War-torn regions of the world are contributing to an increasing number of cases of physical and mental trauma.
Most recently, the occupation of Ukraine by Russian forces has once again revived memories of the horrors of war. The ripples of this conflict will no doubt be felt for many years to come. Once the bombs and missiles rain down on towns and cities, not just deaths and injuries but also a lack of basic necessities like power, food, water and communication will bring misery to the lives of all. The human and medical costs of the recent conflicts such as the Iraq war and Afghanistan are still being felt across the world and there is no doubt that the war in Ukraine will also have a huge impact on ordinary people for many years to come.
The World Health Organisation (WHO) estimates that around 4.4 million people die around the world each year, constituting nearly 8% of all deaths, as a result of both unintentional (e.g. motor vehicle accidents and falls) and violence-related injuries or trauma (e.g. war, conflicts, interpersonal violence). Trauma claims the lives of 35-63% of people around the world and is dependent on demographics, with head and spinal injuries contributing to the greatest burden on disability in high-income countries.
In a study published in 2020, war or conflict-related injuries sustained by civilians and local combatants were described as primarily affecting males, with nearly 35% of the affected individuals being under the age of 18. Blast and gunshot injuries accounted for 50% and 22% of all injuries, respectively, and the most common site of injuries were the extremities such as legs and arms (33.5%) followed by the head and neck (18%). These injuries sustained have a profound personal toll, with obvious implications of normal day-to-day function and the ability to work but also a significant socio-economic burden on society in general.
The medical cost of the war on Ukraine is likely to engulf all civilians from the young to the elderly and is likely to surpass tens of millions of pounds at the very least. The WHO and other organisations, including governments are working hard to keep the medical supply chain open in neighbouring countries and to support Ukraine’s health system to meet with the immediate demands of the war. This is complicated by severe disruption of supply chains, non-operational distributors, inaccessible stockpiles of medicine due to the ongoing military operations and thus low supplies of medicines with hospitals struggling to provide care to those affected.
Past experience has taught us that post-conflict areas are particularly susceptible to decreases in healthcare provision, raising the risk of infectious diseases and an inability to treat common medical problems due to the decimated public health infrastructure. War-torn areas are plagued with cases of trauma, which can be in the form of physical such as blast and shrapnel injuries to the head, eyes, body and soft tissues as well as psychological such as suicide, depression, post-traumatic stress disorder, alcohol misuse and drug abuse.
Children exposed to war manifest the highest rates of mental health problems compared to children in the general population, complicated by difficulties in communicating or articulating their traumatic experiences. Although children are extremely resilient, war and conflicts have devastating long-lasting effects on children impairing their ability to engage in daily life, focus in school, form relationships and attachments and to feel safe – all of which we take for granted.
As is the nature of war, displacement of ordinary citizens, particularly children, is a common occurrence. UNICEF estimates that around 19 million children were living in displacement within their own countries due to conflict and violence in 2019 alone, some for years. The “Lost at Home” report stated that internally displaced children around the world were already facing a life without proper care and protection, lack of access to basic services and were at risk of violence, exploitation, abuse and trafficking.
The human toll of this war will no doubt take years to become clear, however, we must recognise the impact of the trauma not only on physical health, which is more easily visible but also the mental health consequence, which may remain hidden.