European perspectives on global health: a policy glossary

2. Europe must include global health in all fields of policy
War and health
War is a man-made disaster causing loss of
catastrophic proportions resulting in significant
physical damage or destruction, loss of life and
permanent change to the natural environment
and calling for humanitarian concern over
people’s welfare, the alleviation of suffering
and compassion. Wars lead to destruction of
health infrastructure, cause flight of capital
( both social and financial ) and the diminution
of resources.
The method of waging war is to render the enemy
incapable of fighting through their destruction,
injury, or undermining of support systems such as
government, infrastructure, community, ideology,
religion or culture. Thus wars destroy individuals,
families and communities including health
infrastructure as well as disease prevention and
health promoting efforts. Recent evidence points to
the perniciously deleterious effects of war trauma
on the mental and physical health of individuals,
families and communities. Such mass trauma has
contributed to retarded economic development and
to the emergence and maintenance of diseases and
epidemics in the world with consequent public health
implications. These effects may span generations with
significant negative impacts on the public health and
socio-economic development of affected societies.
Wars may be waged between states or between
groups within states as in Bosnia and Rwanda or by
groups spanning states such Al-Qaeda.
The recent phenomenon of so-called “low-intensity”
warfare causes more casualties among civilians than
among combatants. Such wars have characterised
modern warfare, resulting in millions of civilian
casualties worldwide and creating massive population
displacements, refugees, epidemics and significant
human suffering as well as trans-generational
effects such as genocides, perpetual poverty and
marginalisation. Often civilians are targeted, as
human shields, in genocides, the rape of women
and the use of child soldiers. The phenomenon of
gender-based sexual violence directed to women, as
a weapon of war, has increased in recent wars as was
seen in Bosnia and Rwanda. The long-term mental
and physical health fallout of such traumatisation and
their public health implications to global health has
yet to be fully investigated.
In modern warfare, weapons have increasing lethality
and armies do not distinguish between combatants
and non-combatants, resulting in mounting civilian
casualties and destruction of environments. The
weapons used in these wars are almost always
manufactured and imported from Europe ( France, UK,
Germany ), the USA and the Russian Federation. There
is a massive trade in small arms of which there are
more than 640 million worldwide.
Asymmetric warfare refers to the ability of groups
to wage war on more powerful adversaries by using
non-conventional means, including suicide bombs, bioterrorism
and guerrilla tactics. This has been a feature
of what is now called the war against terrorism. Since
there are many ways in which biological agents could
be used as terrorist weapons, this has been a major
cause of the securitisation of public health.
The long-term mental and physical health fallout
of war and its public health implications for global
health has yet to be fully investigated. But studies
show clearly that war has major direct and indirect,
immediate and long-term implications for global
health.
Over 60 countries of the world today are affected by
war, especially poor countries, resulting in massive
human displacements and affecting more than 19.2
million people worldwide as refugees, internally
displaced persons or the war-traumatised. Hunger
( famines ) and disease ( epidemics ) increase. Europe
is the destination of many of the people who flee
from the disasters of war in their countries. Often such
refugees suffer a triple health burden : the trauma
of war and displacement, the diseases to which they
have been exposed. and lack of access to health and
social support in the country to which they flee due to
language and cultural barriers and lack of provision.
The <strong>European</strong> Commission’s Humanitarian Aid
Office ( ECHO ) includes in its mandate the provision
of emergency assistance and relief to victims of
armed conflicts, and the <strong>European</strong> Rapid Response
Force ( ERRF ) has growing capability to provide
peacekeeping forces. Where war brings with it a major
health risk the <strong>European</strong> Centre for Disease Prevention
24 <strong>European</strong> Foundation Centre – <strong>European</strong> Partnership for Global Health