Cesar Chelala
A physician and writer

The Enduring Cost of War

The Russian aggression against Ukraine shows that we have not learned the lessons of history and are paying a high price for it. Future generations will also pay a significant price for our generation’s sins: fractured and destroyed families; poor social and health services; and a polluted environment. Children with mental and developmental problems are the clearest examples of the inter generational effects of war.

The tremendous stress of war increases the chances of interpersonal violence, particularly against women. When the victims of violence are pregnant women, the intergenerational effect manifests as the increase of still births and premature births among them. Mothers who were the children of Holocaust survivors were shown to have higher levels of psychological stress and less positive parenting skills. During the siege of Sarajevo, perinatal mortality and morbidity almost doubled, and there was a significant increase in the number of children born with malformations.

By analyzing the number of people killed indirectly by the “War on Terror” in Afghanistan, Iraq, Libya, Pakistan, Somalia, Syria, and Yemen, a report by the Costs of War Project at Brown University’s Watson Institute for International and Public Affairs estimates that the war in those countries resulted in 3.6 – 3.7 million indirect deaths, while the total death toll in those same countries could reach at least 4.5 – 4.6 million, and counting.

Stephanie Savell, the Costs of War’s Co-Director and author of the report states, “wars often kill far more people indirectly than in direct combat, particularly young children.” Almost all the victims, says Savell, are from the most impoverished and marginalized populations. Most indirect war deaths are due to malnutrition, pregnancy and birth-related problems, and infectious and chronic diseases.

According to the report, more than 7.6 million children under five in post-9/11 war zones are suffering from acute malnutrition. Malnutrition has serious long-time effects on children’s health. Among those effects are increased vulnerability to diseases, developmental delays, stunted growth, and even blindness, reports UNICEF. Those children affected with malnutrition are also prevented from achieving success in school or having meaningful work as adults.

Although using doctors, patients and civilians as a human shield is a war crime, they are frequent targets of uncontrolled violence. Now in Sudan, Médecins Sans Frontières (MSF) reports that their staff in multiple locations, have been repeatedly confronted by fighters entering health facilities, and stealing medicines, supplies, and vehicles. It is estimated that 70 percent of health facilities in areas in conflict are out of service, and 30 among them are targets of attacks.

In U.N.-sponsored health missions, I was able to see the consequences of war in countries such as Mozambique, Malawi, Angola, El Salvador and Nicaragua, a sobering experience that left painful memories. The sadness and feeling of helplessness I saw in the eyes of women and children still haunt me.

Repeated violence has numbed us to its consequences, our senses overwhelmed by cruelty. Faced with the tragic complexity of life, we are unable to savor its sweet moments of care and tenderness. Eager to escape brutal reality we watch the latest TV news and then mindlessly change the channel to a baking show.

But does war only produce negative effects? What we see now in Ukraine is that the Russian aggression against people of all ages -both soldiers and civilians- has produced millions of displaced people, but it has also given rise to the solidarity of Ukraine’s neighbors, who at high personal and social cost have provided refuge to tens of thousands of families fleeing the war.

Ukrainian women of all ages have also taken up arms to defend their country from Russian aggression. Currently, more than 60,000 Ukrainian women serve in the military, while tens of thousands more are helping their country as journalists, paramedics, teachers, and politicians. At the same time they continue being the center of support for their families. Because men are on the front lines, women must keep hospitals, schools and even villages themselves in operation, often without basic supplies. Although these actions are an example of the best of the human spirit, they do not erase the harrowing cruelty of war.

César Chelala is an international public health consultant and a co-winner of an Overseas Press Club of America award for the best article on human rights. He is also the author of Violence in the Americas: The Social Pandemic of the 20th Century, a publication of the Pan American Health Organization.

About the Author
César Chelala is a physician and writer born in Argentina and living in the U.S. He wrote for leading newspapers all over the world and for the main medical journals, among them The New York Times, The Washington Post, The Wall Street Journal, The Japan Times, The China Daily, The Moscow Times, The International Herald Tribune, Le Monde Diplomatique, Harvard International Review, The Journal of the American Medical Association, The Lancet, Annals of Internal Medicine, and The British Medical Journal. He is a co-winner of an Overseas Press Club of America award and two national journalism awards from Argentina.
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