HEALTH: Study Warns of The Neglected Fall-Out From War – Disease

By Lahai J. Samboma Reprint | | Print |

LONDON, Mar 18 1995 (IPS) - Public health systems in developing countries come under severe strain in countries affected by civil war and need urgent attention, according to a new study compiled by London-based researchers.

“Textbooks on public health pay only cursory attention to the issue, focusing rather on natural and man-made disasters and the likely impact of nuclear war,” write by David Fitzsimons and Alan Whiteside in a just released study “Conflict, War and Public Health”.

The study, published by the Research Institute for the Study of Conflict and Terrorism (RISCT), aims to alert the world to an impending catastrophe the authors contend is little-appreciated.

“The effects of war in less developed countries are under- reported. Some of the basic principles of public health will apply equally to civil conflict and war and natural disasters such as earthquakes or floods but there are significant differences.”

The researchers link an increased rate of the transmission of the human immunodeficiency virus (HIV virus) as a direct consequence of civil conflicts. Carriers of this virus invariably contract AIDS, the Acquired Immune Deficiency Syndrome, an often fatal disease marked by severe loss of resistance to infection.

Conflicts gives rise to the breakdown of social routine and norms and the deployment of the uniformed services — soldiers, militia, police and paramilitaries — groups which previous research has demonstrated tend to have higher levels of HIV infection than the general population.

The resulting stress and tension, the report states, lead to greater rates of sexual activity, as evidenced by the rate of pregnancies in countries with such conditions.

In such situations prevention programmes may not be effective owing to lack of security and resources, and even if they did operate, the study stresses, people are less likely to heed the messages as they have more immediate and pressing problems on their minds — such as their basic survival.

As a consequence, the vulnerability of the general population to infection by AIDS increases greatly. AIDS being an “opportunistic” disease, famine, plague, cholera, dysentery, typhoid and other diseases which always accompany war, provide fertile soil for the epidemic to spread, the study said..

The study adds: “Mass movements of people may ensue, with large numbers of refugees presenting immediate health problems and destabilising host societies. AIDS is not the only disease that is spread through conflict but with the traditional public health problems forms an unholy alliance in further attacking the health status of the populace.”

The study is grounded in surveys of conflict situations in various regions of the world ranging from Angola and Sierra Leone to Azerbaijan and Bosnia-Hercegovina.

The deaths late last year of tens of thousands of Rwandans from cholera, dysentery and other diseases in Goma, Zaire, underscores the study’s thesis.

But it is not only in conditions of full-scale war that public health is compromised, according to the study.

For example, the weakening of central power in the former Soviet Union and the subsequent political instability has seen mortality rates rise, life expectancy fall and dramatic increases in cases of diphtheria, tuberculosis, hepatitis and dysentery.

Conflicts, whether by design or intent, can also lead to the destruction of public health and medical facilities such as water treatment plants, sewage works and hospitals, the report says.

Indirect action such as the blowing up of bridges and blockades prevent the distribution of medical supplies, food, fuel and other essentials to besieged populations.

According to the report, while civilians accounted for around half of war-related deaths in the 18th and 19th centuries, today that proportion has shifted dramatically upwards to between 75 and 90 per cent.

If this grave threat to public health is to be successfully tackled, the report submits, concerted national and international initiatives on conflict resolution must be undertaken and the impact of conflict must be incorporated into political thought so that steps are taken to diffuse situations that can lead to disturbances.

“The short and long-term consequences of conflict and civil disobedience for public health, and thus development and social well-being, have never been fully assessed,” the study said.

“Doing this assessment would be an instructive and shocking exercise. The global community of nations, inextricably linked as never before by bonds of trade, communications and development, must face this conclusion and act accordingly.”