to find entrance, and become impacted, than in the respiratory
passages. They are introduced either through the nose or the mouth.
They consist of almost all imaginable substances, introduced either
by accident or design, and belonging to all three kingdoms—animal,
vegetable, and mineral. According to their nature, size, and lodging
place, symptoms of more or less severity will ensue. Migratory
bodies, especially small insects and parasites, may escape from the
nasal cavity into one of the accessory sinuses, where they will give
rise to great irritation, and necessitate perhaps serious measures for
relief. The presence of a foreign body is not always promptly
recognized. In some instances it is discovered only by accident, as
when, having been present for some time, it has produced irritation,
with or without ulceration and offensive discharge. Thus a shoe-
button may have been pushed up the nose of a little child, and
remain there undetected for some time, perhaps to be
spontaneously extruded in the act of blowing the nose. The presence
of a foreign body in the nasal passages, then, will be manifested by
symptoms of obstructed nasal respiration and by other evidences of
local irritation, with pain, tenderness, swelling, and discharge.
An object easily seen is ordinarily easily removed, unless it has
some peculiar shape which impedes its easy withdrawal. Local
cleanliness is the first prerequisite, and then in most instances local
anesthesia, which may be produced with cocaine or one of its
substitutes. After this a probe, bent into the shape of a blunt hook, or
forceps of various patterns and shapes may be required, and will
usually suffice for all ordinary cases which can be detected by
inspection through the nostrils or with the rhinoscope. In more
difficult and unusual cases the fluoroscope or the skiagram may be
made to render great service. Should some larger object be found,
particularly in the antrum, deeply within the cranium, then a more
formal operation will be demanded, whose details should be made to
suit the needs of each individual case. When a mass of inspissated
secretion or of granulation tissue more or less conceals the outline of
the foreign body, everything should be cleaned away with irrigating
spray, or with cotton wrapped around a probe or held within the
forceps.
Calculi.—A rare condition of calculus formation is occasionally
met with in the nose, the concretions being formed by
precipitation of the mineral elements from the nasal mucus, and
constituting the ordinary rhinoliths. These become, in effect, foreign
bodies, and are to be recognized and treated as such. After syphilitic
ulceration portions of bone may be loosened spontaneously, and
dropped into locations where they are caught instead of being
spontaneously expelled.
It is known, also, that, especially in tropical climates, there are
several species of insects which enter the nostrils and there deposit
their eggs, which later are hatched into the resulting larvæ, the latter
sometimes being expelled, or perhaps developing and burying
themselves further within the nasal recesses. Any living organism
may be killed by administration of chloroform or ether, and then
expelled as an ordinary foreign body; or, in most cases, such larvæ
or eggs can be washed away with an irrigating stream to which a
little extract of tobacco should be added. Thus maggots have been
found buried within the nasal mucosa, and requiring extraction by
means of forceps. When larvæ have invaded the sinuses the case
becomes more serious, for it will require free exposure by perhaps a
somewhat formidable operation on the interior of the sinus, which
should then be carefully cleansed and suitably drained. Living
organisms within the nasal cavity or the sinuses will cause
headache, lacrymation, sneezing, nasal discharge, perhaps with
epistaxis, and almost every possible expression of local discomfort.
Foreign Bodies in the Pharynx.—Foreign bodies in the pharynx
are usually, when small, lodged
in the neighborhood of the tonsil, or caught in the lymphoid tissue of
the tonsillar ring. According to their size they may become impacted
at almost any point, and may even cause suffocation. They may be
detected sometimes by the finger alone, or, at other times, only with
good illumination and local anesthesia. The irritation which they
produce leads to frequent acts of swallowing, the latter always
exaggerating the former. Such objects as small fish-bones and the
like, which may cause irritation, may easily escape or defy detection;
moreover, such objects may be multiple.
For the sake of comfort pellets of ice may be frequently swallowed
and cocaine may be used locally. Their extraction should be
promptly practised. In rare instances emergency may call for prompt
tracheotomy, but this is rarely the case unless the object be
impacted below the epiglottis. Curious instances of impaction in the
nasopharynx, of strange foreign bodies, have required the
administration of anesthetics and even serious cutting operations for
their removal, by combined manipulation through the nostril and the
oropharynx. Such bodies, however, can be in some way always
removed.
Liquids may be aspirated through the nose, and cause strangling
attacks of coughing. They are then more easily drawn into the larynx
or trachea, where they will cause reflex phenomena and actual
obstruction, according to their nature. Again by free inhalation of
steam, natural or superheated, burns and scalds of the respiratory
passages may be produced, which will be followed by edema of the
glottis or by pneumonia. The inhalation of extremely strong vapors,
like that of ammonia, may cause spasm of the glottis. The entrance
of blood, as from rupture of an aneurysm, or of pus, as from a
bursting abscess, or the escape of pus from one side of the chest
into the other lung by way of the trachea, may cause serious
symptoms or may produce actual suffocation. In operations for
pyopneumothorax, for instance, with one side of the chest well filled
with pus, one should be careful to avoid turning the patient in such a
way that pus may run over into the other lung and thus suffocate
him. I have seen death occur on the operating table from this cause,
in spite of every precaution, when the accident itself had been
anticipated.
 Solid objects may be of all shapes, sizes, and materials; living
insects are occasionally aspirated and may not be at once killed, the
local irritation caused by their presence producing intense spasm of
the glottis. I have personally known of two cases of suffocation in
restaurants, where men eating hastily died as the result of impaction
of pieces of meat within the rima glottidis. Again, bodies may pass
beyond the glottis proper and enter the trachea, or even one of the
great bronchi; shoe-buttons, for instance; and in one case in my
knowledge a small hat-pin passed down and was only removed after
a low tracheotomy and careful search, aided by a skiagram. Owing
to the anatomical arrangement the right bronchus is more frequently
entered than the left. Immediate danger of suffocation, of
obstruction, or spasm having passed, there is still serious menace
from pneumonia, with or without abscess or gangrene of the lung.
Such condition occurring in a young child, in the absence of the
history of passage of a foreign body, may cause some difficulty in
diagnosis. The greatest help would be afforded by the use of the
Röntgen rays, although the laryngoscope alone will sometimes be
sufficient. To use the latter to advantage it will probably be necessary
to allay local irritation with the cocaine spray. (See Figs. 476 and
477.)
Treatment.—Treatment should be operative, although in some
cases it is sufficient to invert the patient and slap him
on the back. With an object impacted in the glottis relief may be
afforded with the finger, but this may be exceedingly difficult, for in
the later stages of suffocation the jaw may be convulsively shut and
it will be almost impossible to effect entrance. In such case the jaw
should be hastily pried open and the index finger carried down
behind the base of the tongue, lifting the epiglottis and dislodging the
object. If this fail and respiration have ceased, attempt should be
made to hastily open the trachea, even with the blade of a penknife,
and to follow this with artificial respiration. Under these
circumstances the vessels of the neck will be engorged with venous
blood, which will escape freely; this may, however, be disregarded,
the primary indication being to get into the trachea, which may be
held open by turning the knife-blade at right angles, while artificial
respiration is practised, and until a couple of hair-pins, for instance,
can be secured, bent into shape of blunt hooks and made to act as
temporary retractors. This is an illustration of what may be done in
emergencies.

Fig. 476

Toy-pin (actual size) removed by external pharyngotomy from pharynx and

esophagus of a two-year-old child. Recovery. Skiagram by Dr. Plummer. (Buffalo
Clinic.)
 Fig. 477

Skiagram of Fig. 476.

On the other hand these operations should, when possible, be

done deliberately and with local anesthesia. Foreign bodies should
be located with the laryngoscope, after which they may be removed
with the aid of the illumination thus afforded, or by mere sense of
touch. An object impacted in the larynx proper may be extracted by
thyrotomy, whereas when it has passed below the larynx it will be
necessary to open the trachea, perhaps even low down, making
more than an ordinary opening for purposes of manipulation.
Numerous forceps have been devised for these purposes. Roaldes
reports having removed a piece of impacted iron from the bifurcation
of the trachea, by means of a powerful electromagnet.
In the ensuing chapter there will be mentioned a method of
exposing both the trachea and the esophagus by posterior incision
or resection of the thoracic wall.
 Fig. 478

Tack in bronchus of young child, removed after a low tracheotomy. Case of Dr.
Parmenter’s. Skiagram by Dr. Plummer. (Buffalo Clinic.)

INJURIES TO THE RESPIRATORY PASSAGES.

Besides those inflicted by foreign bodies injuries may be produced
here from external conditions, gunshot wounds, fractures, and a
variety of causes which need not be specified. The inhalation or the
entrance of violent caustics, either fluid or volatile, may produce
edema at least, or actual destruction of tissue. The glottis, being the
narrowest portion of the respiratory tract, offers the greatest danger
under conditions of obstruction, and fatal dyspnea may ensue. Thus,
for instance, burns caused by inhaling steam, or hot vapors or flame,
will be followed by most intense reaction, often extending beyond the
trachea and to the air cells. Edema will be prompt, while pain, shock,
dyspnea, and loss of voice will be instantly produced. If the patient
survive the early complications he may succumb to pneumonia or
other disastrous sequels in the lungs.
Wounds of the Larynx.—Wounds are nearly always complicated
by other injuries of the neck or face, which
may involve vessel or nerve trunks of primary importance. Moreover,
such wounds are mostly infected and lead to extension of
phlegmonous involvement, which may later cause mediastinal or
deep cervical abscesses, and all sorts of septic and pyemic
complications. Even when recovery ensues cicatricial contraction
may produce laryngeal or tracheal stenosis, with defective voice, or
sometimes fistulas, connecting usually with the trachea.
Treatment.—In the treatment of such wounds provision should be
made for drainage, and it is seldom advisable to make too accurate
a closure lest its very intent be thereby defeated. Unless the patient
be suffocating the first indication is to check hemorrhage, then to
cleanse the wound, and later to make such approximation of its
surfaces as the case may permit. Occasionally in order to obtain a
good result in the upper part of the respiratory tract it would be good
practice to make a tracheotomy below. At other times an O’Dwyer
tube may be inserted.
The occurrence of edema may be prevented, or at least its
severity in a measure controlled, by the use of adrenalin solution, 1
to 10,000, while the local use of mild cocaine solutions will be
frequently indicated, in order to check irritability and the reflex
phenomena to which it will lead. Local symptoms may also be
combated by inhalation of vapor, with soothing solutions, such as
weak preparations of cocaine or of one of the opiates, followed by
mild astringents and antiseptics—tincture of benzoin or oil of
eucalyptus, or some of their equivalents, being nebulized and used
in a spray. Opiates internally should be prescribed; while with
delirious, drunken, or maniacal patients every effort should be made
to secure physiological rest and to subdue restlessness or frenzy.
Fracture of the Larynx.—Fracture of the larynx is a somewhat
uncommon accident, due to direct
violence, which may instantly precipitate symptoms of the greatest
severity. It may be simple or compound, the thyroid being obviously
most often involved and the cricoid next. These injuries will occur
more frequently in the aged, in whom the external cartilages of the
larynx are prone to calcify and thus become more brittle. A fracture
of the larynx precipitates extreme danger of suffocation, either from
displacement or edema, and will usually require a prompt
tracheotomy, which may be performed with a penknife in the
absence of any better instrument. It may be indicated also by
expectoration of bloody mucus, with froth, with stridulous respiration,
dyspnea, pain—which is increased by pressure or motion, as in
swallowing—and the local indications of injury. Thus death has
occurred upon the field during a game of baseball, from a direct blow
of the ball upon the larynx, no one who knew sufficient to perform it
reaching the patient in time to do an emergency tracheotomy as
above. Edematous laryngitis, which is not sufficiently serious to call
for operation, is characterized by dyspnea, aphonia, dysphagia,
cough, laryngeal irritability, and by more or less chemosis and
congestion of the mucosa. The specialists treat certain of the milder
forms of this condition by local scarification (i. e., with a knife made
for the purpose), in order that by considerable local hemorrhage the
vascular engorgement may be relieved.

NASAL DEFORMITIES.
These consist in large measure of deviations of the nasal septum,
with or without turbinate hypertrophy, due to previous disease of the
Schneiderian membrane, and followed by thickening and structural
change. Nasal deviations are either of congenital or acquired origin.
An absolutely symmetrically arranged and divided nasal cavity is a
rarity. Thus, though one side is rarely a replica of the other,
deviations which are sufficiently marked to cause nasal obstruction
are commonly the result of rapid or slow disease. They will be seen
in connection with other body deformities by which the head is
habitually held in an abnormal position, so that growth in one
direction is thereby favored. Such conditions may be caused either
by irregularities of vision, by enlarged tonsils, or by spinal
deformities.
The acquired deviations are frequently the result of injuries, not
necessarily of those sufficiently severe to produce fractures. The