The enduring legacy of conflicts

Long after the guns have gone silent, the lasting legacy of the evil of war continues to inflict harm on generations of people, including those who are born well after the conflict. Beyond the tragedy of the intergenerational trauma and the bullet ridden buildings that serve as permanent reminder of the mayhem and the killings, there are pathogens that continue to imprint their scar on the life and limb of those who inhibit the land. Conflict does not simply destroy lives by deliberate killings or destruction of houses, places of worship, hallways of schools or centres of healing, it also facilitates emergence of deadly diseases. Earlier this month, it was reported that polio has been detected in Gaza. Disturbing news is also coming from Sudan where cholera has become the latest chapter of a largely forgotten civil war and an extraordinary humanitarian crisis resulting in the deaths of thousands and displacing tens of millions from their home.

The emergence of cholera in Sudan and polio in Gaza - while awfully tragic - are unfortunately not unexpected. These deadly diseases follow a pattern that is well known to researchers and public health experts. Conflict destroys hospitals and clinics and puts an unbearable stress on the healthcare infrastructure. Few necessary supplies and medicines remain accessible to those who desperately need them. At the same time, collapse of sanitation services increases exposure of the weak and the injured to pathogens lurking in wastewater and sewage. Pathogens find enabling environment in the wounds and can then easily colonise the bodies of the maimed, malnourished and the vulnerable. As more and more hospitals get decommissioned, more and more sanitation systems remain dysfunctional, and more and more people get wounded or become weak, the pathogens are able to thrive, proliferate and spread. These pathogens are able to find a permanent home and stay for a long time in the soil and the environment - well after the war has ended.

Examples from recent conflicts, including the US-led wars in Iraq and Afghanistan, the civil war in Syria, the conflict in Yemen, all demonstrate how innocent people pay the price for decades for the actions of others. The pathogens that emerged in Iraq and Syria due to the conflict continue to destroy bodies and lives of countless people to this day. There is every reason to believe that similar situation is playing out in conflicts all around the world and will continue to cause mortality and morbidity for a long time.

While the relationship between conflict and emergence of new and deadly pathogens is on solid scientific ground, our commitment to the well-being of communities is shaky and morally bankrupt. The cholera outbreak in Yemen - which is well documented as one of the deadliest in recent human history and clearly linked to the conflict of the last decade - is not a priority of any country or international organisation. Afghanistan paints a similar story. Sudan is unlikely to get any serious attention beyond words of support and comfort and some unfulfilled promises. There is, however, reason to expect continued support for Ukraine and once the war ends (which I hope is sooner than later) there will be investment, clean-up and probably support for tackling infections. Such a clean-up operation would be most welcome. Communities in Ukraine deserve to have access to care. But so do communities in Gaza, Sudan, Afghanistan, Yemen and elsewhere.

Like all morally bankrupt policies, our selective support or negligence based on racial, religious, ethnic and political preferences is going to be disastrous. Bacteria and viruses, as we know all too well now, do not need visas or passports, or can be deterred by big walls. So one day, when those pathogens that emerged in places that no one cares about, as a result of conflicts supported and enabled by the great powers of our time, show up in the capitals of the so-called civilised world, everyone will be wondering how this could happen.