Climate change, health and armed conflict: the links that still need making

As this issue of Medicine, Conflict & Survival was completed the G20, the self-selected group of countries with the most power over the global financial system gathered in Italy where, not for the first time and not very encouragingly, they agreed to do ‘their utmost’ against climate change. In Glasgow, the world gathered once more to specifically discuss climate change and urgently to come up with agreements for more concrete action. The frustration of the many activists present at COP26 is understandable: 26 years ago Douglas Holdstock wrote the following in an editorial to introduce an MCS special issue on climate change: ‘Water supplies are restricted, temperatures often exceed 30°C, air quality has frequently been poor, and NHS hospitals are under pressure from respiratory emergencies’. He also noted, in relation to nuclear weapons testing at Moruroa, how ‘… the developed countries can set an appalling example when they consider their own short-term interests are at stake’ (Holdstock 1995). Since then, many articles in MCS have stressed the links between climate change, conflict, insecurity and public health most recently Angelika Claussen’s Global Disarmament to Protect the Climate in the last issue. The importance of the key role health professionals need to play in relation to climate change was emphasized in a recent report in the Lancet stating that more representatives from Ministries of Health should attend COP meetings (Burki 2021).

While climate change and the pandemic dominate, other issues continue. The Congolese Nobel Prize winner and gynaecologist Denis Mukwege once more issued a rallying cry ‘to rid our societies of violence against women, and to better learn from their resilience, strength and power’ (Mukwege 2021). China once again threatened Taiwan by sending fighter planes into its airspace (Cheung 2021) while the United States added to their regular joint manoeuvres in the South China Sea by forming a new ‘surface action group’ with Japan (America’s Navy 2021).

Vaccines are still very much on everyone’s mind and two articles in this issue cover immunization and armed conflict. The impact of conflict on health systems and specifically on COVID-19 vaccination is described in detail in Aborode et al.’s commentary on the situation in the Central African Republic, in which they also highlight the global inequalities in vaccine availability. In the other Sato analyses vaccination uptake in Nigeria, comparing areas affected by Boko Haram with those affected by other conflict events, and showing the particularly damaging effect on the uptake of specific vaccines in the former.

In the commentary by Hashim et al., they carry out an analysis of the medico-legal cases admitted to the Department of Forensic Medicine in Dhi Qar governorate, Iraq in 2018, identifying the most common causes of death and highlighting the importance of forensic medicine for justice and for helping to solve community dilemmas.

Munezero and Manoukian’s systematic review examines the relationship between the social determinants of health and health seeking behaviour in the context of armed conflict, shedding light among other things on the difficult decisions individuals may have to make when being forced to choose between taking care of their basic needs and attending health services.

Book reviews in this issue cover related areas: epidemics, war and peace and nuclear weapons. Simon Rushton’s review of Snowden's Epidemics and society: from the Black Death to the present emphasizes the important lessons the book carries for the present, despite being written just pre-COVID, particularly in the way pandemics challenge and shape societal arrangements. ‘There are also lessons from history in Medicalising borders. Selection, containment and quarantine since 1800 edited by Sevasti Trubeta, Christian Promitzer and Paul Weindling reviewed by Leo van Bergen, which sheds a disturbing light on the slippery slope between disease prevention, containment, medical othering and persecution.'

Shirley Hodgson reviews Marc Chagall: the artist as peacemaker by Fred Dallmyer, considering Chagall’s life, philosophy and peace-focused work, but concludes that a deeper examination of his art is needed to make the case that he was a peacemaker.

John Loretz reviews two books on the TPNW: Banning the Bomb, Smashing the Patriarchy, by Ray Acheson director of the Women’s International League for Peace and Freedom, and The treaty prohibiting nuclear weapons: how it was achieved and why it matters by Alexander Kmentt, director of the Disarmament, Arms Control and Non-Proliferation Department from the Austrian Ministry of Foreign Affairs. Acheson roots the history of the Treaty on the Prohibition of Nuclear Weapons (TPNW) in feminist principles, Kmentt sheds clear light on the state negotiations that underpinned it. They both unpick deterrence, a threat based on the notion ‘if I go, we all go’. As John Loretz writes: ‘As a system for global security – or even national security – this [deterrence] is both insane and morally bankrupt’.

The start of Peter van den Dungen’s review of Christopher Coker’s Why War? also refers to patriarchy, as the reviewer gives two short answers to this question: firstly ‘because of men!’ How Van den Dungen feels about the book can be determined by the second answer: ‘because of views expressed in books like this’. Coker asserts that humans ‘are inescapably violent’ and even that it is war ‘what makes us human’. Van den Dungen provides a wealth of fascinating evidence not mentioned in this book which refutes its underlying premise. Even a discussion between Einstein and Freud with the same title is absent.

Understanding Why war? as a means to preventing it is a question articles in this journal have frequently addressed. Climate change is increasingly mentioned as a potential cause of conflict but also offers great potential for peaceful collaboration. More articles on this vital subject would be very welcome.