Introduction by Croakey: ‘Why is war just wallpaper to the public health project?’ was the title of a talk delivered by University of Washington Professor Emeritus Amy Hagopian during a recent seminar at Simon Fraser University in Canada.
Dr Safiyyah Abbas reports from the discussion, which can also be watched here.
It raises timely challenges and calls to action for the public health community in the week marking the third anniversary of Russia’s full-scale invasion of Ukraine, and amid concern about suppression of “scholarly scrutiny and criticism of Israel and Zionism by Australian academics”.
Safiyyah Abbas writes:
The world is now experiencing the highest number of conflicts since World War Two. Last year was one of the worst years for children in armed conflict, according to UNICEF – 473 million children (more than one in six) globally were living in conflict zones.
The World Bank predicts that by 2030, 60 percent of the world’s poorest people could live in conflict zones.
Yet war remains the “wallpaper” in public health discussions, according to Amy Hagopian, Professor Emeritus in Public Health at the University of Washington, speaking at a live-streamed seminar in Canada in January (see related slides below).
On her university website, Hagopian states: “War is, of course, toxic to health. War produces death, disables people and erodes infrastructure that supports health, yet it is entirely preventable.
“Public health can serve in a prevention role, not just a clean-up role. We set up refugee camps and clinics, send in vaccination teams and doctors, but we need to do more to prevent conflicts sooner.”
Hagopian also helped to write the American Public Health Association’s 2009 position statement on armed conflict and war, which states that “the most contentious role for public health practitioners is, ironically, the role that is most traditional for public health professionals: primary prevention”.
Evidence matters
Knowledge is key to building the case of prioritising war as a public health priority. Hagopian emphasised the importance of measuring the harms of war, both direct and indirect.
Hagopian’s research on the US war and occupation of Iraq found that 60 percent of the estimated 405,000 excess deaths were attributable to direct violence, the remainder being due to indirect causes including the breakdown in health services, sanitation, transportation, and communication.
Over the first nine months of Israel’s genocide on Gaza since October 2023, researchers estimated that traumatic deaths were under-reported by the Palestinian Ministry of Health by 41%, undoubtedly a consequence of Israeli attacks on health infrastructure and personnel.
War’s indirect impacts are seen in surviving war veterans and civilians of war, said Hagopian, and, by extension, their families and communities.
There are more than 23 million war veterans in the US (we have about half a million in Australia) who have poorer overall health than the general population, with greater rates of heart disease, cancer, mental health disorders, suicide, and alcohol and drug use disorders.
Gendered harms include over one-third of women in US military service reporting sexual assault and 21 percent of current spouse or partner abuse perpetrated by US men being attributable to combat exposure.
Grief from bereavement is another by-product of war that Hagopian highlighted. In the Rio Negro genocide committed by the Government of Guatemala between 1980 and 1982, a third of the population was killed, leaving two-thirds bereaved.
Cognitive decline has been reported in civilians, related to early life war-related stressors, and war veterans alike.
Environmental impacts
Hagopian discussed the environmental harms of war, citing several examples.
The US Department of Defence is the single largest institutional consumer of fossil fuel and, consequently, greenhouse gas producer in the world.
Burial of chemical weapons in the US has led to remedial action in some areas due to health concerns – usually where those with wealth and resources to engage in legal action reside, remarked Hagopian.
Now prohibited, sea dumping of chemical weapons historically led to death and injury amongst fishermen who accidentally recovered material.
Burning of obsolete weapons releases toxic chemicals into the air and ground, with environmental racism shifting the burden to minority communities.
Explosive remnants of war create dangerous environments for generations to come.
Who benefits from war?
Despite the gargantuan military expenditure of the US – exceeding that of the next nine countries combined – Hagopian observed that the US has not won a war since 1945, losing in Vietnam, Korea, Iraq, and Afghanistan.
This begs the question, why does the US continue waging wars – and why does Australia join in?
Hagopian quoted an article by David Vine and Theresa Arriola which discussed one major reason: “When a bomb explodes, someone profits”.
The beneficiaries are the military-industrial complex formed by, in the US context: Congress, the US military, and a small group of companies involved in the industry of war, including Lockheed Martin, Northrop Grumman, Raytheon (RTX), Boeing, and General Dynamics.
Outside the US, British weapons manufacturer BAE Systems made a “record profit” in 2023 due to the Ukraine and Israel-Palestine wars, and Australia has multiple defence-related export permits to Israel that remain under “review”.
In a press conference earlier this month, US President Donald Trump laid plain his interest in aiding Israel’s warfare in Gaza, describing Gaza like a real-estate developer in his proposal to steal land rich in gas and oil.
The losers of war are obvious – apart from the harms of war already discussed, “every dollar spent on a bomb is a dollar not spent saving a life from a preventable death.”
Cultural conceptions
Hagopian refuted the widely purported idea that war is an inevitable result of interpersonal aggression or heightened emotions.
Our sociocultural normalisation of war must change, she said, starting with how we teach about war to children.
Hagopian spoke about US schools being mandated under federal law to provide military recruiters with access to students and their contact information. Failure to comply results in legal consequences and loss of federal funding.
Hagopian joined a Seattle school’s parent teacher association resolution to oppose school-based military recruiting, resulting in some policy changes but limited to Seattle public schools.
Australia’s educational approach to war must similarly be scrutinised.
Visiting the Australian War Memorial (AWM) is mandatory for school visits to Canberra to receive Federal funding for the trip. The issue, says Medical Association for the Prevention of War (MAPW), is how war is taught – it should not be portrayed as inevitable nor glorified, and an honest discussion should include non-violent pathways to resolving conflict, the suffering and inhumanity of wars, and Australia’s own history of violence against First Nations people during the Frontier Wars.
MAPW also noted that AWM’s acceptance of funding from weapons manufacturers including Lockheed Martin, Northrop Grumman, and BAE Systems threatens its integrity.
Does speaking up make a difference?
The voices of academics and other respected professionals can make a significant impact on public discourse and inspire action.
And this is precisely why, said Hagopian, discussions on Israel-Palestine have been stifled by higher echelons of academic circles.
Hundreds of members of the American Historical Association passed a resolution opposing scholasticide in Gaza which was vetoed by the council. Similar scenes have taken place within the Modern Language Association and American Federation of Teachers, said Hagopian.
In Australia, censorship of Israel-Palestine discussions has escalated with the recent news that 39 universities have endorsed a new definition of antisemitism which “closely aligns” with that of the International Holocaust Remembrance Alliance. The Jewish Council of Australia has strongly opposed this definition and its weaponisation to “threaten academic freedom” through suppressing “legitimate criticism of Israel” and “Palestinian political expression”.
Primary prevention of war necessitates political engagement – demonstrated by well-known public health projects including tobacco, junk food, and sugar companies, the gun lobby, and automobile industries.
Take the example of MAPW President Dr Sue Wareham writing on Australia’s relationship with Israel during the ongoing genocide in Palestine:
“For as long as Australia maintains a close diplomatic, defence and trade relationship with Israel – including a Trade and Defence Office in Jerusalem, 59 active permits for the export of lethal military equipment to Israel (including for parts for the F35 fighter jets), MOUs with Israel on defence industry cooperation and cyber security, to name just a few elements – Australia is part of the problem, not part of the solution.”
Recommended actions
Hagopian shared several suggestions on how the public health sector can engage. We can:
- Lead or join traditional protests and other direct actions, such as petitions calling for the release of Kamal Adwan Hospital director, Dr Hussam Abu Safiya.
- Build connections across lines and invite speakers to foster learning and collaboration, such as the University of Washington’s sister university relationship with Iraq.
- Protect whistleblowers who unveil the harms of war, like Julian Assange.
- Keep vigilant of the role of mainstream media who closely collaborate with warmongers in marketing war and manufacturing consent, whilst staying informed through reputable news outlets like Democracy Now!.
- Join, or build, advocacy organisations and events, and learn from their resources – such as Physicians for Human Rights’ documentation of the misuse and abuse of crowd-control weapons used by law enforcement in response to protestors.
- Conduct and publish research.
- Speak through art, like the famous pro-Palestine artist, Banksy.
Hagopian also spoke about the importance of supporting “strong, inclusive, justice-oriented global institutions” such as the World Health Organization (WHO) and their Sustainable Development Goals.
Collective action with a legal basis provides accountability to working towards global peace, she said.
Time to act
Health practitioners must reckon with their moral and professional obligations in the primary prevention of war, no matter the discomfort involved in speaking up to powerful institutions or engaging in political discussions.
The urgency to act has intensified during the first month of Trump’s second presidency, with his flippant, business-like approach to war and swift undermining of public and global health institutions, including withdrawal from the WHO, mass layoffs in USAID, and information blackout of several governmental websites including the CDC.
We must act now – not when the fighting ends, after a society and its infrastructure have been decimated and rendered reliant on foreign aid in the short, if not long, term; not when global health and security have been weakened beyond repair.
We must act when we can still save lives, not in the aftermath described by author and journalist Omar El Akkad: “One day, when it’s safe, when there’s no personal downside to calling a thing what it is, when it’s too late to hold anyone accountable, everyone will have always been against this.”
We must approach war as the global public health emergency it is, and direct action toward the quintessential role of public health: primary prevention.
• Safiyyah Abbas is a paediatric rehabilitation physician with an interest in public and global health.
Wider commentary
Below are some comments on the Universities Australia statement on racism.
See Croakey’s archive of articles on war, conflict and health
