Mulugeta Gebregziabher1, Pamela DeLargy2, Aisha Jumaan3, Mukesh Kapila4, Leonard Rubenstein5. 1. Department of Public Health Sciences, Medical University of South Carolina, 135 cannon St. Suite 303, MSC 835, Charleston, SC 29425, United States. 2. Arizona State University, United States. 3. University of Washington, United States. 4. University of Manchester, UK. 5. Johns Hopkins University, United States.
War has devastating immediate, long-term, and intergenerational-term impacts on health. Civilians, especially those who are internally displaced, disabled, living in poverty, children, and refugees bear the resulting disproportionate harm. The report ‘health in conflict settings’ documents that 60% of chronically food-insecure and malnourished people globally, including 75% of all children with stunted growth, live in conflict-affected countries. Sub-Saharan Africa, and the Middle East bear most of this burden, though other regions are not exempt. As a result, nations affected by conflict are less likely to meet the UN Sustainable Development Goals. The global arms trade that fuels these conflicts squanders vast resources that could sustain, rather than diminish, public health. For example, in 2020, weapons’ companies sold a US $531 billion worth of arms.Examples of the disturbing facets of armed conflict included the destruction of health facilities, and the displacement, arrest, abduction and killing of health and humanitarian aid workers. The impact of the destruction includes declines in health care delivery and life expectancy whilst increasing infectious disease burden, forced migration, extreme poverty, food insecurity, instability, and fear. Human capital is lost, and capacity building programs shattered. These multi-faceted outcomes are exacerbated by the weakened state of health care systems that typically are already fragile in conflict-affected states.In the past year alone, the health system in the Tigray region of Ethiopia has been destroyed, hundreds of health workers have been arrested in Myanmar, and health facilities in Gaza Strip were once again seriously damaged. Similar destruction has been reported elsewhere, including in Yemen, Syria, Libya and Ukraine.The ongoing war in Ethiopia, which began in November 2020, has brought a catastrophic humanitarian crisis to the Tigray region. A United Nations World Food Program report shows that ‘almost 40% of Tigrayans are suffering from an extreme lack of food, after 15 months of conflict.’ More than 80% of hospitals and health facilities in Tigray have been looted and destroyed. Only 40 of 268 pre-war ambulances remain. At least 22 humanitarian aid and health workers have been killed; only 1300 of the more than 20,000 health care workers prior to the war in Tigray are reporting to their duties. An estimated at least 20,000 women and young girls have been raped by Eritrean and Ethiopian forces. Meanwhile, the Government deliberately blocked humanitarian aid that aimed to feed and provide life-saving services to the millions affected.In Yemen, as a result of indiscriminate bombing and port blockades by Saudi Arabia led Coalition and attacks on health facilities by Ansar-Allah rebels and other warring parties, the health system has all but collapsed. Well over 50 hospitals were hit by airstrikes. As of December 2021, fewer than half of Yemen's health facilities were functioning, even as COVID-19 continued to spread; those that remained open lacked qualified staff, basic medication, and medical equipment and essential supplies.Health professional groups have begun to recognize that it is essential to push for policies that contributes to the prevention of the public health crisis of war and to mitigate it's impacts, as stated by the World Medical Association in the document “Regulations in times of armed conflict and other situations of violence, published in 2017. The time is overdue for health professional associations and schools of public health, medicine, nursing and others to recognize and prioritize war prevention and mitigations as essential to health education and practice.We therefore call on the health community to:Promote concerted global action to stop and prevent wars and promote peaceful solutions to disputes within and among nations.Advocate for access to sufficient humanitarian aid to meet population needs in conflict zones and to mitigate the direct and indirect harms to healthcare delivery.Advocate for the full protection of health care personnel who are subject to violence and arrest and for the protection of health facilities during conflict.Conduct research that promotes prevention of conflict and contributes towards building of resilient health facilities and supporting infrastructure in conflict prone areas.Demand accountability and justice for war crimes, crimes against humanity and other violations of international humanitarian laws.Encourage medical and health associations and health policy makers to include war as a priority agenda.Push for public health, nursing and, medical schools to include peace building policies and practices in preservice curriculum.Together, we can elevate the effects of war as a priority public health issue and shift to a more humane approach to political conflicts to preserve human rights, health and wellbeing.
Contributors
The conceptualization was made by Mulugeta Gebregziabher, while the drafting, editing and final approval was made by Mulugeta Gebregziabher and his co-authors, Leonard Rubenstein, Pamela DeLargy, and Mukesh Kapila, and Aisha Jumaan. All the co-signers have edited and approved of the article though we could not include them as co-authors. All authors and co-signers approved the article.