Armed conflict as a public health problem
Armed conflict as a public health problem
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DOI：
10.1136/bmj.324.7333.346
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发表时间：
2002-02-09
影响因子：
105.7
通讯作者：
Krug, EG
中科院分区：
文献类型：
--
作者：
Murray, CJL;King, G;Krug, EG
战争对健康的影响既密切又普遍。对健康的影响是直接的——人们受伤或死亡——然后影响在空间和时间上向外扩散。这种影响在个人生活中回荡，而且往往会影响到几代人。在热战的最初几分钟、几小时、几天里，身体创伤是首要的：个体的身体被凶残的现代弹药残害。生命结束或永远改变。尽管人们都在谈论“智能”武器和有针对性的攻击，但最初的攻击很少局限于战斗人员。最近的冲突，比如大中东地区的冲突，已经将大量公民卷入了这场大漩涡，造成了毁灭性的影响。1990年代卢旺达和科索沃的冲突造成的死亡人数多达90%是平民。我们很难理解工业和技术战争造成的屠杀规模：20世纪估计有1.91亿人死于与冲突有关的死亡，接近目前欧洲人口的一半。粗略估计，每有一人直接死于战争，就会有九人间接死亡——尽管这在很大程度上取决于冲突的性质和发生冲突国家的基本卫生状况。战争使环境恶化。最近在叙利亚和也门发生的冲突中，蓄意将人造环境及其不可或缺的卫生服务作为攻击目标。即使乌克兰的卫生设施不成为直接目标，对卫生服务和公共卫生的影响也可能是巨大的，特别是如果冲突蔓延到城市地区。民用基础设施非常容易受到现代冲突的影响。由于交通受阻，基本卫生物资中断，卫生工作人员和病人无法行动，健康状况，特别是孕妇和幼儿的健康状况将迅速恶化——我们知道，儿童死亡率和与分娩有关的死亡率受到武装冲突的严重打击。3
The effects of war on health are both intimate and general. Health impacts are immediate—people are wounded and killed—and then the impacts ripple outwards, in space and time. The repercussions echo through individual lives and, all too often, down the generations. In the first minutes, hours, and days of a hot war, physical trauma is primary: individual human bodies are mutilated by the ferocity of modern munitions. Lives end or are changed forever. For all the talk of “smart” weapons, and targeted attacks, the first onslaughts are seldom restricted to combatants. Recent conflicts, such those in the greater Middle East, have sucked huge numbers of citizens into the maelstrom, with devastating effect. Conflicts in Rwanda and Kosovo in the 1990s saw as much as 90 per cent of fatalities among civilians. It is difficult to comprehend the scale of slaughter unleashed by industrial and technological war: the 20th century saw an estimated 191 million conflict related deaths—approaching half the current population of Europe. 1The health impacts of war do not stop with trauma from the fighting. Crude estimates suggest that for each person killed directly by war, nine will be killed indirectly—although much will depend upon the nature of the conflict and the underlying conditions for health in the countries in which it is fought. 2 War degrades environments. Recent conflicts in Syria and Yemen have seen the deliberate targeting of both built environments and the health services integral to them. Even if the Ukraine is spared direct targeting of its health facilities, the impact on health services and public health will likely be shattering, particularly if conflict spreads into urban areas. Civilian infrastructure is exquisitely vulnerable to modern conflict. With transport impeded, the flow of essential health goods interrupted, and health staff and patients unable to move, health outcomes, particularly and initially among pregnant women and young children, will rapidly deteriorate—we know that child and birth-related mortality are hit hard by armed conflict. 3