War and Public Health Victor W. Sidel, MD Distinguished University Professor of Social Medicine

1. War and Public Health Victor W. Sidel, MD Distinguished University Professor of Social Medicine Montefiore Medical Center and Albert Einstein College of Medicine Adjunct Professor of Public Health Weill Medical College of Cornell University Co-editor, War and Public Health Seminar Series on “Crisis as Catalyst in Public Health” Center for Public Health Initiatives University of Pennsylvania Philadelphia, PA -- November 17, 2010

2. Crisis as Catalyst in Public Health Crises in Public Health • Economic recession • Political repression • Climate change and global warming • War and preparation for war • Nuclear weapons

4. The Public Health Impact of War • War has an enormous and tragic impact -- both directly and indirectly -- on public health. War causes death and disability, destroys families, communities, and the environment, diverts resources and destroys infrastructure needed for human and health services, limits human rights, and often begets further violence. • (War and Public Health, 2008)

5. Health and Environmental Consequences of War • Direct impacts on health • Adverse effects on medical care and public health services • Damage to the environment • Refugees and internally displaced persons • Human rights violations • Diversion of human and financial resources • Promotion of violence

6. Deaths Directly Caused by War • An estimated 200 million military personnel and civilians were killed as a direct result of war during the 20th century. • As the century progressed, an Increasing percentage of those killed were civilians.

9. Pablo Picasso, Guernica, 1937

11. Bombs dropped by a U.S. B-17 Flying Fortress in northern Germany, January, 1945 Photograph from BIPPA New York Times Magazine, 3/20/03

16. Napalm attack, Vietnam, 1966

17. Huynh Cong (Nick) Ut, 1972

19. Small landmines, dropped from helicopter, which are brightly colored and look like toys

20. Boy in Cambodia whose right leg was amputated after he stepped on a landmine

21. Health and Environmental Consequences of War • Direct impacts on health • Adverse effects on medical care and public health services • Damage to the environment • Refugees and internally displaced persons • Human rights violations • Diversion of human and financial resources • Promotion of violence

22. Adverse Effects on Medical Care and Public Health Services • Physicians, nurses, and other health workers are injured or killed or they flee • Damage to clinics and hospitals • Reduced supplies of medications and vaccines • Destruction of power supply, sewage treatment, and other protection of food and water supplies

23. Health and Environmental Consequences of War • Direct impacts on health • Adverse effects on medical care and public health services • Damage to the environment • Refugees and internally displaced persons • Human rights violations • Diversion of human and financial resources • Promotion of violence

24. Agent Orange

25. BeforeAgent OrangeAfter

26. Lingering Effects of Agent Orange

27. Mangrove swamp in Vietnam damaged by defoliation using Agent Orange

28. Mangrove swamp in Viet Nam destroyed by bombs, leaving craters filled with stagnant water in which mosquitoes breed

29. Health and Environmental Consequences of War • Direct impacts on health • Adverse effects on medical care and public health services • Damage to the environment • Refugees and internally displaced persons • Human rights violations • Diversion of human and financial resources • Promotion of violence

30. Refugees • 40 million refugees worldwide • 12 million children left homeless from 1990 to 2000 • The vast majority are fleeing violence and war Panos Pictures

32. Health and Environmental Consequences of War • Direct impacts on health • Adverse effects on medical care and public health services • Damage to the environment • Refugees and internally displaced persons • Human rights violations • Diversion of human and financial resources • Promotion of violence

33. Human Rights Violations • Assaults on civilians • Sexual assaults on women • Abduction of children • Ethnic cleansing • Torture of prisoners and other violations of the Geneva Conventions • Violations of medical neutrality

35. Health and Environmental Consequences of War • Direct impacts on health • Adverse effects on medical care and public health services • Damage to the environment • Refugees and internally displaced persons • Human rights violations • Diversion of human and financial resources • Promotion of violence

36. Diversion of Resources “Every gun that is made, every warship launched, every rocket signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and not clothed.” - Dwight D. Eisenhower

37. Federal Spending 2001-2008 >Ongoing and routine funding for the Pentagon has increased dramatically since 2001. >Even excluding the costs of the wars in Iraq and Afghanistan and the global war on terror, funding for defense and related programs has grown at an average annual rate of 4.8 percent per year since 2001, after adjusting for inflation.

40. Diversion of Resources • The wars in Iraq and Afghanistan have cost approximately 600 billion dollars in federal outlays over 5 years. • The total cost of these wars, as estimated by Stiglitz and Bilmes, will amount to 3 trillion dollars, 5 times as much. • Using these estimates, the total cost has been approximately 600 billion dollars a year, 2 billion a day, 100 million an hour, and 2 million a minute, so the cost per second is $30,000.

42. Health and Environmental Consequences of War • Direct impacts on health • Adverse effects on medical care and public health services • Damage to the environment • Refugees and internally displaced persons • Human rights violations • Diversion of human and financial resources • Promotion of violence

45. Nuclear War