War and Health
By: Laura Jaramillo
It has been a little more than a month since Russia waged war on their neighbor, Ukraine. News outlets have primarily focused on the economic consequences and political implications, and admiration for President Zelensky has consumed our social media feeds. But it is important to bring attention to the impact this war has had on health, now as well as in the long-term. Especially since war has been found to cause more mortality and disability than any major disease, it is important to recognize war’s social determinants as well as its obvious and additional unseen impacts on health (Murthy et al., 2006).
At the forefront, the horrific health impacts on innocent individuals caught in the middle of an ongoing war are explicit; death and injuries as a result of bombs, and other war crimes are palpable examples of the collateral damage and violent consequences at a microcosmic level. This violence also has dire impacts on children and families; heartbreaking videos of fathers saying goodbye to their wives and children as they stay to fight for their home have gone viral, flooding our TikTok and Instagram news feeds. While the acts of these fathers are unfathomably honorable and selfless, being separated from parents can have disastrous effects; separation from parents during World War II correlated with impaired social and socio-economic mobility for the children of war veterans (Devakumar, 2014). Moreover, exposure to violence as a child will affect not only health, but even harm one’s body physically, including the brain structure, and consequently, neural function (Devakumar, 2014). Then there are the less obvious implications. In fact, estimates suggest that for every one person killed directly in the war, nine will be killed indirectly (Sheather, 2022).
There are also huge infrastructure impacts; hospitals and healthcare provider resources are not only affected, but their services are entirely interrupted, making it much harder for physicians to provide adequate care. Those who are already sick, pregnant, or in need of care will deteriorate far more quickly. The absence of regular hospital conditions makes already challenging circumstances impossible; for example, without enough healthcare providers to adequately aid mothers in labor, diseases like HIV may be transmitted to newborns or mothers may suffer further from life-threatening conditions (Devakumar, 2014). Mothers are also at risk of in utero infections as they are usually forced to give birth in polluted basements or crowded refugee camps (Devakumar, 2014). This increases the chances of congenital malformations, premature births, and other developmental issues (Devakumar, 2014).
Additionally, as access to fresh water and sanitation decreases as well as combined with high concentrations of people in small spaces, infectious diseases are at a high risk of reemerging. The fall in immunization rates is especially worrisome as it will be accompanied by reductions in herd immunity. More specifically, Ukraine cannot afford low herd immunity, especially after all it has done to implement successful immunization campaigns, despite the legacy of the Soviet Union, which deserted the people of Ukraine with an unstable and corrupt healthcare system (Kluger et al., 2022).
War also significantly impacts nutrition. Just one month into the war in Ukraine, and more than 2 million children under the age of five as well as pregnant women are in need of nutrition assistance (Volunteer FDIP, 2022). This might not only result in increased mortality, but also stunted growth; additionally, nutritional deficits have been associated with lower school attainment and consequently, reduced income, all of which have direct impacts on health (Devakumar, 2014). Moreover, given that war entirely disrupts development during pregnancy, the stress imposed on a mother’s body due to malnutrition may be reflected in many ways, including low birth weight, which, in turn, can increase the chance of psychiatric disorders and developmental delays (cognitive and physical) (Devakumar, 2014). Breastfeeding is also likely to decline during war, which poses a critical threat, as breast milk provides necessary nutrients, including immunological, and anti-inflammatory properties that play a crucial role in the immune system and overall development of a newborn (Office of the Surgeon General, 2011). While there are alternatives to breastfeeding, it is not recommended unless specified by a physician; choosing alternatives to breastfeeding as a result of a violent war disrupting what is deemed the bare minimum is entirely unjustifiable. Plus, given that supply shortages or contamination of supplies is common, it may result in children suffering from diarrhea as well as other infectious diseases (Office of the Surgeon General, 2011).
On a more macro level, migration causes dire health consequences as well, affecting not only those leaving a country, but the countries forced to accept refugees. This is especially important to consider now, as of March 11, “the war in Ukraine had resulted in the largest refugee crisis since World War II” (Weinthal et. al, 2022). For historical context, the civil and resistance war in Uganda caused PTSD and depression rates to spike, proving most prevalent among children living in refugee camps (Murthy et al., 2006). Higher rates of psychopathology in comparison with the general population were also found among refugees (Murthy et al., 2006). Additionally, in the Balkans, internally displaced people were at an increased risk of psychiatric morbidity (Murthy et al., 2006). Lastly, drug use is likely to increase among refugees as it is a coping mechanism for displaced individuals forced to face unprecedented trauma and stress (Devakumar, 2014). As for the countries accepting refugees, they experience increased economic pressures and vulnerability to diseases due to the added strain on resources (UNHCR, n.d.).
Perhaps one of the harshest secondary consequences of war is the effect it has on mental health, both in the moment and in the long-term. The stigma associated with mental health, plus its inarguable invisibility in comparison to other more measurable conditions, makes it even harder to identify. It is estimated by the World Health Organization that "10% of people who experience traumatic events will have serious mental health problems and another 10% will develop behavior that will hinder their ability to function effectively” (Murthy et al., 2006). Even more so, mental health effects multiply across generations. Trauma and psychosocial stress has been found to affect human’s epigenetics and biological pathways, which bleeds into the lives of children, even if they were not alive during the ongoing, traumatic events lived and experienced by their parents (Devakumar, 2014).
Consequently, and sadly, these secondary effects disproportionately discriminate against females . Women are at an increased risk of being affected by the psychological consequences of war (Murthy et al., 2006). And this is particularly worrisome and problematic as a woman’s health and wellbeing is strongly correlated with the well-being of future generations (Devakumar, 2014). Studies in India found maternal mental disorders were associated with negative mental development and cognitive impacts in infants just 6 months old (Devakumar, 2014). Additionally, maternal depression, both during the pre and post natal period, coincides with poorer developmental growth (Murthy et al., 2006). Moreover, maternal stress during a pregnancy was associated with an increased risk of infection and mental health problems such as depression (Devakumar, 2014).
Ukraine has shown incredible resilience and patriotism as state-actors, leaders and civilians unite, putting their lives on the line to protect their home. But as violence and adversity accumulates, the invisible, long term health effects begin to grow. Therefore, the world must be prepared to aid the individuals affected by the war in Ukraine for years to come, ensuring the negative health effects are promptly acknowledged and treated.
Reference List:
Devakumar, Delan, et al. “The Intergenerational Effects of War on the Health of Children - BMC Medicine.” BioMed Central, BioMed Central, 2 Apr. 2014, https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-12-57.
Kluger, Jeffrey, and Tara Law. “Polio's Comeback in Ukraine as War Halts Vaccine Campaign.” Time, Time, 9 Mar. 2022, https://time.com/6155963/polio-ukraine-war/.
Murthy, R Srinivasa, and Rashmi Lakshminarayana. “Mental Health Consequences of War: A Brief Review of Research Findings.” World Psychiatry : Official Journal of the World Psychiatric Association (WPA), Masson Italy, Feb. 2006, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472271/.
Office of the Surgeon General (US). “The Importance of Breastfeeding.” The Surgeon General's Call to Action to Support Breastfeeding., U.S. National Library of Medicine, 1 Jan. 1970, https://www.ncbi.nlm.nih.gov/books/NBK52687/.
Sheather, Julian. “As Russian Troops Cross into Ukraine, We Need to Remind Ourselves of the Impact of War on Health.” The BMJ, British Medical Journal Publishing Group, 25 Feb. 2022, https://www.bmj.com/content/376/bmj.o499.
“Ukraine-Russia War and Its Impact on Psychology and Mental Health Globally.” Volunteer Fdip, https://www.volunteerfdip.org/ukraine-russia-war-and-its-impact-on-psychology-and-mental-health-globally.
United Nations High Commissioner for Refugees. “Access to Healthcare.” UNHCR, https://www.unhcr.org/en-us/access-to-healthcare.html.
Weinthal , Erika, and Jeannie Sowers. “The Environmental and Health Dimensions of the Ukraine War.” UC Press Blog, 16 Mar. 2022, https://www.ucpress.edu/blog/58701/the-environmental-and-health-dimensions-of-the-ukraine-war/.