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Bulletin of the World Health Organization

Print version ISSN 0042-9686

Bull World Health Organ vol.80 n.8 Genebra Aug. 2002 

Books & Electronic Media

War or health — a reader

Edited by Ilkka Taipale, Helena Mäkelä, Kati Juva, Vappu Taipale, Sergei Kolesnikov, Raj Mutalik, & Michael Christ.
Preface by Kofi Annan, Secretary-General of the United Nations.
Published by Zed Books, Ltd., London and New York, 2002
Paperback, ISBN 1 85649 951 0, price: £16.95, US$ 29.95;
Hardback, ISBN 1 85649 950 2, price: £55.00, US$ 75.00

The title is provocative. Hitherto, the tendency has been to talk of war and health, which amounts to seeing how health systems can adjust to the circumstances of war. This extensive collection of articles as a whole shows how a number of changes have had such far-reaching consequences that it no longer makes sense to discuss the ways in which health strategies can come to terms with war: either war is prevented or health is destroyed. These changes include technological developments in the means of waging war; a culture of violence, together with occasional attempts to justify it; an increasing number of armed conflicts; and the weakening of state structures.

After evaluating the impact of war, the authors analyse proposals not only for preventing it, but more practically, for mitigating its effects. They then turn to the role health professionals can play within this strategy.

The chapters describing the impact of war in Mozambique, Bosnia and Herzegovina and West Africa draw on uncontroversial facts to demonstrate the impact of those conflicts on people and health systems. They show how war not only has a direct effect, expressed in the numbers killed and wounded, but also indirect effects stemming from the deterioration or destruction of essential services.

The impact of war is felt for years after conflicts have ended.

A more specific focus is the impact of war on particularly vulnerable groups. The example of sexual violence against women shows the extent to which rape has been a constant in the history of war. Analysis of this phenomenon in recent conflicts indicates that rape is often used as a strategy for adding to the destruction of the victims and their culture. Children too are among the foremost victims of armed conflict. A chapter looks in detail at the death, disability and displacement war inflicts on children — and the problem of child soldiers.

Even after peace has been restored, the effects of war continue to be felt. There is a revealing analysis of the long- term effects of war on both civilians and veterans — those who suffer war and those who wage it. The implications of a variety of weapons are examined, particularly anti-personnel mines and fragmentation bombs, whose impact continues long after conflicts have ended. Not only do weapons continue to kill in peacetime, they also continue to destroy the environment, as in the case of nuclear waste from the arms industry.

The review of the means of waging war and their destructive potential suggests that there is little likelihood of any nuclear war being followed by peace except in the form of the demise of humanity. Similarly, use of biological weapons, such as the smallpox virus, would clearly have a huge impact on populations. Beyond this direct outcome, the authors see in such a scenario a major reversal for humanity which, having achieved the eradication of this disease, would then deliberately bring it back under the cover of war.

A section of six chapters examines human behaviour in relation to weapons. It shows how violence results from the combination of two elements: the development of weapons and the decision, whether irrational or calculated, to use them. Various aspects of this lethal process are examined, especially the way language and communication can lead to aggressive and violent behaviour.

In response to this complex situation, in which technologically highly sophisticated weapons go hand in hand with the archaic reflexes at the root of human violence, the book nevertheless introduces a note of hope. It describes initiatives aimed at limiting the ravages of war, such as international humanitarian law, the nuclear weapons reduction agreements, and preventive diplomacy. It is certainly appropriate to draw attention to initiatives such as these aimed at helping to prevent war, but one cannot help wondering whether others are realistic. As the world heads simultaneously for further globalization and more forceful assertion of cultural and ethnic identity, we will find out whether such notions as defensive security and a civil society upholding the desire for peace contribute to a practical vision for the future or merely offer a utopian dream of safety.

The role played by medical associations and certain individual doctors in these initiatives in the recent past receives detailed attention, and illustrates the undeniable capacity of the medical profession to influence political and military decision-makers. One recent example is the banning of anti- personnel mines, which originated from an analysis of medical data that helped to a significant extent to portray the horrific and indiscriminate effects of these weapons.

We cannot remain indifferent to the role of the medical profession in preventing war. It is not enough to deal with the consequences of war, we have an obligation to prevent it. The full importance of this obligation becomes apparent when we recognize that the current development of the means of waging war poses a threat to humanity itself. In the not too distant future we will have to answer the question: health or war? This substantial volume explores the paths that lead to this destinal question. I recommend it particularly to health professionals in situations of armed conflict.

Pierre Perrin1
(translated from French)



1Chief Medical Officer, International Committee of the Red Cross, 19 avenue de la Paix, 1202 Geneva, Switzerland (email: