Editorial

This issue starts with on a sad note with an obituary for one of our longstanding and influential board members Liz Willis – we will miss her greatly.

In the debates as to whether the world is becoming more or less peaceful, what should qualify as a war or an armed conflict and who should qualify as a combatant, some trends seem clear: ‘civil’ wars are increasingly internationalized and this is one factor making them deadlier and longer, and – probably but not necessarily related – the conflict relapse rate has increased (Einsiedel 2014).

The protracted nature of these conflicts must add to the devastation for those caught up in them and Lafta & Al-Nuaimi’s article War or health: a four-decade armed conflict in Iraq captures this. The documentation of research into the heavy toll on people’s physical and mental health, and on the inadequacy of the country’s health services to meet subsequent needs, is an essential reminder that while some conflicts may appear less in the news the lived reality for their populations is as devastating as ever. While the demonstrations in Iraq at the time of writing have multiple causes, a sheer frustration with a lack of services and security must be one of them. Sixteen years after the invasion of Iraq the lesson that urgent, informed and participative attention to public health services is essential does not seem to have been learnt; this was an area that was neglected and poorly managed post-invasion (Medact 2008), and the longer-term damage this has done has been reinforced by subsequent developments.

A commentary in this issue gives one example of continuing efforts that are being made to try and improve health services for those caught up in settings of extreme adversity. In Responsive health services and quality care in settings of extreme adversity: the case of central and northern Iraq, Jaff, Leatherman & Tamaro make the case that standards of quality of care in these circumstances are ill-defined. Based on their case study they draw attention to activities that could help in these situations and make recommendations in order to ‘define and implement a basic level of responsive care of good quality for the most vulnerable’.

One crucial aspect of another decades-old conflict is covered in Fahouma & Abuelaish’s article Occupation, settlement, and the social determinants of health for West Bank Palestinians. The authors consider the negative impacts that have already been linked to the ongoing and illegal construction of settlements in the West Bank, then review the literature on the social determinants of health to understand more comprehensively how these settlements impact on them. It is eye opening to learn that a spatial analysis study from The Hebrew University and others showed how the settlements and their communicating roads form a linked and gated community, separating them from Palestinian communities which effectively became small ‘islands’ (Handel 2014). It is also a sobering thought that – as the authors point out – the social determinants of health for Palestinians in Gaza are almost certainly worse.

An inspiring and insightful article by Aghabekian about the same conflict offers a positive and informed insight into how greater participation of Palestinian women in politics and decision making, including the negotiations with Israel and internal Palestinian reconciliation efforts, could have a significant and positive influence. Demanding a bigger role: Palestinian women in politics and decision making covers the history of women’s involvement since the late 19^th century, the culture of a male-dominated society, and political developments including the dead weight of the occupation. The author considers participation pre and post the Oslo Accords, and includes a section on the influence of United Nations Security Council Resolution 1325 on women, peace and security. Palestine launched its first National Action Plan for the implementation of UNSCR 1325 in 2016, but the potential for it to have a positive influence on women’s everyday lives has been thwarted by the nature of the occupation and its policies.

Underlying all conflicts are the means with which they are fought, and a key aspect of the trend in the increased internationalization of armed conflict is where the means to fight them come from. The destructive impact of the arms trade on global health has been well documented, and yet, as Arulrajah & Flecknoe point out in Deadly business – a public health case against the British Arms Industry the United Kingdom remains the world’s second largest ‘defence’ exporter, with many exports going to the Middle East. Taking forward the argument that armed conflict should be viewed as a public health problem the authors draw parallels with the response to London’s ‘killer smog’ which resulted in the Clean Air Act of 1956, and argue that ‘a similarly robust legislative response to the British arms industry is warranted on public health grounds,’ particularly given the legally questionable use of British weapons by Saudi Arabia in Yemen.

This issue concludes with two book reviews. The Backwash of War is a reprint of Ellen N. La Motte’s original account of her experiences as a volunteer nurse in the First World War and an extensive biography of the author. Originally banned in England and France as it was considered bad for morale, her writings provide an honest and terrible account of the horror and pain – and of the lessons that seem not to have been learnt.

In James Lovelock’s new book, Novacene: The Coming Age of Hyperintelligence, he describes how he is positive about artificial intelligence eventually controlling the planet and why he is convinced we are alone in the universe. Read the review to understand why he proposed this as something positive.

The articles in this issue, as in many issues given the focus of this journal, describe the terrible health consequences of armed conflict. The importance of documenting these including the debilitating drag of protracted conflict on every aspect of public health is clear if they are to be addressed and avoided in the future. This has been an obvious and consistent refrain from the health community, and we are grateful to the authors who have persisted in their research and documentation of what is happening and made recommendations that could lead towards a more peaceful world.