Neither were the physicians at first of any service, ignorant as they were of the proper way to treat it, but they died themselves the most thickly, as they visited the sick most often; nor did any human art succeed any better. Supplications in the temples, divinations, and so forth were found equally futile, till the overwhelming nature of the disaster at last put a stop to them altogether.

Such concludes the introduction to the Plague of Athens from Thucydides History of the Peloponnesian War. The historian, an Athenian general who lived through the events he described, captures the horror of life in an epidemic, and in isolation. The plague arrived with the Spartan invasion, but it mostly hit the civilian populations of the area in and around Athens, and so the plague brought by invaders became an unintentional ally in the fight. Estimates of deaths from the five-year period that the disease ravaged Athens sit between 75,000 to 100,000, or nearly a quarter of the city-states population at the time.

The specific disease that hit Athens during the siege remains a subject of medical debate. What is known is that the disease originated in Ethiopia, and then it spread through the Mediterranean. Its persistence and lethality are unusual features, even among the ancient world, with candidates including both the plague and smallpox.

For an epidemic to become an epidemic it has to remain deadly while traveling with humans, rather than just killing them outright. It takes a particular kind of connected world, and a particular kind of violence in that connection, to make such a disease stick around and fester, a wound in the body politic.

History is rich with the plagues that followed war. The movement of people and armies and the whole long trail of food and supplies that entails can serve as a vector for diseases that, left to their own locality and without interconnection, might simply have become a local tragedy. Disease spreads through the people doing the fighting, and it spreads among the civilians displaced.

It takes a particular kind of connected world, and a particular kind of violence in that connection, to make such a disease stick around and fester, a wound in the body politic.

When in Revelations John describes the biblical apocalypse as preceded by war, famine, pestilence, and death, he is merely casting the realities of armed conflict into, well, biblical proportions.

Germ theory is too modern a phenomenon to have been reliably incorporated into the strategies of ancient besieging forces, but disease has long been an incidental weapon of war. The most historically famous example is the Mongolian siege of the Genoese-settled city of Caffa on the Black Sea.

As the Mongols retreated in the face of an assault by a relieving force, a contemporary account recorded that the Mongols used their siege weapons to hurl diseased corpses over the city walls, spreading black death.

What seemed like mountains of dead were thrown into the city, and the Christians could not hide or flee or escape from them, although they dumped as many of the bodies as they could in the sea, wrote the Italian notary Gabriele de Mussi, likely based on eyewitness accounts. And soon the rotting corpses tainted the air and poisoned the water supply, and the stench was so overwhelming that hardly one in several thousand was in a position to flee the remains of the [Mongolian] army.

Mussis account of the end of the Siege of Caffa has long been cited as both an early incidence of deliberate biological warfare and a clue as to the route through which the black death made it to Europe, though both claims are contested. Regardless, the nature of a siege is to combine deprivation with density, and for the besiegers to trust that, on a long enough timeline, the people trapped inside, even if supplied by the sea, will succumb to the pressure.

Sieges, with defenders surrounded by hostile armed forces intending to wait them out, still happen in the modern world, much as they seem a fixture of a past era. These sieges, like those in antiquity, come with the diseases of deprivation, and the diseases that pass through populations thrown into violent conflict.

What is structurally different about sieges in modernity is that humans now have a scientific understanding of disease itself, and at least according to the conventions and treaties signed by nations, a humanitarian obligation to treat it. It was easy to see, in 2017 and 2018, an international condemnation of the siege tactics used by Bashar al Assad in Syria, tactics that brought deliberate suffering on civilian populations as a means of consolidating military rule.

It is somewhat harder, in the face of the international COVID-19 pandemic, to see where siege conditions are enforced to siege-like ends by means other than bullets and bombs.

International sanctions regimes, designed to allow primarily the United States to withhold access to the dollar as an international reserve currency from nations it views as acting against American interests, enable a sort of invisible siege. Enforcing second-order sanctions, whereby companies risk losing access to the US dollar if they also engage in business with the targeted country, serves as a way to effectively sever the targeted country from the vast majority of the international market.

By design, these sanctions inflict suffering primarily on civilians within the targeted country. As a coercive tool, the logic is that deliberately depriving the people in a country will make those same deprived people pressure their leaders. The ultimate end state is that, either from pressure below or to relieve suffering, the leaders of a sanctioned state change behavior more in line with US interest.

In a pandemic, these sanctions exacerbate deprivation into full-on crisis. While humanitarian goods nominally are allowed through sanctions, many banks refuse to process those transactions, afraid that doing so would expose them to penalties under second-order sanctions. The Geneva Conventions explicitly permit safe passage for food and medical supplies to physically besieged populations, but those rules do not apply to economic sanctions. While not formally cut off from aid, a global refusal to sell medical supplies under penalty of second-order sanctions can cause deprivation, much the same as an army camped outside the gates did in antiquity.

As reported by the New York Times on March 21st, Secretary of State Pompeo and Director of National Intelligence Richard Grenell have made the case for exactly this ancient military application of disease and siege to the President.

Irans leaders have been harder hit by the coronavirus than almost any other country, and they have been hiding their infection from colleagues, according to intelligence reports heightening distrust and divisions in the government, reports the Times. Trump administration officials who advocate aggressive action have used those reports to press the case for escalating American military action against Iran.

What is happening in Iran is just one example of a multitude of economic sieges across the globe, maintained in the face of a truly international pandemic. To treat this crisis as wholly a public health event without acknowledging the context in which it takes place is to ignore the interrelated histories of war and disease. It is to treat the afflictions, as the ancient Athenians did, as a supernatural occurrence beyond anyones control.

To keep the siege in place is to look at the way it ravages thousands across the globe, and to turn away. It is a cold declaration on the side of cruelty. It is to say, simply, that epidemics are war by other means.

Kelsey D. Atherton is a defense technology journalist based in Albuquerque, New Mexico. His reporting has appeared in Popular Science, C4ISRNET, and The New York Times.

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The Plague and the Long War - Inkstick