European perspectives on global health: a policy glossary

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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 ong>Europeanong> Commission’s Humanitarian Aid Office ( ECHO ) includes in its mandate the provision of emergency assistance and relief to victims of armed conflicts, and the ong>Europeanong> Rapid Response Force ( ERRF ) has growing capability to provide peacekeeping forces. Where war brings with it a major health risk the ong>Europeanong> Centre for Disease Prevention 24 ong>Europeanong> Foundation Centre – ong>Europeanong> Partnership for Global Health

2. Europe must include global health in all fields of policy and Control and WHO will be involved. And where there are refugees or internally displaced persons UNHCR will also be engaged. In all cases a range of health-related non-governmental organisations ( NGOs ) will provide support and assistance. However, recent experience illustrates the problems of providing health care in post-conflict situations. Often one of the most urgent tasks faced is to provide some form of medical service and to instigate public health protection measures. This has proved difficult for military forces who are often ill-equipped to provide such services and find it difficult to work with other agencies and NGOs. This proved a particular difficulty in Afghanistan, where the use of white vehicles by military forces led to a leading NGO pulling out of health care provision. While it may have previously been assumed that health workers would be treated as neutrals and that health services might provide a bridge to peace, experience in Iraq suggests that health workers are being targeted by insurgents. It is also clear that the presence of military forces can itself bring health problems, such as increasing levels of HIV / AIDS infection. Action : Policies need to be put in place to address all these challenges, including weapons manufacture and trade, policy on refugees and immigrants, and global health surveillance in war-torn areas The impact of warfare and modern weapons on health should be examined in greater detail to develop policies for peace and health and to derive new codes of conduct for ong>Europeanong> forces in conflict situations, whether as combatants or peacekeepers. The role of the ERRF and ECHO in providing health relief and in working with other agencies and NGOs should be examined to establish the required competence and to limit possible negative impacts on health. References : Medact. Enduring Effects of War : Health in Iraq 2004. London, 2004. Global Health Watch 2005-2006 : An alternative world health report. London : Zed Books, 2005, in association with the People’s Health Movement, Bangalore ; Medact, London ; Global Equity Gauge Alliance, Durban. Zwi A., Garfield R. and Loretti A. “Collective Violence”, in World Report on Violence and Health. Geneva : World Health Organization, 2002. 213-137 Global Health Policy Glossary 25

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Page 70: About the Editors Ilona Kickbusch s

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