The CDC Just Issued a Warning About Acute Flaccid Myelitis. What's That? The cornerstone of treatment in the initial phase is supportive care. by Jay Desai

 

I experienced déjà vu when I took care of a child with acute flaccid myelitis in 2014, one of the first cases of its kind at Children’s Hospital Los Angeles in many years.

I had taken care of polio patients in India in 1990s and also participated in the pulse polio campaign that led to the country successfully eradicating the devastating disease. But that was almost two decades back, and I had not seen polio or anything like polio since moving to the U.S. back in the late 1990s.

Now, the U.S. and several other developed countries are seeing outbreaks of this polio-like disease, stumping public health researchers on the reasons why. The Centers for Disease Control and Prevention warned on Aug. 4, 2020 of an outbreak this year and urged doctors and parents to be on the lookout for cases of the disease. A record number of cases, 238, were diagnosed in 2018 in the U.S. The cases have spiked in an every-other-year pattern, leading the CDC to issue the warning for 2020.

According to the CDC, there have been 633 confirmed cases of AFM in the U.S. since 2014. Most of them have involved young children. As of July 31, 2020, there have been 16 confirmed cases in the U.S., with 38 patients under investigation for possible illness, the CDC reports.

Acute flaccid myelitis, or AFM, a descriptive term for the clinical manifestations, can be caused by polio or several other related viruses. The term acute stands for the fact that the onset is sudden; flaccid denotes that there is a loss of tone in the limbs that become weak; and myelitis indicates that the spinal cord is involved and abnormal. Acute flaccid myelitis falls under a broader category called acute flaccid paralysis – a term that encompasses several other conditions such as botulism besides acute flaccid myelitis.

Misdiagnosis early in the illness is not uncommon, particularly since polio was eradicated a long time ago. There have been concerted efforts to raise awareness since the initial AFM cases were reported several years ago. But its comparative rarity and pattern of biennial increase can make it difficult to diagnose. And 2020 may turn out to be even more challenging because of the COVID-19 pandemic. Correct diagnosis early-on is key even though treatment at this point is essentially supportive. It will become even more important as definitive treatments emerge with ongoing research.

The U.S. has been polio-free since 1979. The AFM cases in the U.S. since 2014 are polio-like but not due to poliovirus. The cause has been definitely established only in a handful of these recent cases with detection of coxsackievirus A16, enterovirus (EV)-A71, or EV-D68 in cerebrospinal fluid (CSF). These three viruses are types of enteroviruses just like poliovirus is. Enteroviruses are viruses that typically enter through the intestinal tract.

Doctors have suspected that many of the recent AFM patients, in whom the spinal fluid did not identify a virus that caused AFM, may have been due to EV-D68. This is based on circumstantial evidence. At Children’s Hospital Los Angeles, where I practice and conduct research, my group has documented that EV-D68 was circulating in the respiratory fluid of children at a higher rate in 2016 when compared to 2015. This was associated with a higher rate of AFM in 2016 compared to 2015. According to the CDC, the spike in AFM cases in 2014 corresponded with a national outbreak of respiratory EV-D68. It is not known why only a handful of those who have the respiratory illness go on to develop AFM. Researchers hypothesize that genetic factors as well as unusual immune responses may be responsible.

AFM cases have typically occurred in a cyclical pattern in late summer and early fall, and “skipped” a year, with more cases reported in 2014, 2016 and 2018 compared to 2015 and 2017.

Manifestations

Many children have symptoms suggestive of an upper respiratory tract viral infection and fever. This is followed by the most dramatic manifestation of weakness of arm or leg due to nervous system involvement. Either one or all four limbs may be affected. This is accompanied by a loss of tone and deep tendon reflexes. Sometimes, there may also be facial weakness or swallowing disturbances. In extreme cases, respiratory muscles are involved, leading to a need for artificial breathing support. The ability of patients to feel sensations is usually preserved, but pain is often prominent.

Once the disease is suspected, it is important that the child quickly undergo magnetic resonance imaging of the spine which typically shows changes involving the gray matter of the spinal cord. In cases with symptoms suggestive of cranial nerve involvement in the brain, such as facial weakness, brain imaging shows changes involving the gray matter of corresponding regions. Spinal fluid may show an increase in number of cells from what is otherwise found in normal children. Doctors may order nerve conduction studies and they show abnormal nerve impulses. The overall scenario with AFM is distinct and relatively easy to differentiate from diseases with some overlapping manifestations such as transverse myelitis and Guillain-Barré syndrome.

Treatment

A majority of interventions tried in the initial stages of the disease to date have had no success. Drugs that work in several other neuroimmunological illnesses, such as intravenous immunoglobulins, and corticosteroids, have mostly not been effective. Plasma exchange has been tried but has not shown definitive benefit. Antiviral medications have not worked well either. Fluoxetine – an antidepressant – was noted to have in vitro antiviral property and efficacy against EV-D68, and tried by neurologists at several centers around the country in 2015 and 2016, including at my hospital. However, fellow researchers from centers around the country and I, led by Children’s Hospital Colorado, recently published our collective experience, noting that fluoxetine was not effective in improving outcomes.

The cornerstone of treatment in the initial phase is supportive care. Those with less severe manifestations at the outset are likely to do better in the long term than those with more severe initial presentation. Experimental surgical interventions with nerve grafting, after the acute phase is over, has shown some success in several patients.

The CDC has constituted a task force to investigate AFM. It is collaborating with the AFM Working Group, consisting of clinicians and researchers from around the country, in building a consensus to streamline treatment, in looking into and fostering research, and in leading advocacy efforts.

If The Cold War Went Hot, This 1 Nation Was First On The Soviet Chopping Block Iceland. by Robert Beckhusen

 

Tom Clancy’s 1986 novel Red Storm Rising depicts a conventional war between NATO and the Warsaw Pact. It’s one of Clancy’s best books and, interesting for a story about a Third World War, doesn’t involve a nuclear apocalypse.

It does describe a ground war in Germany, naval and air battles in the North Atlantic and — central to the plot — an invasion of Iceland by a regiment of Soviet troops. Clancy, who died in 2013, was known for his realism and extreme attention to technical detail.

In Red Storm Rising, the Soviet troops overwhelm a U.S. Marine company in the Nordic island country after sneaking to shore inside the MV Yulius Fuchik, a civilian barge carrier loaded with hovercraft. Before the amphibious assault, Soviet missile target and destroy NATO’s F-15 fighters based at Naval Air Station Keflavik.

Iceland was an overlooked by highly strategic location in the Cold War. Were the Soviet Union’s attack submarines to break out into the Atlantic and threaten NATO shipping, neutralizing Iceland and penetrating the “GIUK gap” would be of vital importance.

But that doesn’t mean the Soviets really could’ve invaded Iceland … right?

For a possible answer, let’s consult The Northwestern TVD in Soviet Operational-Strategic Planning, a 2014 report by Phillip Petersen — an expert on the Soviet and now Russian militaries for the Potomac Foundation.

In December, the Pentagon’s Office of Net Assessment made the report public and available on its website.

Petersen’s analysis is a revealing blueprint for how to defend Scandinavia from a Russian attack. Much of the report is comprised of military-oriented descriptions of remote rivers and sparsely-inhabited valleys — pictures included — which the word “obscure” can barely describe. Obscure, except in case of World War III.

“Faced with a predominantly sea-oriented NATO coalition dependent on control of the [sea lines of communication], there can be no question but that the Soviets would have liked to capture or at least neutralize Iceland,” Petersen wrote.

“Soviet operations against Iceland could have theoretically covered a wide spectrum of means, ranging from air and missile attacks to troop assaults.”

Supporting the theory that the USSR could have pulled off a Clancy-style surprise attack, the Soviet Union possessed the exact equipment in Red Storm Rising — reflecting Clancy’s attention to all-things hardware — suitable for landing troops in Iceland without the need for a major port.

In fact, the Soviets trained to use such repurposed “roll-on/roll-off” vessels like Yulius Fuchik for precisely those kinds of missions. Meanwhile, NATO kept its military presence in Iceland minimal because of the country’s heated political divisions over its participation in the alliance.

Iceland has not had a military since 1869.

Thus, in the event of a war breaking out, NATO would have to rush troops to the island and shore up its defenses to raise the costs of, and hopefully deter, a Soviet attack.

Iceland’s remote location and ruggedness — and the Soviet Navy’s comparative weakness — meant that a surprise attack by a small and relatively light force before the Western alliance could respond was Moscow’s only feasible strategy.

The Soviet military had experience with similar operations in World War II, including deploying small teams to Norway to spy on German troops. In 2014, Russia carried out an almost-bloodless surprise attack on Crimea which occurred too quickly for Ukraine to respond.

Iceland would’ve been a far more difficult target. For one, there was the problem of distance. The country is also windy and rough, making an airborne drop an exceedingly hazardous proposition. Paratroopers might have been swept away by winds and dashed into rocks, or broken their legs upon landing.

And any Soviet operation would have faced challenges at sea. The Kremlin would have to bet on basically perfect weather and skilled navigators to make it through Iceland’s narrow fjords and around its numerous reefs.

However, “even if the Soviets had attempted a lower-risk effort such as inserting a naval infantry company by submarine,” Petersen wrote, “such a force might have been sufficient to attack the Kevlavik airbase, while special-purpose (spetsnaz) forces, in teams of five to twelve men each, attacked outlying facilities like that at Hofn.”

Hofn was the site of a Cold War-era NATO radar station which tracked Soviet bombers heading south.

So the Soviets could’ve taken Iceland. Or at least caused a lot of chaos and disruption if the United States did not bolster the defenses beforehand.

But that would just be the beginning. A Soviet occupation force would probably face a NATO counter-attack, likely supported by at least one U.S. carrier battle group, without having Soviet warplanes backing them in comparable numbers — and little cover from NATO aircraft flying overhead.

Which is pretty much what happened in the fictional battle for Iceland in Red Storm Rising. NATO won.

The Beirut Explosion Was Exceptional, but the Events Leading up to It Were Not Beirut has shown us the kind of impact a port disaster can have on a city and its inhabitants. Lessons must be learned to make sure a tragedy like this does not happen again. by Scott Edwards and Christian Bueger

 

At the time of writing at least 100 people have lost their lives and a further 4,000 have been wounded following an explosion in the Port of Beirut. While the actual cause remains uncertain, the tragedy calls to attention the tremendous consequences of a lack of port security.

The explosion, on August 4, at around 6pm local time, appears to have been fuelled by 2,750 tons of the highly reactive chemical ammonium nitrate. The chemical had been the cargo on a ship, the the MV Rhosus, which entered the port at Beirut in 2013 due to a lack of seaworthiness and was prohibited from sailing. After the ship’s owner abandoned the vessel soon afterwards, the ammonium nitrate remained in a storage facility in Beirut’s port.

While the disaster itself was exceptional, the events leading up to it were not. Hazardous material is shipped across the world’s oceans on a daily basis. It is often mishandled or illegally traded. Abandoned containers of hazardous goods are found regularly in ports.

While maritime security tends to focus on preventing high-profile events such as piracy, terrorism or cyber-attacks, all too often it is daily mishandling that makes disasters possible. Part of preventing disasters such as what has happened in Beirut will mean strengthening port management and addressing crimes such as smuggling and corruption.

Abandoned Ships

The International Maritime Organization (IMO) has recorded 97 cases of abandoned ships and crews since 2017. Ships are abandoned by their owners if a vessel is no longer lucrative to maintain, or perhaps if the ship has been stopped by authorities and fined. While the situation of the seafarers aboard these ships is often tragic, as they may receive little pay or even food for months, what happens to the load of the vessels is often unclear.

And the IMO number only reflects the cases of ships – we know little about how many containers stand abandoned in ports around the world.

A UN report indicates that this number may be large. Containers often lie abandoned within ports, sometimes even by design, fuelled by criminal activities such as waste smuggling and corruption. Despite some efforts to counter this, the issue remains widespread and there are continued obstacles to tackling it.

International Waste Trade

Shipping companies often sail to Asia with empty containers, as much of the flow of trade is from Asia to Europe. As a result, they are willing to take low-value and high-volume bookings on the initial leg.

This has facilitated a burgeoning waste trade and with it a smuggling sector, where illegal forms of waste such as unrecyclable plastics are shipped from western countries to countries such as Indonesia and Malaysia. Thousands of these containers lie abandoned once they reach the port.

Much of the waste is less dangerous than the ammonium nitrate that fuelled the Beirut explosion, but it can still have dreadful effects. Plastics, for example, can cause hazards if not properly disposed of. Much of it ends up in the ocean, fuelling the ocean plastic crisis.

In 2019, Sri Lankan authorities discovered more than 100 abandoned containers in the port of Colombo. They contained clinical waste, potentially including human remains, and were leaking fluids. The risk that the containers had contaminated the ground and surface water in the two years they had lay in port unnoticed fuelled public health concerns. Sri Lanka has been able to investigate this problem – but it is likely that, in many cases, abandonment goes undiscovered.

Prevention

The abandonment of dangerous containers in ports is not a new problem. Since the 2000s there have been significant efforts to increase security levels in ports through surveillance, training and safety protocols. In light of the continuing abandonment problem, we know that these measures – and their implementation – are insufficient.

First, we have to start seeing the smuggling of waste and the abandoning of ships and containers as major offences. They should be seen as important parts of the blue crime and maritime security agenda. Appropriate legislation is needed to criminalise them. An international database for such crimes is required, as is transnational cooperation to address them.

Second, corruption in ports plays a key part in ensuring that abandonment goes unnoticed. It needs to be addressed with a concerted international effort.

Finally, increased efforts in building the capacity of ports to deal with hazardous waste, to detect smuggling and to deal with abandonment cases are needed. In particular, this will be necessary for ports which have limited resources and are common destinations for abandoned containers, such as ports in Asia and Africa.

The UN Office on Drugs and Crime, the International Maritime Organization and the European Union already conduct port security capacity building work, in particular in Africa. More of this kind of work is needed.

Beirut has shown us the kind of impact a port disaster can have on a city and its inhabitants. Lessons must be learned to make sure a tragedy like this does not happen again.

Beware of Latvians Bearing Gifts These countries should be enticing the French, British and Germans to help them, not Americans who have needs to tend to at home. by Harvey M. Sapolsky

 

Artis Pabriks, Latvia’s minister of defense and deputy prime minister, recently made an official offer to host and pay for some of the U.S. troops President Donald Trump has ordered be withdrawn from Germany in a dispute over Germany’s investment in its own defense. Trump had previously complained about Germans not paying enough for the maintenance of the nearly thirty-five thousand U.S. troops stationed in Germany. In June, Trump approved a plan to withdraw ninety-five hundred troops on the rationale that the Germans were not meeting their NATO obligation to devote at least two percent of their GDP to defense. Subsequently, the number to be withdrawn was raised to 11,900. Robert O’Brien, Trump’s national security adviser, later said that these troops should be more forward-deployed to thwart possible Russian aggression.  

All of this is music to Latvian ears. Latvia is forward-deployed as it is one of the Baltic States, forcibly converted into Soviet republics from World War II until it regained its independence at the end of the Cold War. Offered NATO membership in 2004, Latvia and the other Baltic States are eager to meet the NATO budget standard even if it is ignored by most of the other member states. Currently, Latvia and the other Baltic States, all small in population, host rotational units from the larger NATO members, the United States included, to augment their own limited capabilities. It is not surprising that Latvia, upon learning that the United States intended to forward-station its forces, was quick to offer to pay some of the associated costs. Other countries are likely to follow with similar proposals. Poland has already made an overture.  

Moving U.S. troops forward instead of back to America would be a mistake. America should be behind, not in front of its allies. It is not good to be wedged between the allies and a bullying Russia, serving as a tripwire that would bring the United States into any war. To be sure, America willingly took that role during the Cold War, stationing more than three hundred thousand troops in Western Europe to help protect Europe from an expansionary Soviet Union. Devastated by World War II, the Europeans were too weak to stave off the Soviets without our forces standing between them and Soviet tank divisions. That strategy did work. The Cold War ended peacefully and the Europeans, with U.S. protection, grew prosperous.  

Today, Europe in the guise of the European Union, which includes the Baltic States and many former Warsaw Pact allies of the Soviets, has ten times the GDP and three and half times the population of Russia, the inheritor of the Soviet Union’s nuclear weapons and its dictatorial ways. Latvia and the other Baltic States cannot alone hold off the Russians, but collectively the European Union easily can. That is it can unless we do it for them, subsidizing what are now rich Europeans by taking away their incentive to organize and pay for their own defense.  

America’s strategy of being behind its allies, not in front of them, worked well for it during World War I and World War II. In World War II, America’s European allies and the Soviet Union wore down the Germans before directly engaging them. Compared to all the other participants in World War II, the United States had a good experience (and a fairly good World War I, too). Holding the line against Russia now would be a much more doable task for the Europeans. 

There is no need for the United States to guard Europe against the Russians. The Europeans are rich, numerous, and fully capable of defending themselves. America must resist Latvians or Poles bearing gifts. These countries should be enticing the French, British and Germans to help them, not Americans who have needs to tend to at home. If U.S. troops leave Europe, as they should, then the Europeans will remain friends and allies of the United States because America is their best insurance given that it has saved the Europeans three times over the last century. This time, unless the United States is foolish, it need only watch from a distance.

Serbia Is Sitting at the Great-Powers Crossroads Resolving differences with Kosovo could be the key to Serbia’s emergence as an important force in regional development and stability. by James Jay Carafano and Luke Coffey

 

Serbia has been here before. In ancient times, the Western Balkans sat astride the dividing line between the Roman Empire and the infinite frontier to the East. Later, the region marked the point of converging interests for Imperial Russia and the Austro-Hungarian and Ottoman Empire.  

But sitting at the crossroads on great powers doesn’t necessarily make you the doormat of great powers. On the contrary, it can set you up for peace and prosperity.  

Today, Serbia has a unique opportunity for a strategic reset that could set the country and the region on course for a better future. The road starts with making space for Kosovo statehood.  

When the Past Could be Prologue 

There is a lot more to Dubrovnik than stunning scenery for Game of Thrones. In the eighteenth century, the small city-state (in present-day Croatia), almost entirely surrounded by Ottoman territory, managed to maintain its liberty and thrive. It was a major port of call and business hub, not just for Istanbul, but for many European powers—even reaching out to establish trade relations with the newly established American Republic. All these powers found it served their interests best to allow the place where their interests coming led to flourish. The fathers of Dubrovnik made themselves valuable to everyone.

In building a Europe whole, free and at peace, the Western Balkans are definitely unfinished business. There is scant regional integration. While Slovenia and Croatia are members of the European Union, others’ prospects for accession appear remote. The potential for conflict remains. Transnational crime and corruption are a problem. Russia continues its perpetual meddling in the region, and China is looking to exert more influence there.  

Yet the heart of the region’s disunity lies primarily in the tension between Serbia and Kosovo, which obtained its independence in 2008. Serbian foreign policy actively continues to press nations not to recognize Kosovo and constantly seeks to block Kosovo’s participation in international organizations. Resolving differences with Kosovo could be the key to Serbia’s emergence as an important force in regional development and stability. 

The Way Forward  

Traditionally, Serbia has leaned heavily on relations with Russia and China, even though it receives far more investment and assistance from the West. Yet, as allies, both Moscow and Beijing have underperformed. Both take Serbia for granted.  

Serbia diminishes its own value by not deepening its ties with the West to balance out its relationship with these unappreciative powers. This is not about picking sides. This is about making Serbia a more valuable and responsible regional player, and, in turn, emerging as a more positive force in balancing the interests of great powers in the region.  

The quickest and most productive path for Serbia to balance its relations with the West is to normalize relations with Kosovo. No step would be more constructive.

Hats off to both the United States and the European Union for committing to broker a future rapprochement between Serbia and Kosovo. If this core issue can be resolved, then it could transform the future of the Western Balkans. 

As for Kosovo, its future clearly lies with full integration with the transatlantic community. Kosovo knows it, and Serbia is wasting its time and resources if it thinks Kosovo would ever leave that path. While Kosovo should seek to keep the dialogue with Serbia open and constructive, it needs to continue to look for ways to keep moving forward.

It has already taken the shrewd decision to start developing its national military so eventually, it will be qualified for NATO membership. Meanwhile, the nation should look for creative ways to work with NATO.

Creativity is essential, as some of the more obvious cooperative overtures are not possible.  Participating with the allies in Afghanistan, for example, might seem to be a natural move. After all, this is a pivotal moment for Afghanistan, and additional international support now would be valued and welcome. Moreover, sending even a small contingent would enable Kosovo to broaden and deepen its military experience.  

The hitch, of course, is that five European countries—Spain, Slovakia, Cyprus, Romania, and Greece—do not recognize Kosovo. All except Cypress are in NATO (and Cyprus is in the EU). This is a contributing factor that prevents Kosovo from sending troops to Afghanistan and otherwise complicates its transatlantic path. 

Kosovo should also continue to seek ways to develop a more secure and clean energy supply integrated into a more robust and resilient regional energy architecture. One option, for example, is to develop the proposed Albania-Kosovo Gas Pipeline, which would connect Kosovo to the Albanian section of the Trans-Adriatic Pipeline, itself part of the Southern Gas Corridor that brings gas from the Caspian to Italy and then on to the rest of Europe.  

The Three Seas Initiative (3SI) also presents Kosovo with opportunity. It should enter into a dialogue with 3SI nations to explore partnering opportunities, particularly in the space of digital infrastructure.  

In short, today’s great-power competition need not work to the detriment of the Western Balkans. On the contrary, it gives both Serbia and Kosovo an opportunity to bring greater peace and prosperity to the region.  

In the end, the Western Balkans becomes an area of cooperation rather than competition by demonstrating its value to all sides. There is an imperative right now for both countries to strengthen relations with the West, and the most impactful path forward is to realize the future is two nations living side by side in peace and mutual recognition.  

The Battle of Hagia Sophia: Erdogan’s Conquest of the Turkish Republic This will set a dangerous precedent, emboldening supremacists not only in Turkey but also in the Middle East and North Africa. by Aykan Erdemir

 

Turkey’s Islamist president Recep Tayyip Erdogan has a reputation for turning challenges into opportunities. At a time when electoral support for his Justice and Development Party (AKP) has hit rock bottom in the polls, Erdogan pulled off his most daring trick to date by converting Istanbul’s sixth-century Byzantine church Hagia Sophia into a mosque. As the Turkish president and his ultranationalist allies celebrate the move as the latest in a series of Turco-Muslim conquests in the region, they are fundamentally transforming the Turkish state’s relationship to its citizens. This will set a dangerous precedent, emboldening supremacists not only in Turkey but also in the Middle East and North Africa. 

In announcing the July 10 ruling of an administrative court that paved the way for transforming Hagia Sophia’s status from a museum into a mosque, Erdogan said that the building’s conversion would gratify “the spirit of conquest” of Mehmet II, the Ottoman sultan who captured Constantinople from the Byzantines in 1453. Erdogan’s ultranationalist coalition partner Devlet Bahceli echoed the Turkish president the next day by proclaiming that the course of the Turco-Muslim conquest, “which has been going on for 567 years, has entered a new phase.”

Turkey is unique among NATO’s thirty member states for having a government that continues an active campaign of conquest against its own population and their worship halls. Ironically, it was this very dichotomy between Muslim conquerors and their conquered subjects that Mustafa Kemal Ataturk, Turkey’s founding father, was trying to abolish as he built a secular republic from the ashes of a failed empire. His 1934 transformation of Hagia Sophia from a mosque into a museum was the most symbolic expression of this new spirit, as Muslims, Christians, and others would enjoy access to this monument on an equal footing as former imperial subjects turned equal citizens of a burgeoning republic.

Sadly, the republic failed to deliver fully on its promises, neither securing freedom for nor freedom from religion for all its citizens. Although the Turkish constitution has enshrined the principle of secularism and equal citizenship regardless of ethnicity or religion, the country’s Sunni Muslim majority remained a privileged caste, as religious minorities learned to live with the de facto hierarchies imposed on them by a sinister sectarianism that permeated the entire political spectrum and government bureaucracy.

The idea of equal citizenship, nevertheless, has remained a powerful principle that Turkey’s religious minorities and their pro-secular Muslim allies could time and again turn to for demanding rights and pushing back against discrimination. The Turkish republic, with all its shortcomings, continued to inspire others in majority Muslim countries to challenge sectarian hierarchies and demand the building of secular polities. One of the biggest impacts of Erdogan’s conversion of Hagia Sophia and deployment of the trope of conquest will be to turn back the clock of secularism and equal citizenship in the very country where this ideal started most forcefully in the Muslim world. 

This radical rupture in consciousness was best expressed by Elpidophoros, the archbishop of the Greek Orthodox Archdiocese of America—and a native of Istanbul—as he warned that “a mentality of the conqueror, and claiming conqueror’s rights . . . changes the relationship of the state to its citizens.” He added, “I am a Turkish citizen myself, and I don’t want the state to have the mindset of the conqueror, because I am not a conquered minority. I want to feel in my own country as an equal citizen.” 

Archbishop Elpidophorous and his fellow Greek Orthodox citizens in Turkey, who now number less than two thousand, are not the only ones who feel subordinated. Many pro-secular Muslims, whether they are religious or not, feel that with his latest stunt, Erdogan has also relegated them to a conquered minority. The simple act of supporting Ataturk’s Hagia Sophia decision and opposing Erdogan’s conversion suffices to demote a citizen to the status of a subject that needs disciplining if not punishment. A deputy leader of the AKP, for example, accused such people of acting like “the Byzantines among us,” insinuating they are traitors. Similarly, Bahceli referred to them as “remnants of the Byzantines” and the “clandestine Byzantine lobby’s Westophile native collaborators.” 

The Erdogan government’s Hagia Sophia policy and rhetoric have not only intimidated and marginalized Turkey’s religious minorities and pro-secular Muslims but also emboldened the Turkish president’s Islamist support base. Three days after Hagia Sophia’s conversion, an Islamist weekly owned by a pro-government media group called for reinstating the caliphate abolished in 1924 by none other than Atatürk, reinforcing the pro-secular opposition’s long-running accusations about Erdogan’s hidden agenda to bring back the Ottoman Empire. Although an AKP spokesperson was quick to deny any plans to change the regime’s “democratic and secular” qualities, Turkey’s pro-secular opposition saw this as a potential step Erdogan might take once he feels the time is right. 

To make matters worse, Erdogan’s messaging emboldens not only his loyal followers at home but other Islamists around the world. A Jordanian professor, in declaring his support for Erdogan’s conversion of Hagia Sophia on a Muslim Brotherhood channel, claimed that Ataturk was a crypto-Jew and added, “If we liberate Palestine tomorrow, will we leave the Jewish synagogues intact? No! We will uproot them, along with their people, and throw them into the sea. Allah willing, it will be soon.” In addition to the Muslim Brotherhood, Erdogan’s conversion of Hagia Sophia also received messages of endorsement from a motley crew, including Hamas and Iran, notorious for their use of terrorism to advance their respective Islamist agendas. 

The inspiration for the Jordanian professor’s statement is likely the Turkish president’s promise a week earlier during his announcement of Hagia Sophia’s conversion that “the resurrection of Hagia Sophia heralds the liberation of the al-Aqsa Mosque” in Jerusalem. Erdogan, in his usual opaque style, when it comes to such delicate matters, left it vague as to what this act of liberation would entail.  

The first Friday prayer Erdogan held at Hagia Sophia on July 24, however, showed the limits of the appeal of Erdogan’s conquest rhetoric beyond his Islamist circle. Despite the fact that he invited a long list of notables from around the world, including Pope Francis, there were no world leaders, Muslim or Christian, who agreed to partake in his spectacle. It did not take long for the Turkish president to realize that his Hagia Sophia policy and rhetoric were a public relations disaster, further undermining his tarnished image. On July 28, Erdogan’s communications director tweeted in Greek the steps Erdogan’s Turkey has taken “to preserve cultural and religious diversity,” sharing a video of Greek Orthodox individuals and other minorities who declare how good everything is in Turkey. This was reminiscent of the 2018 statement that Turkey’s non-Muslim minorities issued denying that they faced any oppression in the country, echoing similar statements Iran’s Jewish citizens need to issue on a regular basis. 

Erdogan’s propaganda machine will without a doubt continue to disseminate sound bites praising how perfect interfaith relations are in Turkey. These window-dressing attempts, however, cannot undo the lasting damage the Erdogan government’s Hagia Sophia policy and rhetoric has done to the idea of equal citizenship in Turkey and elsewhere in majority Muslim countries. The world still remembers vividly the recent destruction and forced conversion of religious minority sites in Iraq and Syria by jihadists armed with a conquest mentality. The last thing the volatile region and its vulnerable minorities need is fueling of supremacist sentiments and setting extremism into motion.