War and Public Health
Victor W. Sidel, MD
Distinguished University Professor of Social Medicine
Montefiore Medical Center and Albert Einstein College of Medicine
Adjunct Professor of Public Health
Weill Medical College of Cornell University
Co-editor, War and Public Health
Seminar Series on “Crisis as Catalyst in Public Health”
Center for Public Health Initiatives
University of Pennsylvania
Philadelphia, PA -- November 17, 2010
Crisis as Catalyst in Public Health
Crises in Public Health
•
•
•
•
•
Economic recession
Political repression
Climate change and global warming
War and preparation for war
Nuclear weapons
The Public Health Impact of War
War has an enormous and tragic impact
-- both directly and indirectly -- on public
health. War causes death and disability,
destroys families, communities, and the
environment, diverts resources and
destroys infrastructure needed for
human and health services, limits
human rights, and often begets further
violence.
(War and Public Health, 2008)
Health and Environmental
Consequences of War
• Direct impacts on health
• Adverse effects on medical care and public
health services
• Damage to the environment
• Refugees and internally displaced persons
• Human rights violations
• Diversion of human and financial resources
• Promotion of violence
Deaths Directly Caused by War
An estimated 200 million military
personnel and civilians were killed
as a direct result of war during the
20th century.
As the century progressed, an
Increasing percentage of those killed
were civilians.
Pablo Picasso, Guernica, 1937
Bombs dropped by
a U.S. B-17 Flying
Fortress in
northern Germany,
January, 1945
Photograph from
BIPPA
New York Times
Magazine, 3/20/03
Napalm attack, Vietnam, 1966
Huynh Cong (Nick) Ut, 1972
Small landmines,
dropped from
helicopter, which
are brightly colored
and look like toys
Boy in Cambodia whose right leg was amputated after he
stepped on a landmine
Health and Environmental
Consequences of War
• Direct impacts on health
• Adverse effects on medical care
and public health services
•
•
•
•
•
Damage to the environment
Refugees and internally displaced persons
Human rights violations
Diversion of human and financial resources
Promotion of violence
Adverse Effects on Medical Care
and Public Health Services
• Physicians, nurses, and other health
workers are injured or killed or they flee
• Damage to clinics and hospitals
• Reduced supplies of medications and
vaccines
• Destruction of power supply, sewage
treatment, and other protection of food and
water supplies
Health and Environmental
Consequences of War
• Direct impacts on health
• Adverse effects on medical care and public
health services
• Damage to the environment
•
•
•
•
Refugees and internally displaced persons
Human rights violations
Diversion of human and financial resources
Promotion of violence
Agent Orange
Before
Agent
Orange
After
Lingering Effects of Agent Orange
Mangrove swamp in Vietnam damaged by defoliation
using Agent Orange
Mangrove swamp in Viet Nam destroyed by bombs,
leaving craters filled with stagnant water in which
mosquitoes breed
Health and Environmental
Consequences of War
• Direct impacts on health
• Adverse effects on medical care and public
health services
• Damage to the environment
• Refugees and internally displaced
persons
• Human rights violations
• Diversion of human and financial resources
• Promotion of violence
Refugees
• 40 million
refugees
worldwide
• 12 million
children left
homeless from
1990 to 2000
Panos
Pictures
• The vast majority
are fleeing
violence and war
Health and Environmental
Consequences of War
• Direct impacts on health
• Adverse effects on medical care and public
health services
• Damage to the environment
• Refugees and internally displaced persons
• Human rights violations
• Diversion of human and financial resources
• Promotion of violence
Human Rights Violations
• Assaults on civilians
– Sexual assaults on women
– Abduction of children
• Ethnic cleansing
• Torture of prisoners and other violations of
the Geneva Conventions
• Violations of medical neutrality
Health and Environmental
Consequences of War
• Direct impacts on health
• Adverse effects on medical care and public health
services
• Damage to the environment
• Refugees and internally displaced persons
• Human rights violations
• Diversion of human and financial
resources
• Promotion of violence
Diversion of Resources
“Every gun that is made, every
warship launched, every rocket
signifies, in the final sense, a theft
from those who hunger and are not
fed, those who are cold and not
clothed.”
- Dwight D. Eisenhower
Federal Spending 2001-2008
>Ongoing and routine funding for the
Pentagon has increased dramatically since
2001.
>Even excluding the costs of the wars in Iraq
and Afghanistan and the global war on
terror, funding for defense and related
programs has grown at an average annual
rate of 4.8 percent per year since 2001,
after adjusting for inflation.
Diversion of Resources
 The wars in Iraq and Afghanistan have cost
approximately 600 billion dollars in federal
outlays over 5 years.
 The total cost of these wars, as estimated by
Stiglitz and Bilmes, will amount to 3 trillion
dollars, 5 times as much.
 Using these estimates, the total cost has been
approximately 600 billion dollars a year, 2 billion
a day, 100 million an hour, and 2 million a
minute, so the cost per second is $30,000.
Health and Environmental
Consequences of War
• Direct impacts on health
• Adverse effects on medical care and public
health services
• Damage to the environment
• Refugees and internally displaced persons
• Human rights violations
• Diversion of human and financial resources
• Promotion of violence
Nuclear War
Nuclear Stockpiles
Country
United States
Russia
France
China
United Kingdom
Israel
India
Pakistan
North Korea
Estimated Number
of Active Nuclear Weapons
2,500
4,700
300
180
160
80
60-80
70-90
<10
Source: Federation of American Scientists: Status of World Nuclear Forces, May, 2010
Nuclear Weapons Today
• Approximately 10,000 active nuclear
warheads with the equivalent
explosive force of:
– Over 200,000 Hiroshima-sized bombs.
– 10 billion tons of TNT, 2 tons for every
human on the planet.
• Thousands on hair-trigger alert,
ready to be launched on a few minutes
notice.
“Nuclear Winter”
Use of nuclear weapons could lead to cooling of
the earth’s surface by clouds of soot and dust
produced by the explosions and severe
shortages of food.
Recent studies have predicted that even
detonation of a small number of weapons
would lead to protracted and widespread
cooling.
Regional Cooling
In the event of cooling triggered by a limited,
regional nuclear war, experts have predicted a
global death toll in excess of one billion from
starvation alone.
A global famine on this scale would provide a
breeding ground for epidemics involving
cholera, malaria, smallpox, and dysentery.
Creating a World Without War
Improving the Conditions
in Which People Live
Reducing poverty and socioeconomic and
health disparities
Strengthening the social safety net
Improving education and employment
opportunities
Strengthening public health
Improving quality, accessibility, and
affordability of medical care
Millennium Development Goals
Official Development Assistance
( percent of gross national income)
Norway
Sweden
Netherlands
Demark
Belgium
Austria
France
United
Switzerland
Germany
Canada
Italy
Japan
New Zealand
Spain
Australia
United States
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Millennium Development Goals
(MDGs)
The Millennium Development Goals (MDG)
include:
• eradicating extreme poverty and hunger;
• achieving universal primary education;
• promoting empowerment of women;
• reducing child mortality;
• combating HIV/AIDS, malaria and other
diseases;
• ensuring environmental sustainability; and
• developing a global partnership for
development.
Controlling weapons and
decreasing military expenditures
Anti-personnel Landmine Convention
Chemical Weapons Convention
Banning Cluster Bombs
Banning New Weapon Systems
Taking Nuclear Weapons Off Hair-trigger
Alert
Nuclear Weapons Convention
Creating a culture of peace in which
conflicts are settled nonviolently
United Nations
International Court of Justice (World
Court)
International Criminal Court
Never before has man had such capacity
to control our own environment, to end
thirst and hunger, to conquer poverty and
disease, to banish illiteracy and massive
human misery. We have the power to
make this the best generation of mankind
in the history of the world -- or to make it
the last.
President John F. Kennedy
Address to the UN General Assembly
September 20, 1963
CPHI-WPH-2010-11-17a final