After the first war, before the next

Once more border clashes between Armenia and Azerbaijan are occurring. Lika Zakaryan reflects on what happened since the last war ended.

Lika Zakaryan

Lika Zakaryan is a writer and photographer based in the Republic of Artsakh (Karabakh).

A child protestor holds a placard at a demonstration

Artsakh citizens protest against the blockade and its effects.

VoA, Public domain, via Wikimedia Commons.

More than two years ago the war between Armenia and Azerbaijan for Nagorno-Karabakh/Artsakh ended, but many fundamental issues remain. Who will provide security and services for the region’s residents - Armenians? How is humanitarian aid managed and by whom?. And, nobody knows if the so-called “ceasefire” will hold. 

Azerbaijan won the war, with the Armenian side losing significant territory in and around Nagorno-Karabakh. Over one-third of the population became refugees, losing their homes and everything they managed to create during all their lives. Now Azerbaijan controls those territories, but they mainly remain not inhabited. Those territories that remained under the control of Armenians, are still populated only with Armenians, and Azerbaijanis have to approached them. In order to prevent any armed conflict in the region (in fact, to protect Armenians from Azerbaijanis) 4,000 Russian soldiers-peacekeepers and emergency services staff keep an uneasy peace. 

They were already in Artsakh within hours of the peace agreement’s signing. Artsakh is part of Nagorno-Karabakh, an Armenian enclave within Azerbaijan. Since then, peacekeepers have done a lot: escorting villagers to visit graves, mediating disputes, tending crops, and fixing water pipes. They set up checkpoints along the only road connecting Artsakh to Armenia, to ensure a safe corridor for Armenians living in Artsakh.  

Before the war, there were 150 000 Armenians living in Artsakh. After the war, the numbers decreased to 120 000. Some people didn’t come back from Armenia, where they found a shelter, after losing their homes. Some moved to Armenia or Russia because they didn’t want to live in uncertainty. And, unfortunately, wars take lives, and some people lost their lives during that period. But mostly the people of Artsakh remained resilient and wanted to live in their homes or create new ones, even not knowing for how long they will last. 

It is said in Artsakh and Armenia, that every human being now living in Artsakh is a hero. They say that because it’s not easy to sleep every night not knowing if you are going to wake up in the morning tothe sounds of bombs, or if you are going to wake up at all. Because since the end of the war Azerbaijan has done so much to traumatize people physically and mentally.

According to the peace agreement Armenians and Azerbaijanis should remain in the positions they were in at that moment. In other words, after the signing and the cease-fire, they have no right to move forward and occupy new territory. However, after just one month, Azerbaijan entered and captured two Armenian villages, taking more than 60 Armenians as prisoners of war. After that, during those two years, similar military operations were repeated numerous times by Azerbaijan. Again, people were afraid of the sounds of war, they heard and saw military drones, and felts those feelings again.

It was also a manifestation of psychological violence that the Facebook page of the Artsakh National Assembly was hacked, with a flag of Azerbaijan posted as the main picture. The accompanying text read:

“We call on the Armenians living in Karabakh to leave the occupied territories of Azerbaijan within 168 hours, otherwise all Armenian citizens will be killed.”

People had no idea if they should believe that threat or not. Maybe this was just another provocation, but could it really happen? Did they need to evacuate everyone. Or not believe it and stay in their houses? No matter how hard people try to stay strong, no one closed their eyes that night, thinking that it was possible that Azerbaijanis will enter the cities and villages and commit a genocide against the peaceful residents. 

Many violations happened during these last two years. And then since December 12, 2022, Azerbaijan has blockaded the only road connecting Artsakh to Armenia depriving residents of a basic right - a right of freedom of movement. It’s the only road people can travel in and out on, the only road through which the 120 000 people get food, medical and other supplies. It's the only road that connects Artsakh with the outside world. Blockading this road caused a humanitarian disaster. Lack of food, medicine, work, and cash. Nobody can pass along that road.

The blockade was not enough, and Azerbaijan decided to shut off gas and electricity supplies to Artsakh again during the coldest months of winter. People simply do not have the opportunity to warm up. In a sub-zero temperature, people were deprived of the opportunity to turn on a small heater for hours. The little children, unable to stand the cold, fell ill and ended up in the hospital.

The healthcare system in Artsakh is still a little weak. There are hospitals, but people who are in critical condition, between life and death, are mostly transferred to Yerevan, the capital of Armenia, in order to receive proper treatment there. However, due to the blockade, some people could not be evacuated, and died.

Also, a food rationing system was introduced in Artsakh, where people can get food only with a coupon. According to the system, every person gets one kilogram of rice, one kilogram of pasta, one kilogram of sugar and one kilogram of buckwheat in a month. With those coupons, people come to the stores and buy their share.

Food is so scarce that locals have begun to notice that street animals are starving to death because they can't find food in the dumps. The reason is that people have nothing to throw away.

Many families have been divided because one or another family member mistakenly stayed on the other side of the blockade. Many people went to Yerevan to see a doctor and due to the road’s blockade cannot return home. The same impact was felt for those going in the opposite direction. In total, 1,100 people remained in Armenia and did not manage to return to Artsakh.

Artsakh children are deprived of the right to education. Schools and kindergartens are closed for months because there is no way to heat them. Also, they cannot feed children in kindergartens due to the lack of food, and children in schools cannot take food to school, because there is almost no food at home. And sitting for six or seven hours without food is very difficult for children.

Azerbaijanis also regularly cut telephone and Internet wires, and people are deprived of the only opportunity to even connect with the world virtually.

People are trying to overcome all these difficulties, but no one knows when these provocations and torments will end. When they will finally be able to live decently. And the world hasn't even heard of that small area in the far South Caucasus and the resilient people of Artsakh, who are so loyal to their roots and homeland.

Article

Assisted dying

Comment

Justice

15 October 2024

5 min read

Will clinicians and carers objecting to assisted death be treated as nuisances?

The risk and mental cost of forcing someone to act against their conscience.

Henna Cundill

Henna is a researcher with the Centre for Autism and Theology at the University of Aberdeen.

A tired-looking doctor sits at a desk dealing with paperwork.

Francisco Venâncio on Unsplash.

After a formal introduction to the House of Commons next Wednesday, MP’s will debate a draft Bill to change UK legislation on Assisted Dying. Previously, a draft Bill was introduced in the Scottish Parliament in March 2024, and is currently at committee stage. Meanwhile, in the House of Lords, a Private Member’s Bill was introduced by Lord Falconer in July and currently awaits its second reading. These draft Bills, though likely to be dropped and superseded by the Commons Bill in the fullness of time, give an early indication of what provision might be made on behalf of clinicians and other healthcare workers who wish to recuse themselves from carrying out a patient’s end of life wishes on grounds of Conscientious Objection.

There are various reasons why someone might want to conscientiously object. The most commonly cited are faith or religious commitments. This is not to say that all people of faith are against a change in the law – there are some high-profile religious advocates for the legalisation of Assisted Dying, including both Rabbi Dr Jonathan Romain and Lord Carey, the former Archbishop of Canterbury. Even so, there will be many adherents to various faith traditions who find themselves unable to take part in hastening the end of someone’s life because they feel it conflicts with their views on God and what it means to be human.

However, there are also Conscientious Objectors who are not religious, or not formally so. Some people, perhaps many, simply feel unsure of the rights and wrongs of the matter. The coming debates will no doubt feature discussion of how changing the law for those who are terminally ill in the Netherlands and Canada has to lead to subsequent changes in the law to include those who are not terminally, but instead chronically ill. The widening of the eligibility criteria has reached a point where, in the Netherlands, one in every 20 people now ends their life by euthanasia. This troubling statistic includes many who are neurodivergent, who suffer from depression or are disabled. It is reasonable that, even if a Conscientious Objector does not adhere to a particular religion, they can be allowed to object if they feel uneasy about the social message that Assisted Dying seems to send to vulnerable people.

“You will often find that legislation that provides a right to conscientious objection is interpreted by judges these days in a way that seems to treat conscientious objectors as nuisances”

Mehmet Ciftci

Conscientious Objection clauses can themselves send a social message. A response to the Scottish Bill produced by the Law Society of Scotland notes concern over the wording of the Conscientious Objection clause, as it appears to be more prescriptive in the draft Bill than in previous Acts such as the Abortion Act of 1967. In the case of any legal proceedings that arise from a clinician’s refusal to cooperate, the current wording places the burden of proof onto the Conscientious Objector, stating (at 18.2):

In any legal proceedings the burden of proof of conscientious objection is to rest on the person claiming to rely on it.

The Bill provides no indication of what is admissible as ‘proof’. Evidence of membership of a Church, Synagogue, Mosque or similar might be the obvious starting point. But where does that leave those described above, who object on grounds of personal conscience alone? How does one meaningfully evidence an inner sense of unease?

The wording of the Private Member’s Bill, currently awaiting its second reading in the House of Lords, provides even less clarity, stating only (at 5.0):

A person is not under any duty (whether by contract or arising from any statutory or other legal requirement) to participate in anything authorised by this Act to which that person has a conscientious objection.

Whilst this indicates that there is no duty to participate in assisting someone to end their life, there remains a wider duty of care that healthcare professionals cannot ignore. Thus, a general feature in the interpretation of such conscience clauses in medicine is that that the conscientious objector is under an obligation to refer the case to a professional who does not share the same objection. This can be seen in practice looking at abortion law, where ideas around conscientious objection are more developed and have been tried in the courts. In the case of an abortion, a clinician can refuse to take part in the procedure, but they must still find an alternative clinician who is willing to perform their role, and they must still carry out ancillary care and related administrative tasks.

Placing such obligations onto clinicians could be seen as diminishing rather than respecting their objection. Dr Mehmet Ciftci, a Researcher at the McDonald Centre for Theology, Ethics and Public Life at the University of Oxford comments:

You will often find that legislation that provides a right to conscientious objection is interpreted by judges these days in a way that seems to treat conscientious objectors as nuisances who are just preventing the efficient delivery of services. They are forced to refer patients on to those who will perform whatever procedure they are objecting to, which involves a certain cooperation or facilitation with the act.

This touches everyone, even those who (if the Bill becomes law) will still choose to conscientiously object. Therefore, it is important to consider that the human conscience is a very real phenomenon, which means that facilitating an act that feels morally wrong can give rise to feelings of guilt or shame, even if one has not been a direct participant.

Psychologists observe that when feelings of guilt are not addressed, if they are treated dismissively or internalised, this can significantly erode self-confidence and increase the likelihood of depressive symptoms. But even before modern psychology could speak to the effects of guilt, biblical writers already had much to say on the painful consequences of living with a troubled conscience. In the Psalms, more than one ancient poet pours out their heart to God, saying that living with guilt has caused their bones to feel weak, or their heart to feel heavy, or their world to feel desolate and lonely.

If the Conscientious Objection clauses of the new Bill being proposed on Wednesday are not significantly more robust than those in the draft Bills proposed thus far, then perhaps that is something to which we should all conscientiously object? There is much to discuss about the potential rights and wrongs of legalising Assisted Dying, but there is much to discuss about the rights and wrongs of forcing people to act against their consciences too.