Toxic chemical exposures among civilians in armed conflicts: the need for research equity, justice, and accountability

Abstract

Objective

Armed conflicts result in the release of toxic chemicals into the surrounding environment and civilians are commonly exposed to these toxicants.This paper reviews the evidence on civilian exposure to toxic chemicals, including but not limited to inhaled toxic substances, in post-World War II armed conflicts, and proposes a framework for the implementation of long-term surveillance programs for these populations.

Materials and Methods

Four databases of peer-reviewed health articles were searched for all English-language articles with a primary focus on toxic chemical exposures among civilians in armed conflicts since World War II. The review was supplemented substantially by the gray literature.

Results

In the 66 articles that met the inclusion criteria, the authors categorized the chemical toxicants to which civilians have been exposed in modern armed conflicts as ubiquitous (e.g. smoke, dust, and munitions components present in all conflicts) or particular agents (e.g. specific chemical agents used in a few conflicts). While most studies focused on particular agents, the vast majority of civilians are in fact exposed to ubiquitous agents both in the acute conflict phase and through persistent environmental exposures after the cessation of hostilities.

Discussion/Conclusion

There is a dearth of research concerning civilian exposures to toxic chemicals during armed conflicts. In line with principles of equity, justice, and accountability, robust research and surveillance programs are urgently needed to document exposures and provide ongoing assessments and any necessary treatment for these long-ignored populations, most of whom live in the Global South.

Keywords:

• Toxic agents
• toxic exposures
• armed conflict
• civilian
• health surveillance
• exposure assessment
• smoke inhalation
• dust inhalation
• embedded fragments

Acknowledgements

The authors are thankful for the assistance provided on the literature search by their home institution’s reference librarian Gail Betz.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability Statement

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

Notes

1 The exception to this was the World Trade Center Registry and Health Program cohort, due to its unique informational value in understanding similar potential exposures among civilians in armed conflicts, the population of interest to this paper.

Additional information

Funding

This study was not funded by a particular grant nor by any external entity.