Disease Amplifiers: Wars and Conflicts in the Post-1945 Era

Abstract

The history of war is replete with examples of novel diseases that have suddenly and unexpectedly erupted into human consciousness. As we noted in Section2.2, ancient Greek historians such as Herodotus, Thucydides, and Diodorus Siculus provide classical accounts of the devastation wrought by mysterious war pestilences—diseases which, in many instances, elude classification in modern disease systems, and to which the appellation ‘antique plague’ is occasionally given (Smallman-Raynor and Cliff 2004b: 66–73). In more recent times, we saw in Table 1.7 how maladies such as the idiopathic English sweating sickness, along with venereal syphilis, typhus fever, and yellow fever, appeared— ostensibly for the first time—in association with wars of the late medieval and early modern periods. In the twentieth century, trench fever (World War I, 1914–18), scrub typhus (World War II, 1939–45), and Korean haemorrhagic fever (Korean War, 1950–3) provide further instances of the emergence phenomenon (Macpherson et al. 1922–3; Philip 1948; Gajdusek 1956). In addition to sponsoring apparently wholly new conditions, military conflict has also promoted the re-emergence of many infectious and parasitic diseases. Recent examples include African trypanosomiasis (Ugandan Civil War, 1979–86; Berrang Ford 2007), diphtheria and tuberculosis (Tajikistan Civil War, 1992–7; Keshavjee and Becerra 2000; Usmanov et al. 2000) and epidemic louse-borne typhus fever (Burundian Civil War, 1993–2005; Raoult, Ndihokubwayo, et al. 1998). Figure 8.1 illustrates schematically the sample factors that underpin the warrelated emergence and re-emergence of infectious diseases. As Price-Smith (2002: 129) observes, military conflict acts ‘as a direct disease ‘‘amplifier,’’ creating those physical conditions (poverty, famine, destruction of vital infrastructure, and large population movements) that are particularly conducive to the spread and mutation of disease’. High-level population mobility and mixing, differential patterns of disease exposure and susceptibility, the breakdown of public health infrastructure, and insanitary living conditions are all pertinent to an understanding of the (re-)emergence complex (Lederberg et al. 1992: 110–12). Additional factors also attain prominence. Within the schema of Figure 8.1, heightened exposure to the zoonotic pool has played a particularly important role in the war-related precipitation of disease emergence and re-emergence.