What You Should Know About What’s Happening in Iraq Right Now

6 key things to help you understand the crisis unfolding in Iraq

The recent offensive launched by the Sunni insurgents of the Islamic State of Iraq and Syria (ISIS) is the most significant threat to Iraq’s security since the American withdrawal in 2011. The al-Qaeda offshoot has united thousands of foreign fighters under its black flag and a desire to redraw Middle East borders in order to create an Islamic state—or Caliphate—governed by an extremist interpretation of Islamic law.

Militants seized a number of cities and small towns in a lightning assault south toward Baghdad over the past week, displacing hundreds of thousands of people and igniting a global debate about how to respond. They boasted of executing 1,700 soldiers, but the authenticity of that claim is in question. As concerns ramp up that one of the world’s top oil producers is again teetering on the brink of a sectarian civil war, here are the main things you need to know about the regional crisis:

1. ISIS leader Abu Bakr al-Baghdadi is the new public enemy No. 1

Little is known about the man shepherding thousands of radicals between Syria and Iraq. Also called Abu Dua, he was aligned with al-Qaeda leader Ayman al-Zawahiri before the two broke ties over ISIS’ brutal tactics. Baghdadi is arguably the most successful Islamist terrorist since Osama bin Laden—not even bin Laden managed to control a large stretch of territory in Arab lands—and the State Department is offering a $10 million reward for his capture.

2. Nouri al-Maliki, Iraq’s Prime Minister, has made sectarian tensions worse

Two main reasons why ISIS tore through Iraq’s Sunni heartland so quickly—soldiers ran away when ISIS converged on Mosul, Iraq’s second-largest city—can be traced to Maliki. Iraq’s security forces are weak, despite billions of American dollars spent on training, and the absence of national unity has deeply polarized the political landscape. Maliki and his Shi’ite-dominated government are resented by many Sunnis and Kurds for what they see as sectarian rhetoric and policies that have denied them representation and support.

“Maliki has intimidated and driven key Sunni figures out of his government, ignored agreements to create a national unity government, alienated the Kurds and tried to repress legitimate Sunni opposition in ways that have contributed to steadily rising violence and civilian deaths,” write Anthony H. Cordesman and Sam Khazai of the Center for Strategic and International Studies. Maliki’s undermining of the judicial system, police and army for his own advantage, they say, have kept the country vulnerable to power grabs. “With nowhere else to go,” writes Dexter Filkins of the New Yorker, “Iraq’s Sunnis are turning, once again, to the extremists to protect them.”

3. The Kurds may inadvertently gain from the ISIS offensive

Iraq’s Kurdish minority enjoys a semi-autonomous enclave in the northeast that has largely been spared the attacks that plague Iraq. But the new strife could heighten friction between the Kurds, Sunnis and Shi’ites since the Peshmerga—the Kurdish security forces—filled the power void in Kirkuk after Iraqi soldiers retreated. The Kurds have long sought control of the oil city, which they call its historical capital.

That development could contribute to Iraq splitting along sectarian lines. “This would be a further prelude for the division of Iraq,” Brig. Halgord Hikmat, spokesman for the Kurdistan Regional Government’s Peshmerga Ministry, told the Wall Street Journal. “A united Iraq is not the solution at this moment.” Partition would breed a host of other issues, but with Shi’ite clerics encouraging thousands of followers to pick up arms and counter the Sunni insurgents, the Kurds—left off the map after World War I and seeking their own state—could win out.

4. Any crackdown on ISIS could help Syrian President Bashar Assad

The region has been irreversibly impacted by Syria’s civil war. Turkey, Jordan and Lebanon are grappling with humanitarian crises as millions of Syrians have sought refuge in those countries. But Iraq has fared the worst: Parts of its border with Syria have been erased by ISIS, which took the cities of Fallujah and Ramadi in January and controls swaths of several provinces, and Baghdad is rocked by regular bombings.

The ultra-extremists have flourished in Syria by seizing territories that were poorly run by opposition factions. Brutal takeovers have been followed by what Aaron Zelin, a fellow at the Washington Institute for Near East Policy, describes as “soft-power outreach.” ISIS holds anti-regime forums in neighborhood squares and fun activities for children to gain early support, and also hands out charity while promoting its mandate. Zelin adds: “ISIS is attempting to lay the groundwork for a future Islamic state by gradually socializing Syrians to the concept.”

A stronger ISIS bodes ill for Assad. Facing two battles, one to keep or reclaim territory and the other to win back hearts and minds, he could benefit from outside help to beat the insurgency. One idea proposed by a senior policy analyst at the RAND Corporation is a deal between Damascus and the West to bring peace to vulnerable areas and allow Assad to focus on regaining land: “Assad could help NATO and other willing partners focus time and resources on ISIS, which poses the greatest threat to the Middle East, the United States, and Europe.”

5. Iran wants ISIS stopped

The Islamic Republic has played a major role in propping up the Assad regime. But that assistance has not proven a deal-breaker as Tehran and Western powers work to resolve the nuclear standoff. Political leaders on both sides of those negotiations see ISIS as a growing threat and speculation is rampant they may work alongside each other to quell it.

“We will fight against terrorism, factionalism and violence,” Iranian President Hassan Rouhani said on June 12. Days after a report emerged that units of Iran’s elite Quds Force were dispatched to protect allies in Baghdad and the sacred Shi’ite sites of Najaf and Karbala, Rouhani clarified that Iran is ready to help Iraq—if asked—and would consider “cooperation” with any American efforts. (Military decisions rest with its Supreme Leader, Ayatollah Ali Khamenei.)

6. The U.S. is likely to tread softly

The White House has so far resisted committing serious aid to helping Iraq fight the insurgents. It was criticized for not doing enough to ensure security before its withdrawal, which came after Washington and Baghdad failed to agree on conditions for leaving a residual contingent to, among other priorities, keep training security forces and supporting intelligence efforts against Sunni extremists. Obama wanted America’s bravest back home, but it was an overly stubborn Maliki who ultimately doomed the sensitive negotiations.

What’s happening now is direct fallout, as Iraq couldn’t stand on its own. Obama understands this, saying last week that he wouldn’t “rule out anything because we do have a stake in making sure that these jihadists are not getting a permanent foothold in either Iraq or Syria.” Defense officials are now mulling options that don’t include boots on the ground. But if there is any takeaway from Obama’s address on June 13, during which he asserted “we will do our part” while casting blame on Maliki for authoritarian policies that fueled division among the sects, it’s that what is happening in Iraq is no longer America’s problem. That doesn’t mean he won’t work with an adversary or two to solve it.

TIME central african republic

‘A Question of Humanity': Witness to the Turning Point In Central African Republic

Almost six months after thousands of foreign peacekeepers waded into Central African Republic in a bid to control the fallout from street fighting that left hundreds dead in the capital of Bangui, they remain unable to stem the killing and population shift that has begun to redefine its makeup.

Their arrival under a United Nations mandate forced a retreat by the disbanded militants of Séléka, the mainly Muslim rebel coalition that seized control earlier that year and began a campaign of looting and killing largely against non-Muslims. But that power void, exacerbated by a lax justice system, was quickly filled by anti-balaka. The groups of armed vigilantes, initially organized to combat local crime and whose ranks of Christians and animists includes ex-soldiers, have fought back against the militants and furiously targeted the Muslim minority, which they view as complicit in Séléka’s unpunished abuses.

Anti-balaka now stand accused of crimes worse than what prompted their retaliation as the burning of whole villages and gruesome mutilations, among other threats and attacks, have killed an untold number of people and pushed hundreds of thousands of others from their homes. Amid tales of ethnic cleansing in the west and as reports of crude attacks surface in the east, where Séléka remains in control and is regrouping, the country continues to slide into perhaps the bloodiest and most unstable crossroads of its independence.

Italian photojournalist Ugo Lucio Borga, of the Echo Photo Agency, witnessed this turning point first-hand when he arrived in January. He took advantage of a connection with an army sergeant-turned-commander of a Bangui-based anti-balaka militia, who he met years ago in the remote southeast while covering the hunt for Joseph Kony, the elusive leader of the Lord’s Resistance Army. With prime access to their day-to-day happenings, he could document the conflict as anti-balaka became more brazen and learn more about the fighters beyond the amulets they wear as “protection.”

“They are really young people without education, without culture, but they needed to do something to stop the violence from the Séléka,” he told TIME. With most schools out of operation and seemingly few families who hadn’t seen bloodshed, he could see why they so easily took up arms. “Now the problem is that they know what war really means and they have become another people. They are now fighters.”

Throughout his trip, during which he also shadowed French troops and peacekeepers from Rwanda and Burundi, Borga saw the effect on children—“after one year of violence, continued violence, they consider the situation normal”—and became more aware of the roots of the conflict. The fighting, after decades of corruption and meddling by external influencers, appeared to take on a more religious undertone and sparked concerns of a partition in a country where Christians and Muslims have historically lived in peace, despite instances of marginalization. But Borga found that not all anti-balaka wanted to outright rid the country of its Muslims. This specific militia told him they targeted foreigners because, among other reasons, Séléka included militants from Chad and Sudan.

Borga left in February having captured a series of raw, intense scenes that stand out for their intimacy. He plans to return ahead of the elections, scheduled for February 2015, but knows that making a big influence is a tall order when the conflict is so neglected on the international stage. Still, it’s the ability to inform that drives him, as well as an innate curiosity as to how it will end: “I think it’s a question of humanity, if it exists somewhere.”

TIME Africa

Migrants Storm Border Fence to Hop From Africa to Europe

Sub-Saharan migrants scale a metallic fence that divides Morocco and the Spanish enclave of Melilla, early on May 28, 2014.
Santi Palacios—AP Sub-Saharan migrants scale a metallic fence that divides Morocco and the Spanish enclave of Melilla, early on May 28, 2014.

Some 400 African migrants are estimated to have successfully scaled a border fence between Morocco and the Spanish territory of Melilla on Wednesday, crossing from Africa to Europe

A thousand migrants stormed and attempted to scale a 20-foot-high border fence between Morocco and the Spanish territory of Melilla before dawn on Wednesday, its mayor said, with about 400 estimated to have successfully hopped from Africa into Europe.

Melilla is one of Spain’s guarded but vulnerable enclaves on Morocco’s northern coast that has become a hub for sub-Saharan migrants, many from Somalia and Eritrea, who want to seek asylum or work in Europe.

Wednesday’s incident is the latest in a tide of dangerous and sometimes deadly attempts by large groups of African migrants to enter Melilla and Ceuta, another Spanish enclave nearby, the European Union’s only land borders with Africa.

About 140 of the approximately 700 migrants who charged the barbed-wire fence in Melilla on May 1 slipped past security officers, resulting in some injuries. And clashes erupted in February when more than 300 migrants stormed it—a third of them successfully—leading to some 96 arrests.

The BBC reports that some of the migrants who crossed over on Wednesday are likely to spend months or years at a temporary immigration center in Melilla, which now houses five times the amount of people it was meant to hold. Others are expected to be transferred to additional centers in Spain or returned to their home countries.

TIME photo essay

Dark Gold: Giulio Di Sturco Goes Inside Madagascar’s Cocoa War

Giulio Di Sturco visited Madagascar twice in 2013 to document the cocoa battle between the farmers who produce the beans, the gangs who steal them and the police who aim to stop the violence

There are two narratives of how Dina, a gang member in the northern village of Matsaborilava, Madagascar, died last August. Police suspected the 33-year-old was partly responsible for the death of a cocoa plantation’s security guard earlier in the year. When they went to his house, officers claimed he lunged at them with a machete and that they shot him dead in self-defense. Dina’s wife, the mother of his two children, tells it differently: After officers barged into their home at night and asked three times “Are you Dina?,” to which he replied yes, they handcuffed him and then shot him twice in the head.

Giulio Di Sturco, an Italian photojournalist based in Bangkok and New Delhi, arrived the next day, five months after his first assignment documenting the cocoa battle between farmers and gangs. Dina’s death marked the first in the local police’s new operation against the bandits. Having kept in touch with an official in northern Ambanja through his fixer, Di Sturco arranged a three-week trip to see it all: the plantations on which farmers earn their living and from which gangs steal; the ill-equipped police; the middlemen who actually turn a profit; and the families who never asked to be involved in the mayhem.

Cacao trees in the remote Sambirano Valley yield some of the world’s finest cocoa pods, a favorite among chocolatiers in the West, and should be a boon for farmers. But a coup five years ago prompted a repeal of external funding, which had accounted for 40 percent of the state’s budget, pushing poverty higher and causing investments to dry up. For a country where some 92 percent of its 22 million people live on less than $2 per day, making it one of the poorest in the world, cocoa banditry can be an attractive option.

Gangs in the north steal beans from farms or hijack shipments on the roads, keeping laborers poor. Many large farms make enough money to employ security teams, Di Sturco says, but smaller ones must defend themselves. “From 3 o’clock in the morning until the sun is high, they patrol their small plantations with machetes and javelins, and the gang comes in with homemade guns,” he adds. “It’s a small medieval war.”

Di Sturco spent most days with the farmers and nights with the police. His honesty with the gangs resulted in access he had only dreamed of during his first trip. “They said, ‘We’ll speak with you, we’ll let you take pictures,'” he recalls, “but they said, ‘we trust you not to go with the police.'” In response, Di Sturco told the gang members that if they killed somebody, he was going to take pictures of the funeral. “And they were kind of okay with that.”

Before he could photograph Dina’s funeral, he had to wait in his hotel for access. The formal tradition is that a member of the deceased’s family comes to talk, over a pot of tea, and then makes a decision. Once Di Sturco told the family how police recalled Dina’s death, a version that differed from theirs, they agreed to let him document the funeral. Dina’s coffin was paraded around Matsaborilava so everyone could see he was killed by the police, but Di Sturco says they weren’t told why. Two policemen showed up, one of them the commissioner, whose apology to the mother of Dina’s wife was viewed as sincere.

Di Sturco is finishing a long project in India and Bangladesh about the Ganges River but says he will return to Madagascar if there’s a big development in this story. He plans later this year to photograph at a chocolate fair in Paris, where there will be many beans from Madagascar. Those images will give him the whole project, from bean to bar and everything in between. Di Sturco admits this work isn’t about getting people to change their opinions or habits: People won’t stop eating chocolate just because others are killing each other over it. Rather, it’s about informing them about the consequences of their cravings.

“Everybody knows that cocoa in Madagascar is good,” he says, “but nobody knows the war.”

Giulio Di Sturco is a photographer with Reportage by Getty Images. His work has appeared in TIME, Geo magazine, Vanity Fair, The Daily Telegraph, The Sunday Times Magazine and many others.

Andrew Katz is a homepage editor at TIME and reporter covering international affairs. Follow him on Twitter @katz.

TIME photo essay

Jerome Sessini In Eastern Ukraine: Rebel Vote Turns Deadly

Magnum photographer Jerome Sessini captured the fallout as armed men identified as Ukrainian national guardsmen fired on a crowd gathered at polling location for a sovereignty referendum, deemed illegitimate by the government, in eastern Krasnoarmeisk.

Tension in eastern Ukraine, where pro-Russian separatists have seized control of government buildings in recent months, was already high on May 11. In Donetsk, one of the two largely Russian-speaking regions that was holding a referendum deemed illegal by Ukraine’s new government, residents were prompted for a yes or no to the question: “Do you support the act of self-rule for the People’s Republic of Donetsk?”

The vast majority of voters favored “self-determination,” according to the organizers, but it was a standoff outside a poll in the town of Krasnoarmeisk that showed how quickly confrontations can now turn deadly.

Paris-based Magnum photographer Jerome Sessini arrived at the town hall at around 3:30 p.m. Sessini has covered the unrest in Ukraine for months, from the protests and clashes in Kiev’s Independence Square to the March referendum in the Black Sea peninsula of Crimea, which led to the quick annexation by Russia.

At the scene in Krasnoarmeisk were about 100 supporters of the breakaway movement who were eager to vote but had been barred after men identified as Ukrainian national guardsmen entered the building and pushed everyone out, sparking a protest.

A group of women loosely organized a poll in a nearby green space, but Sessini says most people were scared and opted against participation. Several men then went to speak with the guards. One of them whipped a protester in the face with the butt of a gun, Sessini recalls, thrusting the man down the steps and causing his head to violently hit the cement. Other people in the crowd pulled him away.

For a few seconds, Sessini says, “there was a dead silence.” Moments later, some people chanted “Why are you doing this? We just want to vote?” while others labeled the guards “Fascists!”

Less than an hour later, a group of people approached the entrance. A half-dozen armed men then appeared and pointed their guns at them, then began to shoot in the air. Sessini saw a man in front of him talking with the guards, then take a bullet to the leg. At the same time, the man next to Sessini dropped. The protester had been shot in the chin, right below his lips, and died quickly. Sessini promptly took cover behind a tree.

The crowd tended to the injured man, then returned to the guarded entrance once an ambulance had taken him away. A middle-aged man in jeans and a sleeveless, light blue shirt then appeared in Sessini’s viewfinder. The man had just thrown an object at the guards and was about to do it again. “He was very upset and he was protesting a lot since the beginning,” Sessini says. But just as he was about to wind up his arm, he was struck by a bullet.

It happened within the span of a few seconds, from the shot to falling near the other dead man to turning over, but Sessini captured it all. “You don’t have time to think, you just act by instinct,” he says.

Once he realized what had happened, he stopped taking pictures and ran with two journalists to the man’s aid. One tried to stop the bleeding as another cradled his head in his hands, trying to keep the wounded man awake. “We were trying to help him turn his body to stop the blood,” he recalls. “At one point, we saw that he didn’t have any reaction and the skin on his face was turning very white. And you can see in the eyes there was no reaction. No life.”

Three hours, and two killings, after Sessini arrived, he left. It was getting dark out, and therefore less safe, and it was all a lot for him to process. The next day, after he had watched a video of how the events unfolded, Sessini realized how close he was to it all. “I saw the moment when the guy was shot. I was standing right next to him,” he says. “It’s a strange feeling. I don’t know if I was lucky. I think that guy was shot by the sniper. It was not a random killing. I hope so, because the luck can turn.”

Sessini photographed their funerals on Tuesday. He learned their names and spoke with family members. He wanted to know more about the men he watched die, who were just there to vote. “One guy tried to throw one stone, one threw an egg, that’s it. They didn’t deserve to be killed.”

In recent days, Sessini says many people in the region told him they were participating in the illegal referendums not to pivot toward Russia, but as a show of force against the new government in Kiev. “It’s all about politics,” he says. “Normal people are always caught between politics and violence.”

Jerome Sessini is a French photojournalist represented by Magnum.

Andrew Katz is a homepage editor and reporter covering international affairs. Follow him on Twitter @katz.

TIME the backstory

Photographer Camille Lepage Killed in Central African Republic

The body of French photojournalist Camille Lepage was found in the Bouar region of Central African Republic, the French presidency said in a statement on Tuesday. Lepage, a young photographer committed to the deep documentation of under-covered conflicts in eastern and central Africa, was 26.

The body of French photojournalist Camille Lepage was found in the Bouar region of Central African Republic, the French presidency said in a statement on Tuesday. Lepage, a young photographer committed to the deep documentation of under-covered conflicts in eastern and central Africa, was 26.

The statement released by the office of French President François Hollande said Lepage was found “murdered” after French troops stopped a vehicle driven by anti-balaka, the militiamen comprised of Christians and animists who have spent months attacking Muslim civilians and battling disbanded factions of the mainly Muslim rebel coalition Séléka that overthrew the state in March 2013.

“All means necessary will be used to shed light on to the circumstances of this murder and to find her killers,” the statement said.

Lepage was based in Juba, South Sudan, for about a year and a half before arriving to Bangui, the riverside capital of Central African Republic, last fall. It was there that she met another French photojournalist, William Daniels, who was on his first trip to cover the conflict. Daniels told TIME he and Lepage quickly connected and decided to work together on a trip to Bossangoa, in the northwestern region of the country.

“She was very active, very patient, very passionate about this work. She wanted to do some very good long-term work about Central African Republic,” he said. “She stood out by being well-connected with the people of the country. In Bangui, everybody knew her. Everybody liked her,” he added. “They were impressed by her, because she was this young, white girl. Very brave.”

Lepage opened up about her interests in conflict and photojournalism last year in an interview. Asked about her top moments of her career to date, she responded, “Not sure I can talk about my ‘career’ just yet, I’m still just getting started! I find it amazing to be able to travel probably to some of the most remote areas, meet wonderful people everywhere and being able to document them.”

Fred Dufour—AFP/Getty Images

Toward the end of the interview, Lepage admitted the struggle of documenting scenes that might barely make it into a news cycle, no matter what her pictures portrayed. “It’s so frustrating to be covering something so tragic, that no one wants to publish and that can’t see the public light apart from social media.” Still, her work in Central African Republic shows that didn’t stop her, but instead motivated her.

News of her death immediately lit up social media, pushing her name into a worldwide trend on Twitter as friends, aid workers and other journalists recalled her memory and shared her photographs. Lepage was especially active on Instagram and used the image-sharing platform to frequently share scenes from her travels.

In her final Instagram post, uploaded a week ago, Lepage said she was traveling with anti-balaka fighters to Amada Gaza, the site of recent Séléka attacks.

Lepage’s final Instagram post

Lepage had recently returned to Bangui from a trip to New York, where her portfolio was reviewed and workshopped by some of the country’s top photo editors. On the lapels of her army green jacket were two cheap flag pins from a roadside shop in Bangui, making it easy to stand out.

In New York, Lepage spoke often about her experiences working in Central African Republic. She admitted fear, but didn’t show it, when discussing her work around anti-balaka or ex-Séléka fighters. And her knowledge of what was causing the devastating scenes she encountered was astounding. She wasn’t drawn to violence, as other photographers tend to focus on, and instead chose to find the humanity of it all, the otherwise unseen lives of civilians and fighters as the streets turned deadly.

Lepage hailed from Angers, France. Her photographs appeared in French newspapers Le Monde and Libération as well as major U.S. outlets like the New York Times, Washington Post, Wall Street Journal and Los Angeles Times.

Andrew Katz is a homepage editor and reporter covering international affairs. Follow him on Twitter @katz.

TIME Infectious Disease

Officials Confirm Second U.S. Case of MERS

This undated file electron microscope image made available by the National Institute of Allergy and Infectious Diseases - Rocky Mountain Laboratories shows novel coronavirus particles, also known as the MERS virus, colorized in yellow.
AP This undated file electron microscope image made available by the National Institute of Allergy and Infectious Diseases - Rocky Mountain Laboratories shows novel coronavirus particles, also known as the MERS virus, colorized in yellow.

Health officials have confirmed a second case of the MERS in an Orange County hospital less than two weeks after the first appeared in Indiana. They told reporters the newly infected patient is a health care provider who lives and works in Saudi Arabia

Updated 3 p.m. ET

Federal and state health officials confirmed a second U.S. case of the deadly Middle East Respiratory Syndrome on Monday, less than two weeks after the country’s first case appeared in an Indiana hospital.

Officials from the Centers for Disease Control and Prevention and the Florida Department of Health told reporters the newly infected patient is a health care provider who lives and works in Saudi Arabia. The person flew from Jeddah to London, and then to Boston. From there, the patient traveled to Atlanta and then Orlando to visit family members, officials said.

The person began feeling unwell during the flight from Jeddah to London—suffering from symptoms like a fever, chills and a slight cough—and then continued to feel ill on subsequent flights, officials said. The person went to the emergency room of a hospital in Orange County on May 8 and was admitted the same day. The patient was then placed in isolation, and remains in stable condition.

John Armstrong, Florida’s state surgeon general and secretary of health, said the patient’s family was “staying home” at the moment and that the hospital would release more information later Monday.

Officials said they are reaching out to anyone who may have had close contact with the patient before the person entered the hospital. That includes more than 500 people who were on the patient’s last few flights in the U.S.

On desktop, roll over this graphic to get a closer look; on mobile, click to zoom.

Heather Jones

The first U.S. case of MERS appeared in Indiana in late April after having popped up in more than a dozen countries around the world. That patient is currently in good condition at Community Hospital in northern Munster and is expected to be released in the near future. The unnamed victim is a hospital worker in Saudi Arabia, home to about 450 lab-confirmed cases and 118 deaths.

The patient in Indiana, who was on a planned visit to see family, was placed in full isolation and all staff members who had contact with him previously have tested negative for the disease. Health officials have been contacting people who might have come into contact with the patient on public transport.

MERS is in the same virus family as Severe Acute Respiratory Syndrome (SARS), which killed more than 700 people about a decade ago. It has no vaccine or treatment, but researchers believe it may have originated from bats or camels. Human transmission has so far largely occurred between people with close contact with those infected, especially in health care settings. To date, there have been at least 538 confirmed cases and 145 deaths.

TIME photo essay

Christian Werner in Post-War Iraq: A Photographer Investigates a Health Crisis

Photojournalist Christian Werner made two trips to Iraq in 2012, and returned with a series of images that shed light on a growing post-war public health issue

Photojournalist Christian Werner made the following images on two trips to Iraq in 2012.

On a gray day in April 2012, an elderly woman walked out of the Sadr Teaching Hospital in Basra carrying two plastic bags. Once across the road, she crept through hundreds of small piles of concrete, each marking a grave in the children’s cemetery, and into a small room. Her daughter had just given birth to two stillborn fetuses and asked her to immediately bury the bodies. The woman gently laid the bags on a stone table, then left. A man untied the bags, poured a bucket of water over the corpses as he hummed a Koranic verse, wrapped them in white linen and placed them in the ground.

German photojournalist Christian Werner witnessed four of those burials during his first trip to Iraq. He was there to document what some believe may be the effects of contamination from metals in munitions fired during the Gulf War and the war in Iraq, namely depleted uranium. Forty percent less radioactive than natural uranium, but just as chemically toxic, it was used by U.S.-led coalition forces in shells to pierce the enemy’s armored tanks and as reinforcement in their own against weaker enemy firepower. Depleted uranium can enter the body through the ingestion or inhalation of particles created upon impact, contaminated wounds or shrapnel fragments. Whether anything happens as a result—some studies have looked into links between depleted uranium and higher rates of leukemia or other cancers, as well as spikes in congenital birth defects—is heavily debated.

One study published in 2012 found that the rate of defects at a maternity hospital in Basra increased 17-fold between 1994 and 2003. The team of Iraqi and Iranian researchers, including an environmental toxicologist who used to work at the University of Michigan School of Public Health, concluded that the shelling of Basra and Fallujah “may have exacerbated” pre-natal exposure to metals, “possibly culminating in the current epidemic of birth defects.” Higher lead levels were found in the hair of parents in Basra whose children had birth defects than those with normal offspring, and the enamel of a fallen-out tooth from a child with birth defects had nearly three times the lead than the whole tooth of a child from an unaffected area. No official cause was determined.

Another report released in September by Iraq’s Ministry of Health and supported by the World Health Organization noted a sharp increase in reported birth defects from 1988 to 1992 (7.6 per 1,000 births) and 2003 to 2007 (26.2 per 1,000 births). Yet, its finding of “no clear evidence to suggest an unusually high rate of congenital birth defects in Iraq” was panned because it relied largely on self-reporting rather than medical data.

Many Western researchers consider evidence that links depleted uranium to negative health circumstantial at best. Something is happening, as Werner documented, but not everyone agrees what it is.

Bernard D. Rostker, a senior fellow at the RAND Corporation and former Special Assistant for Gulf War Illnesses to the Deputy Secretary of Defense, said there is “no science” behind claims of poor health from exposure to depleted uranium. Rostker cited several reports by the Institute of Medicine, an independent nonprofit that provides advice to the government and private sector on public health issues, which couldn’t find enough evidence to determine whether exposure caused health problems reported by veterans. “It’s bogus,” he told TIME.

Werner, 26, a fierce critic of the wars, learned about depleted uranium years ago while browsing conspiracy theory and alternative media websites. But, unable to find many mainstream news reports, and despite having come across the reports suggesting there were no ill effects from exposure to depleted uranium, “I thought someone has to be wrong so I just wanted to see it for myself.” Werner set aside $7,000 and planned to stay a month that April, traveling to Baghdad and then Fallujah and Basra.

At the general hospital in Fallujah, Werner saw in front of him the subjects of the pictures he had looked at for years: People with deformities that made it difficult for him not to turn away. Days later, he went to Basra. Doctors there were willing to help him take pictures if it meant bringing attention to their patients’ plight and his young driver would later introduce him to a family whose three children each had a deformed eye. Werner’s funds ran out after only nine days in Iraq, but he felt he had enough to tell his story and returned home.

Months later, after processing what he had seen, Werner showed the work at a German photojournalism festival. The publication Der Speigel sent him back to Basra with a writer that October to work on a special multimedia report. In March, Werner won a Magnum Foundation Emergency Fund grant, which supports photographers who document under-covered social issues and which he hopes to use to continue the project in other parts of the world.

“I hope the people who are seeing these pictures will open their eyes and will think about how the war isn’t finished when troops go home, that people are suffering for decades on,” he said, adding that he hopes his work will influence more researchers to look into the matter and eventually form a conclusion. “I want them to rethink, in general, the effect of war.”

Christian Werner is a photojournalist based in Nordstemmen, Germany, who recently won a Magnum Foundation Emergency Fund grant.

Andrew Katz is a homepage editor and reporter covering international affairs. Follow him on Twitter @katz.

TIME Infectious Disease

Deadly Middle East Virus in U.S. For First Time

Officials have confirmed a case of Middle East Respiratory Syndrome in Indiana, the first known incident of the virus in the U.S. There have been more than 400 cases worldwide, a third of which have been fatal, since the virus was first discovered in 2012

Update: May 3, 10:18 p.m.

A hospital in northern Indiana is treating a patient infected with Middle East Respiratory Syndrome, marking the first time a case of the deadly virus has appeared in the U.S., state and federal health officials confirmed.

The Indiana State Department of Health said the patient at Community Hospital in Munster is a male health care provider who had recently returned from a trip to Saudi Arabia, where cases of the virus have been most prevalent since it was first identified in 2012.

Researchers have been largely stumped by the origin and transmission patterns of the virus, which looks like the flu, as it has gradually spread around the Middle East. It has been linked to both bats and, increasingly, camels but the reservoir remains elusive.

There have been more than 400 cases of the SARS-like virus scattered among a dozen countries, nearly a third of which have been fatal. Saudi Arabia has seen the bulk of the cases—more than 320 with some 94 deaths—but others have also appeared in Jordan, Britain, France and Italy.

Representatives from the Centers for Disease Control and Prevention and Indiana’s state health department released details about the case in a briefing with reporters on Friday after a positive laboratory result was confirmed.

The man had arrived in Chicago from Saudi Arabia and then took a bus to Indiana. (Public Health England later said it was advised of a passenger, now confirmed to have MERS, who was on British Airways Flight 262 when it arrived at London’s Heathrow Airport on April 24. The man then boarded American Airlines Flight 99 to Chicago.)

On April 27, the man began experiencing respiratory symptoms like shortness of breath, coughing and a fever. He went to the emergency room the next day and was admitted as a patient to Community Hospital, where he received immediate care and was placed in isolation.

Hospital officials said in a statement on May 3 the patient remained hospitalized “in good condition” and is improving each day. “The swift diagnosis and precautionary measures taken have undoubtedly greatly helped reduce the risk of this potentially serious virus spreading,” said State Health Commissioner William VanNess II.

Staff at the hospital who had direct contact with the man before he was isolated were taken off duty and placed in temporary home isolation, the statement added. They will be allowed to return to work once the incubation period is over—it could take up to two weeks for symptoms of MERS to appear—and their laboratory results are negative. No additional cases of MERS have been identified.

It remains unclear how the man became infected, how many people he was in close contact with and whether those people became ill. British and U.S. health officials said they had contacted other passengers on the flights but asserted the risk of infection between them appears low.

(MORE: A Deep Look Inside the Battle Against MERS)

Public health experts have warned for months that it could be only a matter of time before a case appeared in the states. “It’s something we’ve predicted and expected,” said Peter Daszak, president of EcoHealth Alliance, a New York-based organization that patrols the animal-human health border and has worked closely with researchers looking for MERS’ origin.

Daszak said he remains concerned the virus is widespread in camels in Saudi Arabia and that it’s likely more rampant across the region where camels are common. While the virus doesn’t pose a “high risk” to the public yet, he said, “people continue to get infected and travel with this virus. That’s the concern for something that may have the ability to evolve into a pandemic risk.”

Dr. Ian Lipkin, an epidemiology professor at Columbia University and a leading researcher in the hunt for the virus’ origin and pattern of transmission, said he wasn’t surprised either that a case has appeared in the U.S. and originated in Saudi Arabia.

Officials in Egypt just diagnosed their first case and other infected people have recently traveled from either Saudi Arabia or the United Arab Emirates to the Philippines, Malaysia and Greece. But the caseload in the Kingdom jumped 89 percent in April, highlighting whether its Ministry of Health is doing enough to find the reservoir and warn the public about any threat.

In a rare move in late April, King Abdullah dismissed the health minister without an official explanation. The position was quickly filled by Labor Minister Adel Faqih, who immediately promised “transparency and to promptly provide the media and society with the information needed.”

Saudi Arabia has come under fire for its handling of MERS, as months pass with little or no progress made on nabbing its origin or how it spreads to people. “It’s a difficult place in which to work,” Lipkin said, “but there’s optimism that the change in leadership may be productive.”

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