Responding to War: Is Public Health the Answer?

As current political tensions point toward war, the protection of civilians in conflict area’s right to health must be considered and protected [1]. Given the past century’s extensive encounters with this kind of violence, it is necessary to examine what measures can be taken to better serve global populations and respond to potential chaos. With war and conflict comes the spread of violence and immediate threats to the health of affected populations. While this presents an obvious problem for the health of individuals, it is relevant to examine the lasting effects that conflict has on health systems within affected countries.
In January 2018, the global health community was shocked by how members of the Turkish Medical Association (TMA) were imprisoned following their statement towards the decision of the Turkish government to involve itself in the Syrian conflict. The TMA had released a public statement expressing how “war is a man-made public health problem” [2]. The power of this statement is clear—reprimanding the government’s actions in clear neglect of the well-being of its citizens—and raising a question of the place of war in today’s society. 

A large issue that arises when considering public health during a war or armed conflict is that of measurability and surveillance. The way that war affects the mortality and morbidity of a population is unprecedented, even considering that it is a time when the state of population health is the most difficult to accurately measure and describe [3]. With either absent or inadequate systems of health in place to accurately quantify and address civilian injuries and casualties, as well as the inevitable presence of chaos and social breakdown, it becomes clear just how much of a problem mankind is making for itself [4]. 

The presence of armed conflict and war on global health agendas worldwide is scarce and often an outcome of just how much this issue lies outside traditional disease outbreaks and epidemics [3]. Nevertheless, health problems that rest in the hands of mankind are only growing and require stronger, more adaptable health systems to address them appropriately.

The Middle East is currently experiencing a trend of specific targeting of healthcare workers and infrastructure within conflict zones, presenting an even greater threat to an already unstable service [4]. In 2018 alone, 973 attacks were reported on healthcare facilities, transport vehicles and workers across 23 different conflict-ridden countries [5]. These targeted attacks jeopardize any potential for universal healthcare or global health security. These issues present serious negligence to International Humanitarian Law (IHL), creating a serious challenge for policymakers attempting to make a change in the livelihoods of at-risk populations [6]. 

Negligence of IHL is problematic and often too common in periods of war and political unrest. Given the severity of this negligence and the furthering of this “man-made public health problem,” consistent investigation and stricter sanctions are required to maintain good health and ensure that healthcare systems can remain responsive to the population in need [2]. The enforcement of sanctions and the recognition of IHL also requires consistent communication between state actors and humanitarian organisms. As destructive and often irrational as armed conflict and war seem, there must still be room for dialogue and the protection of basic human rights for innocent civilians on the sidelines. 

But even without this direct action against healthcare infrastructure, armed conflict still manages to interrupt important supply changes that feed the normal functioning of these structures and the environment in which healthcare workers must do their job. In the case of the Syrian conflict, there were reports of mass waves of professional immigration that occurred right as the war began, creating a drastic difficulty for hospitals and clinics to run normally [4]. 

To respond to the growth of this violent phenomenon, an article was published in Conflict and Health outlining important steps and measures that can be taken to ensure that health systems remain functional during times of conflict [6]. Given how necessary health structures are when rebuilding a country post-conflict and post-war, maintaining the stability of these structures is pivotal. This must include a better system to encourage populations, especially medical doctors and healthcare providers, to return to their countries and aid in stabilizing and rebuilding their country. 

While humanitarian aid and the involvement of charitable organizations in relieving the harsh effects of war have proven to be an important step in the right direction, a strong and stable healthcare system is needed in vulnerable countries to minimize the devastating consequences it has on population health. The effects are long-term and move across generations, requiring attention that moves beyond emergency response. War has the power and ability to regress years of development and infrastructure of any targeted country, creating a need for better response and support of international organizations already on the front line and health workers more broadly. With appropriate measures in place, public health can stand as a powerful tool in the response and rebuilding process of any war-ridden country. 

References

[1] The New York Times Editorial Board (2020, January 4). Congress, Stop President Trump’s Rush to War With Iran. Retrieved from https://www.nytimes.com/2020/01/04/opinion/editorials/trump-iran-threats-Suleimani.html.

[2] Razum, O., Barros, H., Buckingham, R., Codd, M., Czabanowska, K., Künzli, N., et al (2019). Is war a man-made public health problem? The Lancet, 394(10209), 1613. doi: 10.1016/s0140-6736(19)31900-2

[3] Hagopian, A. (2017). Why isn’t war properly framed and funded as a public health problem? Medicine, Conflict and Survival, 33(2), 92–100. doi: 10.1080/13623699.2017.1347848

[4] Levy, B. S., & Sidel, V. W. (2016). Documenting the Effects of Armed Conflict on Population Health. Annual Review of Public Health, 37(1), 205–218. doi: 10.1146/annurev-publhealth-032315-021913

[5] Schlesinger, D. (2019, May 15). Deadly Attacks On Health Care Workers And Patients Rising In Conflict Zones. Retrieved from https://www.healthpolicy-watch.org/deadly-attacks-on-health-care-workers-and-patients-rising-in-conflict-zones/.

[6] Druce, P., Bogatyreva, E., Siem, F. F., Gates, S., Kaade, H., Sundby, J., et al (2019). Approaches to protect and maintain health care services in armed conflict – meeting SDGs 3 and 16. Conflict and Health, 13(1). doi: 10.1186/s13031-019-0186-0