War and Disease: Recent Trends and Future Threats

Abstract

In the foregoing chapters, we have focused on the intersection of war and infectious disease over the 140-year period from 1850. We have examined long-term trends in disease activity in civil, military, and displaced populations (Chs. 3–5), outlined some of the analytical approaches used to describe the spread of war epidemics (Ch. 6), and we have explored in a regional context recurring themes at the interface of war and infectious disease (Chs. 7–12). In this concluding chapter, we examine the epidemiological consequences of wars and war-like events in the years since 1990.We begin in Section 13.2 by reviewing the empirical evidence for the spread of diseases in association with three recent conflicts: the Gulf War (1990–1); the Bosnian Civil War (1992–5); and Afghanistan and the ‘War on Terrorism’ (2001–). In Section 13.3, we examine the role of war both as an obstacle to disease eradication and to disease-control strategies while, in Section 13.4, we focus on biological weapons as one of the foremost threats to global security in the modern world. Finally, in Section 13.5, we isolate a series of further war-related issues (militarism; economic sanctions; international peacekeeping; disease re-emergence; and post-combat syndromes) that—given the balance of probabilities—are likely to be of continuing epidemiological significance in the current century. As we enter a new millennium, there is an undercurrent of academic thought that nuclear weaponary and the end of the Cold War have rendered war obsolete; that war is, and will be, increasingly supplanted by economic competition between states and regions (see e.g. Black, 2000).Yet it is clear from Figure 13.1 that wars—of greater or lesser intensity—have continued to increase, rather than decrease, in number over the last few decades. This increase has remained largely focused in the less developed regions of the world (van der Wusten, 1985; Brogan, 1992; Arnold, 1995). By way of illustration, Figure 13.2 delimits the global pattern of conflict in the year 2000. As the map shows, levels of conflict intensity were highest in some of the poorest of the world’s regions—in Sub-Saharan Africa, Central and South Asia (Murray et al., 2002).