Costs of conflict on human health: How violence kills and injuries

While the crisis in Haiti has temporarily taken over front pages, television and radio airwaves, its important to remember other smoldering health catastrophes that have dimmed in the public consciousness. After all, over the next several weeks Haiti too will fade from public view as newer stories take precedent. Much work will remain to rebuild the country, treat the populations health, social and general development needs. The acute crisis will be over, but the long hard road to recovery will only just be beginning. Will we remember and continue to support those efforts? It remains to be seen.

Not so long ago another crisis captured the world's imagination: Darfur. We hear little from the entire east African region today, though troubles continue throughout the area. The death toll in Darfur alone may be twice the estimated 200,000 killed in Haiti.

Darfur also carries other grim lessons about civilian population health in conflict zones. While it is well known that civilians bear the brunt of casualties in "hot" war zones, what about the slow burners? It has only been relatively recently in history that bullets have caused more deaths than disease on the battle field. Unlike conflicts in Kosovo, Iraq or Afghanistan, Darfur was characterized more by rampaging thugs on camel-back than aerial bombardment and exchanges of firepower. Fewer chances for civilians to be caught in cross fire or fall victim to misguided bombings. So does this distinction make a difference in terms of civilian casualties?

A new study from Brussels reports that fully 80% of the 300,000-400,000 suspected civilian deaths in Darfur are due to disease. A staggering figure. For every person killed by an act of violence, 4 more died as a result of the disease and displacement caused by that violence. One bright spot: Humanitarian organizations who may not be able to stop the fighting that kills that single person, can provide shelter, food, sanitation and health care to save those 4 others from disease.

Another new study looked at warzone injuries among a completely different population: Military personnel. A doctor from Johns Hopkins University analyzed all US military personnel evacuated from Iraq and Afghanistan to medical facilities in Landstuhl Germany and found the leading causes for their westward egress were musculoskeletal and connective tissue injury. These accounted for 24% of injuries. Combat was second at 14%, and neurological injuries were third at 10%. Over the four years analyzed those rates remained comparatively constant, with the only dramatic increase being the growing rate of psychological injury tied with repeated deployments. The weight of protective equipment was cited as a principle contributor to the occupational joint injuries.

While conflict is something to be avoided at all costs, it does offer opportunities to learn. In these cases it reaffirms the importance of effective humanitarian response in reducing civilian casualties, and the opportunity of learning how to mitigate occupational musculoskeletal injury among soldiers, information that could no doubt be applied to other civilian professions as well.