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By Barry S. Levy and Victor W. Sidel

War is hell. War kills people, mainly non-combatant civilians, and injures and maims many more — both physically and psychologically. War destroys the health-supporting infrastructure of society, including systems of medical care and public health services, food and water supply, sanitation and sewage treatment, transportation, communication, and power generation. War destroys the fabric of society and damages the environment. War uproots individuals, families, and often entire communities, making people refugees or internally displaced persons. War diverts human and financial resources. War reinforces the mistaken concept that violence is an acceptable way of resolving conflicts and disputes. And war often creates hatreds that are passed on from one generation to the next.

During the Korean War, a grief stricken American infantryman whose friend has been killed in action is comforted by another soldier. In the background, a corpsman methodically fills out casualty tags. Haktong-ni area, Korea. August 28, 1950. Public domain via Wikimedia Commons.

War is hell. Yet we, as a society, have sanitized the reality of “war” in many ways. In the absence of a draft, many of us have no direct experience of war and do not even personally know people who have recently fought in war. And the US Congress has long since ceded to the President its authority to declare war.

The government and the media infrequently use the word “war.” Instead, they use many euphemisms for “war,” such as “military campaign” and “armed conflict,” and for the tactics of war, like “combat operations” and “surgical strikes.” Nevertheless, we, as a society, often think in a war-like context. We use “war” as a metaphor: the War on Poverty, the War on Cancer, the War on Drugs. And militaristic metaphors pervade the language of medicine and public health: Patients battle cancer. Physicians fight AIDS. Health care providers addressing especially challenging problems work on the front lines or in the trenches. Public health workers target vulnerable populations. And the main office of the leading professional organization in public health is called “headquarters.”

We envision a world without war and see the need to develop the popular and political will to end war. To create a world without war, we, as a society, would need to stop using sanitized phrases to describe “war” and to stop thinking in a militaristic context. But much more would need to be done to create a world without war.

A central concept in public health for the prevention of disease is the use of a triangle, with its three points labeled “host,” “agents,” and “environment.” This concept could be applied for developing strategies to create a world without war — strategies aimed at the host (people), strategies aimed at agents (weapons of war and the military), and strategies aimed at the environment (the conditions in which people live).

Strategies aimed at people could include promoting better understanding and more tolerance among people and among nations, promoting economic and social interdependency among nations, promoting nonviolent resolution of disputes and conflicts, and developing the popular and political will to prevent war and promote peace.

Strategies aimed at weapons of war and the military could include controlling the international arms trade, eliminating weapons of mass destruction, reducing military expenditures, and intervening in disputes and conflicts to prevent war.

Strategies aimed at improving the conditions in which people live — which often contribute to the outbreak of war — could include protecting human rights and civil liberties, reducing poverty and socioeconomic inequalities, improving education and employment opportunities, and ensuring personal security and legal protections.

War is hell. A world without war would be heavenly.

Barry S. Levy, M.D., M.P.H. is an Adjunct Professor of Public Health at Tufts University School of Medicine. Victor W. Sidel, M.D. is Distinguished University Professor of Social Medicine Emeritus at Montefiore Medical Center and Albert Einstein Medical College, and an Adjunct Professor of Public Health at Weill Cornell Medical College. Dr. Levy and Dr. Sidel are co-editors of the recently published second edition of Social Injustice and Public Health as well as two editions each of the books War and Public Health and Terrorism and Public Health, all of which have been published by Oxford University Press. They are both past presidents of the American Public Health Association.

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By Barry S. Levy and Victor W. Sidel

Chemical weapons are horrendous agents. Small amounts can kill and severely injure hundreds of people in a matter of minutes, as apparently occurred recently in Syria. Some analysts consider them “poor countries’ nuclear bombs.” The international community has, with the Chemical Weapons Convention, banned their use, development, production, acquisition, stockpiling, retention, and transfer. Nevertheless, several countries have continued to develop, produce, acquire, stockpile, retain, and transfer these weapons.

Chemical weapons were used on a wide scale during World War I and were also used during World War II. Saddam Hussein used them in Iraq in the 1980s to crush internal opposition to his regime. A terrorist cult in Japan used them twice in the mid-1990s, killing 20 people and injuring hundreds. Now they have been used in Syria — maybe more than once.

Their use in Syria cannot go unchecked. But that is not the issue before the US Congress. The issue is whether or not President Obama should authorize the “limited” use of cruise missiles, launched from US ships in the eastern Mediterranean, to “degrade” Syrian President Assad’s ability to launch additional attacks.

There are three reasons why we oppose such a strike.

First, such an attack by the United States would likely violate international law and undermine the United Nations’ ability to enforce the Chemical Weapons Convention. The report of UN weapons inspectors who investigated the recent attack has not yet been issued. The United States does not have the right to enforce international treaties — militarily or by other means.

Second, a strike by the United States would have uncertain consequences within Syria. It is likely to kill and injure noncombatant women, men, and children. It may lead President Assad or others in Syria to use chemical weapons in retaliation. And it may lead to wider access to the massive store of chemical weapons there, leading to further use of chemical weapons in Syria — and beyond.

Third, and most importantly, such a strike by the United States would have uncertain consequences throughout the Middle East and beyond. It could lead to a much wider war in this region, where there is an overabundance of weapons supplied by the United States, Russia, and other countries. Such a strike would be equivalent to tossing a match into a barrel of gasoline. There is already much conflict in this region within countries, most prominently within Egypt and Iraq, and there is much potential conflict between countries. The reaction by several countries and non-state actors in the Middle East (and beyond) to a US strike cannot be predicted, but there is a predictably high likelihood of a miscalculation, or a whole series of miscalculations, that could easily lead to a much wider conflagration. We should remember that the assassination of one person ignited World War I.

The civil war in Syria, which has already led to more than 100,000 deaths and two million refugees, cries out for a nonmilitary solution. There needs to be a response to the chemical weapons attack there, but it should be an international nonmilitary response — not a US cruise missile attack that is likely do more harm than good. The suddenly increased focus on the civil war in Syria represents an opportunity for the international community to find ways to end this conflict and to promote peace in the region.

Barry S. Levy, MD, MPH, and Victor W. Sidel, MD, are co-editors of the following books, each in its second edition, published by Oxford University Press: War and Public Health, Terrorism and Public Health, and Social Injustice and Public Health. They are both past presidents of the American Public Health Association. Dr. Levy is an Adjunct Professor of Public Health at Tufts University School of Medicine. Dr. Sidel is Distinguished University Professor of Social Medicine Emeritus at Montefiore Medical Center and Albert Einstein Medical College and an Adjunct Professor of Public Health at Weill Cornell Medical College.

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Image credit: Cover of the Chemical Weapons Convention used for the purposes of illustration via opcw.org.

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