Pirate Medicine

You might think that health care workers would just take it on faith that being kidnapped by pirates is unhealthy for you, but the scientific method dictates that we test all hypotheses, even the ones that seem guaranteed to be true. After a few years of research, scientists have confidently demonstrated that being kidnapped by pirates is unhealthy for you. Now we know!

Dr. Eric Lis is a physician, gamer, and author of the Skirmisher Publishing LLC sourcebook, Insults & Injuries.

You might think that health care workers would just take it on faith that being kidnapped by pirates is unhealthy for you, but the scientific method dictates that we test all hypotheses, even the ones that seem guaranteed to be true. After a few years of research, scientists have confidently demonstrated that being kidnapped by pirates is unhealthy for you. Now we know!

Many of the major health problems that faced humans in history, and which continue to face our characters in medieval fantasy, are no longer much of a part of the modern world, at least in the industrialized Western nations. People sometimes forget that piracy is a problem which is still with us today. Granted, high-seas piracy is hardly the same thing today as it was in the days of Francis Drake, Edward Teach, and Henry Morgan, but it remains a danger in the waters around West Africa, South America, and Southeast Asia. While our imaginations are probably sufficient to conceive of the negative effects of piracy on everyone involved, in recent years, there have been a few good studies of the effects of piracy on victims and on the pirates themselves.

Let's start by looking at the risks that pirates pose to others. This paper, published a little bit less than a year ago, reviews data collected about pirate attack committed between 2002 and 2012, and to my knowledge it's the most up-to-date data on the topic. The authors reviewed information gathered from over 3800 attacks over that decade, and they quite rightly add that, of course, they cannot comment on how many attacks go unreported. In those 3800 attacks, there were 7636 acts of violence towards people; unfortunately, the authors don't discuss whether the majority of attacks are perpetuated by particularly violent pirates or whether on average pirates tend to wound two to three crewmembers to make a point, but we can certainly infer that the vast majority of people on board an attacked ship are unharmed. 6118 people were taken hostage (generally entire crews at once) and about 350 ransomed.  

The vast majority of attacks are against freighters and commercial ships; passenger and cruise ships are thought to be relatively safe, presumably because a ship full of oil is easier to profit from rapidly, but also because they are on average faster than a merchant ship and have higher sides that make it more difficult to board. The larger crew, which often includes trained security personnel, also make these ships harder to attack. In the reviewed cases, only 13 recorded attacks were on passenger ships. In contrast, yachts with small and often ransomable crews, are at greater but still smallish risk (82 out of 3800 attacks).

Among the other trends that the authors noticed was a rise in kidnappings over the period studied. Historically, pirates rarely kidnapped prisoners given the costs and complications of holding them, and this is doubly true for pirates whose ships rely on winds and sails instead of more reliable engines. As the idea of taking hostages has spread, however, and as some of those hostages are successfully traded back for money and other exchanges, pirates begin to see it as feasible and profitable, which means it becomes more common.

Obviously, there are negative health effects to the whole thing. Over the period studied, 26 people were held hostage for a period of over two years, and the risk of being subjected to violence rises with the length of captivity, as does the risk of developing sickness and malnutrition. Fifty seven percent of hostage reportedly face mistreatment while held, which I'll admit is actually a bit lower than I might have guessed. On the reported deaths, 8 were killed directly by pirates, 8 died from disease or malnutrition, and 19 died during rescue efforts escape attempts. Psychological problems such as post-traumatic stress have understandably been reported in the victims, as well as in family members who may themselves have received threats from pirates to speed up the paying of ransoms.

Although there are extensive protocols from various organizations regarding how to best repel pirates, once they're on board, the data suggests that a crew's odds of survival really are highest if they offer no resistance and cooperate fully. As every storyteller knows, this is generally the last thing that our players will do in-game.

When hostages are rescued (after an average captivity of 5 months, based on data from 2010), the guidelines for health care practitioners advise that the medical workup include a complete but non-confrontational interview to assess what risks they were exposed to, investigation for general signs of infection and injury, and tuberculosis testing, since pirates tend not to have the finest sanitation, especially for their prisoners. Some guidelines recommend routine prophylaxis against malaria, which is endemic to many regions where piracy is a problem. No data exists that I could find about rates of HIV among pirates or rates of sexual abuse among their captives, but testing should be considered in at-risk victims. Lastly, the guidelines recommend isolating rescuees from journalists, who tend not to be gentle with them and can worsen the psychological outcomes.

There's also data about the acute management of health problems in pirates, and it's been shown that their health may be no better than that of their hostages, especially if they've been captured by enthusiastic security personnel. Interestingly but perhaps not surprisingly, the guidelines for assuring the health of the pirates covers basically the same issues as the hostages... the pirates' living conditions tend not to be much better.