When we consider war, the first things that tend to come to mind are tanks, missiles, and cities in shambles. But there is another aspect of conflict that doesn’t make the front pages as frequently—how war slowly creeps into our global health infrastructure, reaching people far beyond the battlefield. The truth is, the health toll of war extends far beyond the immediate wounds. They spread out in ways both destructive and profound, touching people in ways we never take the time to think about.
Take the case of the war in Ukraine. What began as a local crisis developed into something much bigger when Russia launched missiles at civilian targets after the Crimean bridge attack. It’s a harsh reminder of the manner in which wars can blow up so quickly—and how that can subsequently become a global health crisis. As international health expert David P. Fidler put it, “the Russian escalation of the war threatens to expand the scope of military mayhem, the magnitude of human devastation, and the intensity of the challenges facing the global health community in the years ahead.” In other words, it’s not just a war zone scenario. It’s something that permeates healthcare systems and homes around the world.
The immediate impacts are devastating. Clinics and medical centers are destroyed or ruined, taking away the most needed care from the patients. Families have to be relocated and are left in crowded shelters or refugee camps where illness spreads quickly. The psychological toll is staggering—especially among children and the aged. On top of that, supply lines get disrupted. Food, medicine, and other necessities stop their flow, not just in the war zone but in other countries that rely on them. The World Health Organization and others have warned that the secondary effects are likely to create additional malnutrition, spawn unintended chronic illness, and fuel new health crises in already weakened areas.
And the damage does not stay at the borders. Political and economic resources drawn toward the management of war necessarily consume less energy and funds for other pressing international health problems. The recovery efforts from the COVID-19 pandemic have slowed down. The preparation for preventing future outbreaks falters. Climate change, already seriously impacting global health, becomes secondary. Since Fidler has reminded us, war has retarded the progress towards stronger health systems and global cooperation—just when we need both most.
War has also remade itself technologically. Modern conflict is not only fought with soldiers, but with drones, cyber warfare, and robots. These weapons can be more finely targeted—but also harder to defend civilians against. There is increasing fear that autonomous weapons might not necessarily tell the difference between combatants and civilians. And when targets such as power plants, water facilities, or hospitals get struck—whether by bombs or cyberattacks—the public health implications can prove catastrophic and long-term.
All of which is taking place in a world where the old rules for global cooperation are being discarded. The days of mass global cooperation are being replaced by struggles for power and profound political divisions. As Fidler describes, “balance-of-power and ideological competition constrict the political space in which global health operates, especially when the competition is violent.” That is to say that not only are health policies being determined by politics and conflict instead of science or compassion, but science and compassion are being displaced as drivers of policy.