Preventing War

Journal of Public Health Policy, Sep 1991

Rodolfo Saracci

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Preventing War

and extend access to Journal of Public Health Policy ® www.jstor.org j 5 T the timeof writing,endof MarchI99I, one month ^ aftertheendof hostilitiesin theGulfwar,an accurate inventoryof allcasualtiesc,ivilianandmilitaryi,ncludingtheperiodsincetheinvasionof Kuwaitby Iraqon ' Augustz, I990, is stillnotpossible;moreoverc,ivilwar has ensuedwithin Iraq, as well as mass repression againsttheKurdpopulationt,herebyaddingto thevictimtoll.Justduring thefirst,essentiallyaerial,phaseof thewar,fromJanuaryI 7 to February 23, I99I, some go,ooo sortiesweremadeby the alliedairforces(i). Takingthis as a crudeoverallmarkerof war activitiesandspeculating that,unlessthe bombsweresentto desertedareas,one majorcasualty, i.e.,a deathorsevereinjuryc,ouldresultfromanythingbetweenoneand tensorties,thecasualtytollforthefirstphasealonemightruninthetens of thousandsT.hisfitswiththelikelyspanof figuresquotedfortheIraqi deathsduringthe 43 daysof the Gulfwar, rangingfrom ioo,ooo (z) down to theentirelyunspecified"nota greatnumber"(3). Itshouldbe kept in mind that some 30,000 deathswould approximatelyamount to thedoubling- duringthewarperiod-of thecrudedeathrateoftheIraqi population. The casualtytoll demonstrateosnce morethat, irrespectiveof how mucha war can be seen,fromone's own viewpoint,as ethicallyand legallyjustorpoliticallyandeconomicallyjustifiable(orevennecessary), a majorresultis loss of humanlivesandpermanenotr transientinjury, physicalorpsychologicalt,o thelivesofothers.Healthdamageinvariably accompaniewsars.Fromapublichealthperspectivwearcanberegarded as an epidemicdisease-or, as for somechroniccivilwars,an endemic one-that onceit escapespreventioncannotbe fullycontrolledat later stages:at the bestthe numberandseverityof casualtiescanbe limited. Casualtiesof whichfightingside?Economiccalculationsandeconomy- - JOURNAL OF PUBLIC HEALTH POLICY * AUTUMN 1991 basedchoicesin thehealthdomainencounterseveraldifficultiess,ome of themostfundamentasltemmingfromtheneedto translateintoquantitativeestimatesthe valueof humanliveswhencomparingcostsand expectedbenefitsof intrinsicallyheterogeneouisntervention(s4): for instance,when havingto allocatelimitedresourceseitherto establishing a hearttransplantservicefor adultsor a screeningfacilityfora congenital defectin newborns.Yet,withinthe frameof referenceof peace,open and extensive discussionsby a varietyof involvedpartiescan take place to settleby socialconsensuswhat mayappearat firstas irreconcilableissues of values. In war no consensussolutionsexist. Evenwithin each of the battling sidesopen analysesof therelativevaluesof thelivesatstakeareeschewed, lest too muchlightis focusedon the kindof choicesimplicitand actually made in war, often in an expeditious,oversimplifiedway, with little, if any, room for consultation:choices between,say, the riskof sacrificing some of the enemy civilians, including children, through bombing a militarypositioninstalledin a village,andtheriskof exposingadvancing soldiersto the position's fire.Alternativesand decisionsof this nature, often involvingsizablenumbersof lives,areinevitablefor anyone,however humaneand rational,exercisinghis rationalitywithin the frameof referenceof war, irrationalin its very foundation,as it brutallyequates what is right with what is gained by violence. Moreover, human behaviour, especiallywhen faced with life and man-inflicteddeath, can hardly be simplifiedto "rational"acting of the kind assumed,for instance,in abstracteconomic models. It may be arguedthat in von Clausewitz'sdictum ( 5 ) that "war is a simplecontinuationof politicsbyothermeans,"the keyword is "other" as the meansof war arenot merelypassiveinstrumentsto an end. To be activatedthey first requirea change in the value system prevailingin peace, and to turn out effectivethey usuallyincludeamong the results the loss of humanlives, an outcome aliento peace. Preventingthe loss of humanlives fromwar is a pertinentconcernfor publichealthprofessionals,as is preventionof otherviolent deaths.The escalatingnumberof war deathsin thiscentury-sixty millionandmore deathsin the two world wars alone ( 6 ) -and the catastrophicscenarios for health and the environmentwhich could derivefrom nuclearwar have prompted,particularlyover the last decade,some incisiveactions againstnuclearwar, recognizedby the Nobel Prizefor Peaceconferred in I 9 85 on "InternationaPlhysiciansforthePreventionof NuclearWar." SARACCI * PREVENTING Theinjuriesto lifeandhealth,directandindirect(forexample,through environmentadleteriorationo)f theGulfwardemandrenewedinitiatives to preventall formsof war, includingthose startedas international "policeoperations"withtheexecutiveassentof theUnitedNations.This label,anymorethanthe label"inthe nameof God,"doesnot exempt them from scrutinyof theirreasons,ends, meansand actualresults, amongwhichhumanlossesfromallsidesstandprominentT.hosemost directlyinvolvedin preventions,uchas publichealthprofessionalasnd epidemiologistsc,antakethelead,alongat leasttwo lines: i. P (...truncated)


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Rodolfo Saracci. Preventing War, Journal of Public Health Policy, 1991, pp. 265-269, Volume 12, Issue 3, DOI: 10.2307/3342842