Violence Prevention in Low- and Middle-Income Countries Finding a Place on the Global Agenda: Workshop Summary (2008) / Chapter Skim
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Collective Violence: Health Impact and Prevention--Victor W. Sidel, Barry S. Levy
Collective Violence: Health Impact and Prevention--Victor W. Sidel, Barry S. Levy
Pages 171-200
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Levy, MD, MPH2 Introduction Collective violence, especially in the form of armed conflict, accounts for more death and disability than many major diseases worldwide. Collective violence destroys families, communities, and sometimes entire cultures.
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Collective violence may also be associated with interpersonal violence. For example, individuals and groups engaged in armed conflict may commit interpersonal violence, sometimes fueled by ethnic tensions or in the military by conflict with superior officers or with fellow servicemembers in the midst of war.
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��, are also discussed since these are weapons that pose the risk of indiscriminate and widespread devastation, injury, and death. Definition of "Low- and Middle-Income Countries" The World Bank classifies countries into economic groupings based mainly on the country's gross national income (GNI)
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. During the post–Cold War period of 1990-2001, there were 57 major armed conflicts in 45 locations -- all but three of which were civil wars (Stockholm International Peace Research Institute, 2002)
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Indirect Effects of War and Other Military Activities Along with the direct impacts of war and other military activities on health, collective violence may also cause serious health consequences through its impact on the physical, economic, social, and biologic environments in which people live. The environmental damage may affect people not only in nations directly engaged in collective violence but in all nations.
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In addition, the vast majority of the 22 to 25 million internally displaced persons worldwide have left their homes to escape war. The vast majority of refugees and internally displaced persons as a result of war are women, children, and elderly people who may be highly vulnerable not only to disease and malnutrition, but also to threats of their security.
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. Specific Wars Civil Wars in Africa According to data from the Stockholm International Peace Research Institute, for the 1990-2005 period, the regions that had the largest number of armed conflicts were Asia and Africa.
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3. This war demonstrated the importance of recognizing and preventing the public health and human rights consequences that generally accompany armed conflict.
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. In the 1991 Persian Gulf War, tens of thousands of people died, many were injured, and many became chronically ill.
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During World War II, for example, extensive carpet bombing of cities in Europe and Japan accounted not only for many deaths and injuries, but also widespread devastation of urban environments. As another example, the more than 600 oil well fires in Kuwait during the Persian Gulf War accounted for widespread environmental devastation as well as acute, and possibly chronic, respiratory ailments among people who were exposed to the smoke from these fires.
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. The historic high in explosive capacity of the world nuclear weapons stockpiles was reached in 1960 with an explosive capacity equivalent to 20 thousand megatons (20 billion tons or 40 trillion pounds)
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. Chemicals A variety of chemical weapons and related materials have the potential for direct health effects during collective violence and also for contaminating the physical environment during war and the preparation for war.
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The disposal of chemical weapons required by the CWC has raised controversy about the safety of two different methods of disposal: incineration and chemical neutralization. The controversy about safety and protection of the environment has delayed completion of the disposal by the date required by the CWC (Lee and Kales, 2008)
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Mines, in addition to maiming and killing people, also make large areas of land uninhabitable. Remaining in place for many years, they pose long-term threats to people, including refugees and internally displaced persons returning to their homes after long periods of war.
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An International Criminal Court (ICC) was established in 2002 for jurisdiction when international courts are unwilling or unable to investigate or prosecute genocide.
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. Some analysts, on the other hand, construe the term terrorism to encompass the use by countries of weapons designed to cause mass casualties among civilian populations, sometimes termed "state terrorism." Attacks
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Since the September 11, 2001, attacks, billions of dollars have been spent by federal, state, and local governments in the United States on emergency preparedness and response capabilities for potential terrorist attacks, part of the "war on terror." Although some of this money has been used to improve public health capabilities, work to prepare for low-probability events has diverted much attention and many resources from widespread existing public health problems (Rosner and Markowitz, 2006)
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Advocacy for Sound Policies and Programs Advocating for improved policies and programs can help prevent collective violence and minimize the public health impact of war and terrorism. Public health workers can address the underlying causes of war and terrorism and promote a greater understanding of these issues.
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prevention, primary prevention, secondary prevention, and tertiary prevention. Pre-primary prevention consists of measures to prevent adverse health consequences by removing the conditions that lead to them.
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The Carnegie Commission on Preventing Deadly Conflict has identified the following factors that put nations at risk of violent conflict, including the following: • Lack of democratic processes and unequal access to power, particularly in situations where power arises from religious or ethnic identity, and leaders are repressive or abusive of human rights • Social inequality characterized by markedly unequal distribution of resources and access to these resources, especially where the economy is in decline and there is, as a result, more social inequality and more competition for resources • Control by one group of valuable natural resources, such as oil, timber, drugs, or gems • Demographic changes that are so rapid that they outstrip the capability of the nation to provide basic necessary services and opportunities for employment (Carnegie Commission, 2007) Wealthy nations can play an important role in preventing collective violence by increasing funding for humanitarian and sustainable development programs that address the root causes of collective violence, such as hunger, illiteracy, and unemployment.
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Growing socioeconomic and other disparities between the rich and the poor within countries, and between rich and poor nations, also contribute to the likelihood of armed conflict. By addressing these underlying conditions through policies and programs that redistribute wealth within nations and among nations, and by providing financial and technical assistance to less-developed nations, countries like the United States can minimize poverty and other forms of social injustice that lead to collective violence.
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This includes not only wars between nations but wars within nations as well. Strengthening of Nuclear Weapons Treaties Unlike the implementation of treaties banning chemical weapons and biological weapons, there is no comprehensive treaty banning the use or mandating the destruction of nuclear weapons.
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The International Court of Justice (the World Court) in 2006 in an advisory opinion urged that the nations possessing nuclear weapons move expeditiously toward nuclear disarmament, as is required by Article VI of the NPT (Weapons of Mass Destruction Commission, 2006)
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Controversies about safety and protection of the environment during the disposal of chemical weapons required by the CWC has delayed completion of the disposal, and large stockpiles still remain in a number of the world's nations that pose a continuing threat to health and to the environment. The United States and other nations have failed to fully support the OPCW in its difficult tasks of inspection and in urging nations to comply with CWC (Lee and Kales, 2008)
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Secondary prevention methods include strengthening adherence to the Geneva Conventions and other treaties that lessen the effects of war; reducing military activities, including preparation for war; and negotiating effective treaties to lessen environmental damage. Tertiary Prevention Efforts after the end of an armed conflict to reconstruct the damage and to prevent new conflicts and new collective violence are extremely important.
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Humanitarian assistance organizations may also play a role in primary prevention of specific acts of violence and atrocities. They may be strong advocates on behalf of civilian populations among whom they live and for whom they provide humanitarian assistance (Waldman, 2008)
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2008. Chemical weapons.
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199-219. Stockholm International Peace Research Institute.
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2008. Displaced persons and war.
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