War and Epidemics

By John Kiwanuka Ssemakula, April 22, 2002

War has long been associated with disease outbreaks by creating the conditions necessary for epidemics. Destruction of infrastructure including water supply and sanitation facilities, displacing civilians and creating refugees who are often driven to camp in overcrowded, unsanitary settlements ideal for breeding disease. War in Africa has killed millions and brought suffering to millions more and setback development. The New Partnership for Africa’s Development (NEPAD) has given conflict resolution in Africa priority as a necessary prerequisite for sustained development in Africa.

HIV/AIDS and War

A notable example of war facilitating the spread of disease, is the Uganda / Tanzania war of 1979 and the spread of HIV/AIDS in Uganda. Geographers at Cambridge University, UK suggested the spread of AIDS could be traced back to the route the fleeing soldiers of Idi Amin’s defeated army took in 1979 while being pursued by Tanzanian soldiers. They concluded that the ethnic base and reported spatial pattern of AIDS is significantly related to the ethnic composition of the defeated Uganda National Liberation Army (UNLA) in 1979. In this instance war enabled the escape of the virus out of South West Uganda as the soldiers seeded it along the route from the South to the North of Uganda. This could help explain the spread of AIDS from the South to its secondary focus in the North of Uganda. ¹

Since the epidemic began, more than 60 million people have been infected with the virus worldwide. HIV/AIDS is now the leading killer in Africa, where there are now more than 28 million people infected.² The effects of war on the spread of disease were the subject of a two-day meeting of experts in New York to discuss issues surrounding the role of armed conflict in the spread of HIV/ AIDS from April 18-19, 2002. The meeting was hosted by the UNFPA, the U.N. High Commissioner for Refugees and the Women's Commission for Refugee Women and Children. The meeting was seeking to address the concerns in light of earlier U.N. Security Council resolutions (including Resolution 1308) on the role of conflict in the spread of the disease.³

World War One and the Flu pandemic

World War One (WW1) may have been responsible for the great flu pandemic of 1918 that killed at least 40 million people.⁴ The authors of a report published in The Lancet when reviewing past mortality and morbidity reports from the early part of 20^th century found evidence in the years preceding the 1918 pandemic of sentinel outbreaks at training camps and barracks in the UK, where many young soldiers were succumbing to a pneumonic like illness and rapidly dying after a short time.

The barracks with their dormitory like buildings were ideal for dissemination air borne disease. When these young men were sent off to the war front there they came in contact with hundreds of thousands of other soldiers, allowing the virus to spread, change and mutate and become even more virulent. The frontlines had all the conditions of refugee camps, with hundreds of thousands of young men living in squalid unsanitary, overcrowded camps, ideal areas for the spread of disease. When the soldiers left the frontlines and returned home, they came back carrying more lethal forms of the bug and re-introduced it into the civilian population.

Re-emerging epidemics

Some epidemic disease are making resurgence due to wars in Africa and putting people at risk. For example epidemic typhus reappeared in Burundi in 1997 after an absence of twelve years associated with the civil war that broke out in 1993. Typhus is spread by lice and epidemics are associated with high density populations such as in refugee camps. ⁵

War and new diseases

There are currently numerous wars in Africa. The genocide in Rwanda in 1994 and the war that followed to drive out the Hutu perpetrators forced them into the jungles of neighbouring Democratic Republic of Congo (DRC) and created a huge refugee crisis. The DRC is of course where the deadly Ebola virus was first isolated in 1976. Since then there have been increasing reports of outbreaks, partly due to better surveillance, but also undoubtedly attributable to the civil war raging there that has already claimed an estimated 3 million civilians. The war involves soldiers from the DRC, Rwanda, Angola, Namibia, Uganda and Zimbabwe.

It is conceivable that refugees driven into the jungles of the Congo, or soldiers fighting in the DRC will invade the habitat of the natural host of the Ebola virus (to date the host is still unknown, but is presumed to be a wild animal of some sort), or even worse will be exposed to even more hitherto unknown lethal diseases that will escape into the general human population.

In West Africa, where HIV is now thought to have originated, jumping from the chim

panzee SIVcpz form into the more lethal form into man⁶, researchers are alerting people to an increase in outbreaks of haemorrhagic fevers, possibly due to increased contact between man and animals especially monkeys that may be the reservoir for Ebola. Liberia and Sierra Leone are two countries that have just come out of civil wars that created large numbers of refugees displaced into the surrounding jungles.

Source: WHO OutBreak News

The cost of war

Between 1980 and 1997 it is estimated that war caused at least 5 million excess deaths and cost Africa $13 billion dollars each year. In some countries war has destroyed up to 70% of the health networks and infrastructure. ^6,7

War causes displacements of populations which increases the risk for disease and epidemics. In driving people off the land, war disrupts farming and agriculture leading to reduced food production, putting people at risk of famine. This leads to a reduce ability to withstand disease and therefore at greater risk of epidemics. The concurrent destruction of health networks, further impairs the abilities and resources of nations to fight outbreaks of disease leading to even more deaths in the long term.

Conclusions

Conflict and war has and continues to be an important factor in the spread of disease in Africa. While unresolved conflicts continue in regions such as the Democratic Republic of Congo, the emergence of new and deadly diseases still remains an extremely grave threat. Conflict resolution in Africa is not just a matter of national or regional concerns but is also of global interest.

As the examples of the spread of the ‘Flu’ epidemic in the early part of the 20^th Century and AIDS in the later stages of the 20^th century show, epidemics precipitated or facilitated by war have the ability to spread far beyond the confines of areas of conflict in a relatively short time to threaten millions all over the world.

Disease surveillance efforts need to be prioritized in the countries involved in conflicts. More funding and support is required from the international community to develop underdeveloped surveillance facilities in Africa. At the same time more efforts should be made to prevent war and end the conflicts currently raging in Africa.

References:

1. JHS Kiwanuka Ssemakula. HIV/AIDS & the Health Care System in Uganda, MPH Thesis, Dundee University, 1992

2. UNAIDS, AIDS Epidemic Update, December 2001

3. UNFPA Press release, Expert Meeting Examines Impact of Armed Conflict on HIV/AIDS Epidemic, 18 April 2002

4. JS Oxford, A Sefton, R Jackson, RS Daniels and NPAS Johnson. World War 1 may have allowed emergence of “Spanish Influenza”, The Lancet, Volume 2, Number 2, 2002

5. Raoult D, Ndihokubwayo JB, et al, Outbreak of typhus associated with Trench fever in Burundi, Lancet, 1998, Aug 1;353-8

6. Gao F. Bailes E. Robertson DL. Chen Y. Rodenburg CM. Michael SF. Cummins LB. Arthur LO. Peeters M. Shaw GM. Sharp PM. Hahn BH. "Origin of HIV-1 in the chimpanzee Pan troglodytes." Nature; Feb. 4 1999; 397: 436-441

7. Disasters in Africa: Old and New hazards & growing vulnerability; World Health Stat Q: 1996 (3-4) 179-94

8. Loretti A: Armed conflicts, health and health Service in Africa; Med.Conl.Survival,1997, Jul-Sep, 13:219-28