Santa Catarina, Brazil
|A wounded American soldier receives a blood transfusion at an improvised hospital in New Guinea c. 1942-1945. Source: Daily Mail|
All those who seek to destroy the liberties of a democratic nation ought to know that war is the surest and shortest means to accomplish it.
– Alexis de Tocqueville
War has been written about since the beginning of human history. It was notably recorded by Thucydides in his account of the Peloponnesian War between Athens and Sparta; and in China by the military strategist Sun Tzu in the fifth century BC. But the writers of war have mostly been historians, military men, or diplomats, who emphasized the events and outcomes of war rather than the human aspect. As Cooter stated:
“Despite that the last couple of centuries of Western civilization have largely been taken up with nations either going into or coming out of war, and that the injury and repair of the bodies of the participants have not been insignificant, professional historians of medicine seem hardly to have noticed war-declarations of heroic battles against microbes notwithstanding.”1
Writers have emphasized state strategies, of wars being fought to gain or maximize power, or to guarantee strategic resources. But in truth it has always been individual human beings who do the actual fighting. Many warfare analysts have neglected the horrors of physical and psychological damages that soldiers and civilians suffer in armed conflict. This has not been overlooked by medical professionals, however. Medicine has played a great role in the history of war, and the emergence of both modern warfare and modern medicine have coincided. According to Harrison, “The birth of modern warfare coincided with the emergence of medicine as a modern profession. Around the middle of the nineteenth century, medicine began to assume a form that we would easily recognize today.”2
One of the first historical works to examine war beyond the notion of a “boy thing” or an instrument of diplomacy was Anne Summers’ book Angels and Citizens: British Women as Military Nurses, 1854-1914, published in London and New York in 1988. Anne “meticulously examines female nursing practice and politics within the context of upper-class feminist aspirations. Thereby she enlarges women’s history and offers much that is new to medical history.”3
The physical and psychic effects of war on people’s lives has not received enough attention, neither in studies of medical history, nor in social sciences. Even the field of psychology took a considerable time to realize the traumatic impact of war on individuals and society. One of the clearest examples of this was the way in which British psychologists handled the impact of the German bombing offensive against Britain during World War II, as “civilian air-raid victims in 1940 were simply told that they were exhausted, that there was nothing wrong with them and that they should go back to work; very few were given pensions at the time and elaborate treatment was discouraged.”4
Despite war’s major impact on public health throughout history, countries rarely balance the human costs of war before entering the battlefield, or ponder the “necessity” of going to war and the irreparable damage it might bring about:
“War has an enormous and tragic impact –both directly and indirectly –on public health. War accounts for more death and disability than many major diseases combined. It destroys families, communities, and sometimes whole cultures. It directs scarce resources away from health and other human services, and often destroys the infrastructure for these services.”5
The impact of war on the public health of a society is also long lasting. In the Vietnam War, according to Levy and Sidel, “more than 58,000 U.S. service members died during the war and more than 150,000 were wounded. Many suffered from post-traumatic stress disorders and other mental disorders and from the long-term consequences of physical injuries.”6
But what is the role of healthcare practitioners in helping to decrease the terrible effects of war on people’s health? Indeed “The people caught up in armed conflicts constitute a permanent challenge for health personnel.”7 The medical effort of humanitarian workers, a field sometimes called “humanitarian medicine,” is extremely important in addressing health problems generated specifically in the context of armed conflict. As stated by Brauman, humanitarian medicine differs from traditional medicine not in technique, but in location and goal:8
“Battlefield medicine and surgery, rural dispensaries in remote areas, campaigns to raise awareness about health problems in poor countries, emergency teams in disaster situations, vaccination campaigns, health education, help for marginalised groups in affluent countries and public health advice are just some examples of actions that fall within the scope of “humanitarian medicine” […]”.9
The work of medical practitioners involved in humanitarian actions has been extremely important in reducing the negative effects of warfare on people’s health. Medicine has walked beside war for a long time. It is now time to realize the importance of the medical care that is delivered, and to measure the human costs of war in order to prevent it from happening.
Learning to kill is a matter of habit / The more you have done it, the better you’re at it
Learning to fear is a matter of habit / The more you have done it, the better you’re at it
Cruelty is a matter of habit / The more you’ve seen it, the better you’re at it
Learning to love is a natural thing / It will find a way if you just let it in / It will be strange at first, but then you’ll see it / That learning to love is a matter of being
– A Matter of Habit (Moddi)
- Cooter, Roger. 1990. “Medicine and the Goodness of War.” Canadian bulletin of medical history 7 (February): 148. https://www.researchgate.net/publication/11727912_Medicine_and_the_Goodness_of_War?enrichId=rgreq-1b117d2b8cdc5e3f23f1ccbc38d398f7-XXX&enrichSource=Y292ZXJQYWdlOzExNzI3OTEyO0FTOjE2NTYwMjYyMjcxMzg1N0AxNDE2NDk0MTUwMjEw&el=1_x_3&_esc=publicationCoverPdf.
- Harrison, Mark. “WAR AND MEDICINE IN THE MODERN ERA.” In War and medicine, 11. 1st ed. London: Black Dog Publishing, 2008.
- Smith, F. B. “Anner Summers, Angels and citizens: British women as military nurses 1854-1914.” Book Reviews: 134. Accessed January 01, 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1035778/pdf/medhist00060-0147.pdf.
- Shephard, Ben. “WHY THE PSYCHIATRY OF WAR IS TOO IMPORTANT TO BE LEFT TO PSYCHIATRISTS.” In War and medicine, 168. 1st ed. London: Black Dog Publishing, 2008.
- Levy BS, Sidel VW. In: Levy BS, Sidel VW, eds. Preface. War and public health. Washington, DC: American Public Health Association, 2000: ix-x.
- Levy, Barry S., and Victor W. Sidel. “Adverse health consequences of the Vietnam War.” Medicine, Conflict and Survival 31, no. 3-4 (March 2015): 162. Accessed January 03, 2018. doi:10.1080/13623699.2015.1090862.
- Pierre Perrin. “Introduction.” In WAR AND PUBLIC HEALTH: A HANDBOOK, XXI. 1st ed. Geneva: International Committee of the Red Cross, 1996.
- Brauman, Rony. La médecine humanitaire. Paris: Presses universitaires de France, 2009.
- Ibid., 7.
ERICK DA LUZ SCHERF is a third year undergraduate student of International Relations at the University of Itajaí Valley (Universidade do Vale do Itajaí) in Santa Catarina, Brazil. He is a researcher in the field of Human Rights in the Center for Social and Legal Sciences at his university, has published articles in national law journals, and has participated as a seminar lecturer in Brazil.