May 4, 2010

The health costs of war are lasting and monumental, UW conference finds

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If there is anything that emerged from a recent, three-day Conference on War and Global Health at the University of Washington, it is that the full fury of war is felt long after the last bomb is exploded and guns go silent, when countries at war are forced to deal with health and social maladies that can linger for decades.

In this, there are no victors. The aggressor and the victim, victor and loser, end up suffering big time. And not just in terms of health consequences. The grave after-effects include total destruction of health supply infrastructure as well as the cost of long-term treatment and care for military and civilian casualties of conflicts.

It is often assumed that deaths, injuries displacement and other forms of social disruption characterize human conflict. But the conference underscored the fact that the gravest difficulties are borne years or even decades after the cessation of hostilities…long after media crews have re-directed TV cameras and laptops to other stories.

With a long and celebrated experience of documenting how wars affect global health, members of the Nobel-prize winning Physicians for Social Responsibility (PSR) presented evidence of the monumental cost as well as severity of health complications occasioned by wars; the escalation in the numbers of war victims and how war situations have worsened global health.

 Dubbed War & Global Health; Transforming Our Professions, Changing Our World, the two-day Conference was co-sponsored by a host of institutions including Health Alliance International, Physicians for Human Rights, Washington Global Health Alliance, Center for Global Studies at the UW's Jackson School of International Studies, among others. It brought together experts from a diversity of professions who believe that war ought to be viewed as the greatest threat to the health of human kind in the world today.

Shock and awe hits home

Revisiting its aptly-named 2007 report, Shock and Awe Hits Home: US Health Costs of the War in Iraq, PSR estimated that caring for Iraq war veterans could consume $650 billion, thus surpassing all the cash spent on Vietnam War veterans. PSR, whose members work to create awareness of the health consequences of war, says that more billions will continue to be expended for the same program.

 “The tragedy is that this is a direct removal of resources from the way they ought to be used resulting in difficulties for the people of United States,” said Dr Victor Sidel, a member of PSR attached to both Montefiore Medical Center and Albert Einstein College of Medicine in New York. To him, this is one part of federal government expenditure the Obama administration is not willing to reduce. “When Obama set up a commission to look into how the U.S. deficit ought to be reduced, he ruled out any reduction in the resources used up in war. These reductions were to be made in social programs.”

To Physicians for Social Responsibility, hundreds of thousands of Iraq war veterans (or 30 percent) fall into the category of people with serious mental problems. Those with difficult mental problems include veterans with serious anxiety disorders, Post Traumatic Stress Disorders (PTSD), substance abuse problems as well as those experiencing dangerous mood swings. PSR representatives stated that of the 100,000 Iraq and Afghanistan veterans visiting Veterans Administration facilities, 25 percent were treated for mental disorders, with those with PTSD being the dominant diagnosis. PSR estimates that the figure is bound to rise by hundreds of thousands because more than 1.5 million soldiers have been deployed to serve in the two war fronts.

“We are now approaching two million individuals who have been deployed in Iraq and Afghanistan…which translates into over 400,000 suffering from PTSD,” said Dr. Juanita Celix, a PSR member from the University of Washington. She said most of the patients live in a perpetual state of anxiety. “They see danger everywhere, besides being unable to maintain jobs or good relationships with their loved ones.”

Blast injuries and polytrauma

Among those with serious injuries are veterans who suffered blast injuries and polytrauma (multiple, severe traumatic injuries). Here, members of Physicians for Social Responsibility says that though the body armor given to servicemen and women has been more effective, insurgents have also raised the potency of the improvised explosive devices.Although the explosive devices might leave the torso intact, they often result in horrific injuries to the head, face legs and arms. In addition, while advanced medical treatment within the battlefields keeps many soldiers alive, but when they come back, they often find themselves living with the trauma long years after the cessation of their call of duty.

“Among the common complaints made by veterans coming from Iraq and Afghanistan was that they did not know who the enemy was and expressed anger from feeling like they were lied to,” observed Celix. Some have difficulties maintaining employment, are unable to complete many tasks and are exposed to other health complications including weakening of their immune systems and thyroid complications. This appears to be a bigger problem than previously thought. Exposure to combat contributes 7 percent to 8 percent of mental health problems in the U.S., the group believes.

Besides PTSD, suicide rates amongst the veterans have remained at an all-time high -rising from 115 in 2007 to 140 and 160 in 2008 and 2009, respectively. And suicides among young veterans between ages 18 and 29 has risen by 26 percent. Many of the suicides are not related to battlefield situations but to what happened after veterans returned home – to job and financial losses, separation from spouses and divorce.

In Washington state, U.S. Sen. Patty Murray has called attention to the issue, in 2008 scolding the Veterans Administration for withholding accurate information on the issue.

"The suicide rate is a red-alarm bell to all of us." Murray also said that the VA's mental health programs are being overwhelmed by Iraq and Afghanistan war veterans, even as the department tried to downplay the situation.

Earlier this year, Murray said the VA's new efforts were making a difference, but said "more comprehensive" efforts were needed to break down the barriers to accessing mental health care for returning soldiers.

Health problems not deterrence

But the emergence of horrendous health situations appears not to be a strong deterrence to humanity hell bent on engaging in ever deadlier conflicts and at a rising frequency. Instead, war has remained a constant phenomenon -one that the world almost feels it can not do without. For instance, unknown to many in attendance was the  fact that over the last 17 years, the world has experienced over 110 different conflicts. And though they took place in such far-flung areas as Afghanistan and the Democratic Republic of the Congo, developing countries had the lion’s share of the conflicts and commensurate health problems.

Wars in the 20th century alone killed more than 200 million people, yet humanity seems slow to start learning any lesson from past conflicts. Instead, the world keeps on churning out deadlier arsenal and has remained focused on raising, exponentially, the potency with which it might, one day totally annihilate itself. The gravest danger to humanity is the threat of a nuclear conflict, whether occasioned by terrorists or by conventional warfare. A number of medical experts and analysts who made presentations during the conference gave the audience a rare glimpse of the likely horrifying global health scenario should a nuclear conflict erupt. Besides killing millions directly, hundreds of millions would die largely because of what they termed “a nuclear winter” that would affect food production. At the same time, tens of thousands of medics and physicians would themselves either be dead or so critically injured to offer any assistance to burn victims. Mass starvation, horrendous radiation-related illnesses would follow leading to deaths of hundreds of millions more.

 They also expressed cynicism on the ability and political willingness of a renewed Obama push to rid the world of its disproportionate number of nuclear arsenal. And as the reactions came from the audience, it was evident that to most, this was a really scary and nightmarish scenario.

Wars worsen the conditions in which hundreds of millions of people live as it leads to the re-direction of immense resources from catering for other aspects of human development including social schemes. For instance, data from War Resisters League – a US-based group that has been resisting wars since 1923 – show that if cash raised from trust funds are excluded, past and current US military spending will gobble up $1,398 billion (or 48 percent) from the country’s Federal budget in 2011 with the conflicts in Iraq and Afghanistan taking up $159 billion. However, government statistics put this at 24 percent.

“The bottom line is that the cost of caring for veterans is (always) greater than the actual cost of (the actual) military operation,” said Dr Sidel.

A world where wars are unnecessary?

Speaker after speaker called on health professionals to work towards bringing about a world where war would become unnecessary. However, the real dilemma is that the military industrial complex in developed countries remains one of the biggest employers and generates huge financial benefits for the nations. The biggest question is how the US and other major producers of military hardware could shift to providing their citizens with other types of work particularly and at a time when their economies are not doing so well. During the Conference, some suggested that the immense resources gobbled up in war could be invested in less destructive sectors as well as in creating ‘green’ jobs. The argument for such a shift was boosted by claims made by the physician organization that ‘real’ security for the U.S. depends not just on the military hardware but also on education.

Some observers castigated the glaring silence over the millions of people killed, and tens of millions more who continue to suffer irreparable health problems, from wars and war-related situations in developing countries. These are wars that are less attractive to the media. For instance, the long-running and complicated conflict in the Democratic Republic of Congo (formerly Zaire) has led to the deaths of an estimated 5 million people. In addition, about 15 million people are living as refugees while a further 26 million are displaced in their own countries.

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