By Dr Arun Mitra
War is the one of the most serious threat to public health with catastrophic effects on infrastructure & environment and accounts for more deaths and disability than many major diseases combined. It destroys families, communities and sometimes-whole cultures. It channels limited resources away from health and other social needs.
The escalation of tension between India and Pakistan has to be viewed in that context. When the tension persists there is always an imminent danger of its entering into larger war. Warning about such situations, Maj. Gen. (Retd.) Vinod Saighal in a letter to the Prime Minister in 1990 had written “another war between India and Pakistan could result in physical suicide for Pakistan, economic suicide for India and a catastrophe for the subcontinent”. It holds true now as well, even more so. Events in the last few days are witness to it. In wars, wellbeing of people is the chief concern; their livelihood, health, nutrition and other needs all become uncertain.
The issue in the present context is of much more seriousness as both India and Pakistan are one of the most deprived in the world. The priorities in the two countries have to be to correct the abysmally poor human development index of 130 and 150 in India and Pakistan respectively. Hunger index of India at 103 and Pakistan at 106 out of 119 countries is a matter of grave concern. War will mean destruction and further deprivation, hunger, disease, mental problems and unprecedented loss of life.
Health effects during war times range from displacements, injuries, incapacitation, mental stress, lack of food, under nutrition, starvation and death. During the two world wars around 9 crore people are reported to have died. In 1965 Indo-Pak war which lasted for 17 days the Indian army suffered 11,479 casualties with 2862 killed and 8617 wounded and according to Indian records 5800 Pakistanis were killed. Inter-communal violence between Hindus, Sikhs and Muslims at the time of partition resulted in between 500,000 and 1 million casualties. Deaths and disabilities due to ongoing terrorist violence for a long time is an issue of grave concern. It causes of further escalation of tension and a precursor to war.
During war times there occur large number of displacements from near the border areas and people have to live in the refugee camps. There were 21.3 million refugees worldwide in 2015. The health indicators of refugee population are poorer than the communities from which they come. They are more prone to diarrheal diseases, measles, acute respiratory infections, malaria, malnutrition and other infectious diseases. The incidence of Sexually Transmitted Diseases and HIV transmission are high in refugee camps due to engagement with sex workers, rape, and insufficient access to reproductive health services.
Refugee camps are generally away from the main population and poorly accessible by road, and lack basic amenities like clean drinking water supply, proper sewerage system and have a limited power supply. The high mobility of the refugee setting, with the constant inflow and outflow of people, presents a unique challenge because it is difficult to provide sustained care over a period of time.
Loss of family life, death of near and dears, uncertainty of the future leads to extreme mental stress; the children are more likely to be affected. They are likely to develop Post Traumatic Stress Disorder (PTSD). Women and children are worst sufferers as they are more vulnerable to be abused. All this affects their behavior even after the things get settled down and they return to their native places.
The International Physicians for the Prevention of Nuclear War (IPPNW) in its Aiming for Prevention – International Initiatives on small arms had carried out One Bullet Stories by its IPPNW-Kenya affiliate. The One Bullet Story (OBS) is about the people, their stories, and the injuries caused by the guns and bullets. It was done with the aim to infuse the human face into the campaign against armed violence by highlighting the plight of the victims through their experiences and powerful testimony. Health professionals are in the front lines as the primary witnesses of the horrific impact of firearm violence.
The Ottawa Process that led to the Mine Ban Treaty achieved its high level of success largely through the exposure of the plight of the victims and survivors of the mine explosions. It is the gruesome photos of the innocent and unsuspecting civilians injured by the Antipersonnel Mines (APMs) that created the public outcry and attracted high profile personalities like the late Princess Diana to the campaign. The initiators of this outcry were the International Committee of the Red Cross (ICRC) field surgeons such as Robin Coupland MD who brought the focus of the international community to bear on the indiscriminate and horrific nature of landmine injuries.
Nuclear weapons have totally changed the war scenario. Testimonies by the Hibakusha (Atomic Bomb Survivors of Hiroshima and Nagasaki) would move any one. It is of utmost urgency that tension between India and Pakistan has to be deescalated. Present day bombs are much more deadly compared to those dropped at Hiroshima and Nagasaki. Even a limited nuclear war would put over 2 billion people at risk. It is through highlighting the Humanitarian Impact of Nuclear Weapons that the IPPNW and the International Campaign to abolish nuclear weapons (ICAN) played a vital role in getting the Treaty Prohibiting Nuclear Weapons (TPNW) passed in the UN General Assembly in July 2017 and won the organization Nobel Peace Prize that year.
There is no place for Jingoism in such situation. Any talk of war today means mutually assured destruction. Nothing is more precious than a healthy life of our children. There is no place for Jingoism in such situation. Any talk of war today means mutually assured destruction. There is need for confidence building and collectively combating terrorist menace with sincere efforts. Nothing is more precious than a healthy life of our children.