They shoot eyes in... Switzerland?

How a part-time mum came to write a paper on eye injuries by rubber scattershot after decades of private practice
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Reading newspapers can be upsetting. In 2020, I stumbled over a report of a Swiss prosecutor telling an injured demonstrator that "rubber bullets cause no more than bruises" and that he could just as well have injured his eye by ramming the handle of his own transparent into it.

The thing is: I knew better. Like most ophthalmology residents in Zürich in 2000-01, I had witnessed the series of eye injuries by kinetic impact projectiles later published by our colleague Dr. Sutter. Since I don't believe in alternative facts, I determined to set the record straight. It turned out to be far more difficult than expected. Still, it was worth while. The resulting article shows that multiple KIPs always carry a risk of permanent visual loss. That's not rocket science: even a Nerf toy gun can do lasting damage to an eye. All the relevant information was already out there. It just took someone to piece it together:

doi.org/10.1038/s41433-024-03215-w

Although my work focussed on Switzerland, local events soon fit into a bigger picture. Less-lethal weapons, including kinetic impact projectiles, have been proliferating all over the world for use in law enforcement and notably crowd control. The injuries they cause have been reported in several countries that use them, but by no means in all. (While this article was in press, injuries from KIPs in Kenya and Georgia made the news.) In authoritarian regimes, it can be dangerous to protest or even describe their risks. What we know is probably the tip of the iceberg. 

Unanswered question: What about the alternatives? Advocates of KIPs assert that baton charges are riskier. Are there any reliable data on this? All I found were a few studies dating from long before the recent increase in KIP use. Obviously, lathi charges can be deadly. Probably anything can, if it hits the head or the neck. Still, with a baton, it is possible to take aim. Even single KIPs are more likely to hit their actual target (albeit with greater force) than multiple ones. Multiple KIPs are inherently imprecise and risk hitting bystanders. The OHCHR's condemnation of them is crystal clear, as quoted in the article. Personally, I wish dialogue and de-escalation could solve everything. They probably can't. Still, are we trying hard enough?

It came as a surprise to me that peaceful little Switzerland is one of only two Western European countries known to use multiple KIPs.  Why local majorities have considered their use normal for over four decades is anyone's guess. The introduction of KIPs is easy enough to understand in retrospect. The political climate of the late 1970s was full of fear: Rote Armee Fraktion in Germany, Brigate Rosse in Italy, the Jura conflict at home, budding environmental protests everywhere... However, why didn't we ever try to take a rational look at the risks and make an informed decision?

This begs another question: How free was Zürich's press during the youth unrests of the 1980s? The Neue Zürcher Zeitung, true to its traditions, demanded the youngsters be severely punished. The liberal Tages-Anzeiger tried to remain neutral but caved in after a department store whose windows had been damaged threatened to withdraw advertisements. Better minds than mine have suggested that Zürich's infamous "Needle Park" was partly a reaction to the repression the protesters had faced. (Hamburg and Amsterdam were more tolerant, as were other Swiss cities, despite similar unrests at the time.) Public opinion was so solidly in favour of the use of force that in 1983, the leftist Sozialdemokratische Partei (SP) lost its seats in the city's executive body for the only time since WWII - due to its concerns about KIPs. There were brief discussions in Zürich's legislative body about acceptable ratios of KIPs to blinded eyes... but without counting all the eyes! They followed predictable party lines and soon subsided. I'd love to read a historian's account.

It would also be interesting to hear the perspective of a sociologist: Are KIPs employed more often in countries where inequality is higher? Some recent escalations were provoked by civil unrest among the have-nots. Would states take equally drastic action against well-heeled citizens able to afford legal battles?

The psychological aspects would be fascinating too: Is othering a prerequisite for the use of KIPs? After all, they originated in the colonies of the British Empire. During the Troubles, there were those in Northern Ireland who saw themselves as Britain's last colony. And rumour has it that public opinion in France - the only other Western European country known to use multiple KIPs - didn't have many objections as long as KIPs concerned "only" the banlieues, which allegedly changed after the gilets jaunes were targeted, since so many could identify with their goals.

Last but not least, what about the legal issues? Use of force should be proportionate. According to a recent report from Amnesty International, excessive use of force against peaceful protesters is on the rise in Europe. There are injured persons from Spain and France who stood no chance in court. Sounds familiar. That said: I believe police work is vital. (If you disagree, read Norm Stamper's "Breaking Rank".) In Switzerland, many police corps are understaffed, leading to overwork and stress, and in turn to errors. IMHO defunding the police is not the way to go. However, from what I have seen, there is room for improvement in the fairness of trials.

My own immediate association was Friedrich Dürrenmatt's legendary speech "Die Schweiz als Gefängnis". (Online and highly recommended if you speak German.) The author compared Switzerland to a prison where inmates guard each other, believing themselves to be free. The Swiss value stability, consensus, peace and quiet. Could this perhaps lead to fear of speaking up about the risks of KIPs? Physicians did so in France, in the States, in Chile and even in Iran. And, of course, in the UK, back in the days. (The list is incomplete.) Here, there were only a few, and they were considered "political". That's probably happened to me already. It will never change my conviction that the really political thing to do is refusing to face a problem for political reasons. Accountability, transparency and the rule of law are irreplaceable in democracies.

The local taboos meant the going was tough. But there were dozens of people able to help, and I picked the brains of anyone willing to answer. From experts who shared their knowledge generously and asked all the right questions, to patients who trusted me with their stories: thank you. 

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