The war in Ukraine: part of a fragile jigsaw

The war in Ukraine has once again made perfectly clear how fragile this world is, now one of the largest nuclear power plants on the planet is under threat. What is happening in the Zaporizhzhia nuclear plant with its six reactors (three now shut down) and front-line position on the Dnieper River is almost impossible to know. Claims are contradictory and news sources that say the ‘wrong’ thing for either side are disputed. What is clear is that it is a highly dangerous situation, and at the time of writing, International Atomic Energy Agency representatives are urgently negotiating a visit to the plant.

The doctors of the International Physicians for the Prevention of Nuclear War (IPPNW) used the occasion of the Review Conference of the Non-Proliferation Treaty (NPT; 1- 26 August 2022) in New York to urge the attending governments to ban military attacks on nuclear installations (IPPNW 2022a). They also highlighted the legal gap which means that there are no clear rules under international law in relation to ‘safe’ distances that should be respected around nuclear power plants.

This situation clearly illustrates one of the reasons that building new nuclear power plants is not the answer to the world’s energy problems. As described in the article in this issue The nature and consequences of a nuclear war: lessons for prevention from Ukraine 2022 (Boulton pp7–8), they represent potential threats to life and the environment if the cooling systems – including of spent fuel – are interrupted, and modern weaponry could potentially breach protective walls to expose fuel rods. They are also hugely expensive, a massive diversion of funds from investment in real sustainable energy sources and leave a toxic legacy for future generations.

A new report has made it clear that even a ‘limited’ or ‘regional’ nuclear war, one that saw the detonation of fewer than 1/20th of global nuclear weapons, would have planetary consequences more dire for the climate and global food supply chains than previously understood, even a few years ago (IPPNW 2022b). On a more positive note, a commentary in this issue Don’t listen to the Naysayers: Momentum for Nuclear Weapons Divestment is Growing (Orgel) describes how this strategy for removing finance from nuclear weapons production is having some traction due to the UN Treaty on the Prohibition of Nuclear Weapons entering into force and prohibiting such investment under international humanitarian law. We need good news.

The loss of life, destruction and global insecurity that the war in Ukraine has unleashed has in no way diminished the suffering caused by armed conflicts elsewhere, including their psychosocial and mental health consequences. Two commentaries in this issue cover this subject: Cox’s Bazar’s health crisis and imminent mental health concerns amidst COVID-19 and fires (Awan et al.), and Syria’s fragile mental health services in the midst of conflict and violence: Call for Action (Swed et al.). Even when conflict is limited to certain regions in a country its influence can be pervasive: Sato et al. find that ‘exposure to conflict has the largest and strongest relationship with depression’ (pp1) in The relationships between adverse life events, depression, economic activities, and human capital investment in Nigeria, even given the other significant causes of stress in people’s lives in parts of that country.

Of course, the damage caused by conflict does not stop when weapons are given up, put in store, destroyed or hidden, and three commentaries in this issue deal with the aftermath. Poor healthcare capacity in Afghanistan amidst a surge in COVID-19 cases and a humanitarian crisis (Essar et al.) describes the dire situation of the health system in Afghanistan and makes a clear case for urgent international support and cooperation. Jaff’s Landmines and unexploded ordnances: the silent killers that take innocent lives is a wake-up call that this problem is far from over, and that in the south and Kurdistan region of Iraq landmines and unexploded ordnance continue to maim and kill an alarming number of people including children. The influence a history of conflict can have on the most vulnerable in society is examined in Access to Healthcare for People Experiencing Homelessness in the post-conflict society of Northern Ireland (McNeill, O’Donovan & Hart), in which the authors suggest that the COVID-19 pandemic ‘illuminates the enduring presence and steady growth of health inequalities, creating an opportunity to re-evaluate how our society views and manages health’ (pp7). Conflict in work settings continues to be a major source of stress for health workers, something that is examined in the commentary from Hasan et al. in Baffling dilemma of workplace violence in healthcare: will there be an end? in which they consider the factors behind this persistent issue at the ‘patient-related, professional, organizational, and societal’ (pp2) levels.

Neglected tropical diseases are a problem enough in themselves, and conflict can weaken the response in what Nnawuihe et al. describe as ‘a noma favourable environment’ (pp1) in A review of noma cases in a tertiary hospital located in a conflict endemic region in Nigeria. The destruction this infection causes to the oro-facial tissues if left untreated is terrible for every aspect of life of those affected and the authors make practical recommendations to improve the situation as well as identifying conflict as a causative factor and yet another reason for conflict resolution.

The research behind articles that appear in this journal, and research into health and conflict more generally, faces considerable obstacles. These are examined in Challenges of conducting research on emergency response and health services provided during conflict in LMICs – case of Lebanon (Abu-Sittah et al.), which includes some crucial insights into why people may or may not want to talk about their suffering, even years later.

All these issues have been complicated over the last few years because of the Covid-19 pandemic, a pandemic that is the subject of one of the winning essays of the Holdstock-Piachaud Student Essay Competition organized by the editorial board of this journal. How to be social in a pandemic? by Jonathan Franklin puts social distancing and anti-vaccination attitudes in a historical context and concludes that ‘our social networks are a crucial – and too often neglected – weapon against misinformation in pandemics’ (pp6). While the war in Ukraine and energy supply concerns may appear to have pushed climate change concerns slightly aside; this is not the case for another winning essayist Muhammad Hasan who wrote Climate Justice and COP26: A New Perspective on the Climate Crisis. This makes absolutely clear the necessity for greater inclusion of lower income countries, who are being struck hardest by consequences already impossible to prevent and for which they bear least responsibility, in climate change debates and decisions, and for climate justice in the distribution of the necessary resources. The essays that result from this competition are always a source of inspiration and hope.

The four books reviewed in this issue cover the concept of genocide, religious violence, the health impacts of war and Mary Seacole’s nursing role in the Crimean War – all subjects key to the aims of this journal; the reviews are insightful for readers who do not have time to read the books and will inspire others to do so.

With best wishes to all our readers and thank you for caring about these issues.