War and public health | Journal of Public Health

‘When the rich wage war it’s the poor who die’.¹

Jean Paul-Sartre.

On 24 February 2022, as the world was still dealing with the Covid pandemic and trying to navigate the challenges it posed, Russia invaded Ukraine. The devastating results have since been seen daily on our television screens: images of prosperous towns and cities where the population were leading normal lives in ruins, people lying dead on the streets and in improvised graves, people in shock and despair at what is happening to their country. On 3 May 2022, according to the Office of the High Commissioner for Human Rights, 6469 civilian casualties were recorded, including 3316 deaths. The actual figure could be significantly higher as reported victims are confirmed. Tens of millions of people are in ‘potential danger of death’.² On the 3rd of May, this year, the Office of the United Nations High Commissioner for Refugees estimated that >5.2 million people have fled Ukraine and >7.7 million Ukrainians are internally displaced. This is the fastest forced population movement since the Second World War.²

The Russian invasion of Ukraine has brought a new war into existence. According to The Council on Foreign Relations, an American think tank specializing in United States foreign policy and international relations there are presently 27 active conflicts around the world. Some of these conflicts have been going on for decades, others for only a few years; all have disastrous consequences.

In Yemen, years of civil war has created the world’s worst humanitarian crisis. Recently, David Gressly, the United Nations Humanitarian Coordinator for Yemen said ‘the numbers this year are staggering’. Over 23 million people – or almost three-quarters of Yemen’s population now need assistance. That is an increase of almost 3 million people from 2021. Nearly 13 million people are already facing acute levels of need’.³

The Syrian conflict is now in its 12th year. Joyce Msuya, Assistant UN Secretary-General for Humanitarian Affairs said ‘for Syrians living through the twelfth year of this crisis, the future looks bleak. The basic necessities for a healthy, dignified life are even further out of reach for millions of people due to escalating food and fuel prices, and unprecedented water shortages in 2021 are already taking their toll on farmers and livestock producers’.⁴

The United Nations reported that there is a severe shortage of food and humanitarian supplies as a result of the conflict in Tigray region of Ethiopia, with >90% of the population in urgent need of assistance.⁵

Armed conflict between warring states and groups within states have been major causes of ill health and mortality. Conflict obviously causes death and injuries on the battlefield, but also health consequences from the displacement of populations, the breakdown of health and social services, and the heightened risk of disease transmission. War also has an impact on mental health, gender-based violence, reproductive health and long-lasting effect on the environment.

In 2008 in their introduction to the 2nd edition of War and Public Health,⁶ Levy and Sidel wrote ‘War has an enormous and tragic impact — both directly and indirectly — on public health. War accounts for more death and disability than many major diseases combined. It destroys families, communities and sometimes whole cultures. It directs scarce resources away from health and other human services, and often destroys the infrastructure for these services. Yet, despite all of the effects of war on human health and well-being, up until now war and its prevention have not been seen as integral parts of the work of public health professionals and have not been adequately covered in their professional education.

The authors go on to outline the role of Public Health professionals in times of war. They include surveillance and documentation of the health effects of war and factors that may cause war and advocating policies and promoting actions to deal with war and its health consequences. They are of the opinion that public health professionals could use primary, secondary and tertiary prevention strategies to address war and also develop the evidence base for public health. Levy and Sidel recommend this should be part of the ‘curricula of schools of public health, the agenda of public health organizations, and the practice of public health professionals’.⁶ In her article War and Public Health,⁷ Diana Benjamim notes that public health professionals should include in their remit the effect of war on the physical and mental health of combatants returning back from wars, assessing the health needs of immigrants and refugees, studying the impact of war on public health resources. Banatvala and Zwi⁸ in a comprehensive article entitled ‘Public health and humanitarian interventions: developing the evidence base’ discuss the need for evidence base and highlight the areas of research to develop this evidence-base.

The anthropologist Fry in his book Beyond War: The Human Potential for Peace⁹ claims war is not inevitable and is a relatively recent phenomenon. He attributes the reason for this to the changes in social organizations specifically the development of nation-states. Until the time comes when John Lennon’s dream of ‘all the people livin’ life in peace’ when ‘there’s no countries, nothing to kill or die for’, ¹⁰ public health professionals have a vital role to play in mitigating the health consequences of war and contributing to the possibility of preventing conflicts.

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