War

War is generally defined as armed conflict conducted by nation-states. The term is also used to denote armed action by a group within a nation against governmental or occupying forces; such armed actions are often termed civil wars, wars of liberation, or revolutionary wars. This entry examines the physical and psychological impact of war, terrorism, and other forms of armed violence, and the role that epidemiology can play in understanding and preventing violence.

War accounts for more death and disability than many major diseases. War destroys families, communities, and sometimes entire nations and cultures. War siphons limited resources away from health and other human services and damages the infrastructure that supports health. War violates human rights. The mindset of war—that violence is the best way to resolve conflicts—contributes to domestic violence, street crime, and other kinds of violence. War damages the environment.

An estimated 191 million people died during wars in the 20th century, more than half of whom were civilians. The exact figures are unknowable because of poor recordkeeping during wartime. Over the course of the 20th century, an increasing percentage of people killed in war were civilians; in some wars in the 1990s, possibly 90% of the people killed were noncombatant civilians. Most of them were caught in the crossfire of opposing armies or were members of civilian populations specifically targeted during war.

During most years of the past decade, there were approximately 20 wars, mainly civil wars that were infrequently reported by the news media in the United States. For example, more than 3.8 million people died in the civil war in the Democratic Republic of Congo during the past several years. As another example, more than 30 years of civil war in Ethiopia led to the deaths of 1 million people, about half of whom were civilians.

Several of these civil wars have been considered to be genocidal. In the Iraq War, which began in 2003, more than 2,500 U.S., British, and other Coalition troops had been killed as of March 2006, and more than 16,000 were wounded. An unknown number of Iraqi civilians have died as a result of the war; estimates range to more than 650,000, based on a cluster sample survey of Iraqi households that was performed in September 2006.

Many people survive wars only to be physically scarred for life. Millions of survivors are chronically disabled from injuries sustained during wars or the immediate aftermath of wars. Landmines are a particular threat; in Cambodia, for example, approximately 1 in 250 people is an amputee as a result of a landmine explosion. Approximately one third of the soldiers who survived the civil war in Ethiopia were injured or disabled; at least 40,000 had lost one or more limbs.

Millions more are psychologically impaired from wars, during which they have been physically or sexually assaulted, have been forced to serve as soldiers against their will, witnessed the death of family members, or experienced the destruction of their communities or entire nations. Psychological trauma may be demonstrated in disturbed and antisocial behavior, such as aggression toward others, including family members. Many military personnel suffer [Page 1092]from post-traumatic stress disorder (PTSD) after military service.

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