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War destroys countless lives immediately, but it also destroys health systems and key social structures, turning societies once able to nurture health and save lives, into societies stripped of that ability. "It's basic and obvious, hidden in plain sight," writes Lefko. (Photo: Courtesy of the author)

Modern War: A True Global Health Emergency

A unique historical moment to look at global health, with a special look at Iraq after more than twenty years of war

Claudia Lefko

When I said Iraq was facing a public health crisis—and this was a few years ago—others in the audience jumped up and accused me of avoiding the real issue: war and western imperialism.  But, I wasn't. I was speaking to conditions on the ground in Iraq, trying to focus attention on one of the most serious problems Iraqis have been living with as a result of war and western imperialism: the disatrous decline of health and health care capacity.

It has become one of those long-standing crisis that are so familiar they've become ordinary, like poverty and food insecurity. These situations, lives lived in these circumstances, become normalized—"normal" in the public view and public discourse. Even, it may seem, normal to the people directly affected.  But the situation in Iraq is not normal, there is very little about life in Baghdad in the last decades that can be seen as normal.

Dr. Salma al-Hadad, Director of the Pediatric Oncology at Children's Welfare Teaching Hospital in Medical City Baghdad and her colleague Dr. Mazin al-Jadiry put it this way in the introduction to their chapter about Iraq in Palliative Care to the Cancer Patient: The Middle East as a Model for Emerging Countries

Iraqis as a whole have been living with the life-threatening "diseases" of violence, chaos and instability. The overall health of the population—which WHO defines as "...a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity"—has suffered. Our sense of well-being, our capacity to enjoy life and believe in a better future has been compromised.

One aspect of the health crisis is the ever-increasing cancer rate in Iraq.  It has  become the norm;  normal is not newsworthy. Newsworthy events—ongoing violence and sectarian struggles—push cancer and health out of the headlines and out of the news altogether. And so the crisis is missing from the media and generally speaking, missing from the agenda of activists and international health organizations.

Enter ISIS and Ebola, putting health and Iraq and crisis back into the news, creating a unique opportunity to look at Iraq and Iraqis beyond the headline-grabbing topics of war and western imperialism to one that concerns daily life and impacts the very future of  of life in that country and in every country sufffering from a natural disaster such as an epidemic or from human-made disasters such as war: health. 

The media is giving us numbers and a name—more than five thousand stricken with Ebola; and a location, West Africa.  It's a humanitarian crisis, but the actual humans, aside from the few stricken westerners, are missing from the story—individuals lost in the sea of numbers, lost to our fear of the disease and lost to the story surrounding "the crisis". And then the questions: where are the drugs, why can't we control it, how can we protect ourselves?  It's the same with war reporting.  For the most part, it's also about numbers killed and about the "teams" involved: ISIS, Sunnis, Shia and Kurds.   It gives us names of locations, but tells us nothing about the actual geography, the rivers , the desert environment and historical places being devastated by ever more bombing.  The human narrative of life on the ground, the story that would connect us in our common humanity, that would have us still caring about a people and a place when the war is over or the health crisis contained, is missing.

For some years now, prominent doctors, medical organizations and institutions such as Partners in Health (PIH) have been talking about the  critical importance of "life on the ground" factors that influence health. And even more importantly, they have been initiating and implementing projects based on a holistic, human rights approach and encouraging others to do the same.  PIH has been promoting support for international covenants that guarantee health as a human right,  understanding that the health of individuals and communities is directly impacted by other guaranteed rights: adequate housing, education, food, social security, decent work, and "the right to the highest standard of physical and mental health."

A February 2014 paper published in The Lancet goes even further. The report—The Lancet-University of Oslo Commission on Global Governance for Health: The political origins of health inequity: prospects for change—points out that in today's globalized world, ensuring health requires  looking beyond communities or country borders to "... policy areas that affect health and that require improved global governance: economic crises and austerity measures, knowledge and intellectual property, foreign investment, treaties, food security, transnational corporate activity, irregular migration and violent conflict."

It's radical and powerful stuff: controlling transnational corporate activity or abandoning a war because it threatens health?  This is stuff you don't hear or read in the mainstream media, and stuff you may not think about if you're not in the medical profession, reading journals such as The Lancet.  But, on some level it's common sense, something everyone,  everywhere knows; your health is the sum total of every aspect of you and the world you inhabit.  Your "health" was being determined before you were born, by your parent's circumstances and by those of their parents.  It's basic and obvious, hidden in plain sight.

In the background of the Ebola crisis, quietly day by day, out of the headlines and seemingly unimportant, the US and others are bombing in Iraq and Syria; no one is talking about how this will impact health or the health care system in those countries. In the case of Iraq, the question is how it will further exacerbate the already disastrous and ever-deteriorating health situation that has been developing over the last twenty four years, since the First Gulf War and UN Sanctions in 1990.

The country once had the best medical care in the Middle East.  It was a modern country, with modern facilities and infrastructure.  Social and economic policies supported  other aspects of life that contributed to a healthy population: free and mandatory education through university, affordable housing, ample food availability and high employment, guaranteed by government subsidized jobs. Most, if not all of this is long gone, along with the general state of  good health and well-being of the population in Iraq.  It shouldn't surprise anyone.  As the famous poster said, back in the 60s, War is not Healthy for Children and Other Living Things.  Another obvious truth gathering dust in closets all over the USA.

Ebola is a serious disease that demands our best attentions at this moment. But, war is also a serious disease that has been taking a toll on millions of people. In places too numerous and painful to list... Iraq, Syria, Palestine, and the Democratic Republic of Congo to name a few.  It also demands our best attentions. "...the present global health crisis is not primarily one of disease, but of governance," writes independent global health consultant Ilona Kickbush, echoing the sentiments of the Lancet-University of Oslo paper. 

I am heartened by the critical work of these medical professionals and organizations.  It gives us, as activists and agitated citizens, a powerful platform to stand on.  Collectively, this is an important moment.  In the aftermath of the huge climate change actions across the globe, we have an opportunity to create new alliances, with new possibilities.  Our job is to find, maintain and maximize the connections that will aggregate our struggles in support of healthy people living  on a healthy planet.

Our work is licensed under Creative Commons (CC BY-NC-ND 3.0). Feel free to republish and share widely.

Claudia Lefko

Claudia Lefko, a long-time educator, activist and advocate for children, is the founding director of The Iraqi Children's Art Exchange and its project, Baghdad Resolve: An International Collaboration to Improve Cancer Care in Iraq.

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