Abstract
A quick search of online databases will reveal a surprising scarcity of recent health services research reports about Middle Eastern military conflicts written by public health and medical researchers. Some reports appeared about the psychological health of American combat veterans, and the performance of the veterans administration has caught the attention of presidential candidates. However, evidence-based and well-reasoned studies with clearly stated policy implications are much more likely to address the roll-out of the Affordable Care Act than to present a detailed analysis of the impact of our contemporary long-term military conflicts. Perhaps this lack of evidence is due to a reluctance on the part of investigators to risk the ire of hawks or doves (depending on the findings). Or perhaps the necessary data are kept secret for strategic or political reasons. No doubt clandestine agencies have written prognostic reports based on various assumptions. Nevertheless, the public health community, which fearlessly and routinely takes on powerful interest groups, should be producing a flood of research. Lacking hard data, an editorial is indicated.
As an academic who is concerned with population health, the basic question seems to be this: what are the odds of doing more good than harm associated with 3 basic strategic approaches to the wars in the Middle East; that is, fighting more aggressively, maintaining the current level of effort, or withdrawing. How would researchers quantify the negative consequences and the benefits to assess the impact on public health?
Negative consequences are obvious. Harm to soldiers includes death, physical injury, psychological damage, loss of civilian jobs, and impact on families. Similar harms are suffered by civilian casualties. Bombs strike hospitals and civilian neighborhoods. Large-scale medical and social service programs are required to address these needs.
In addition, the health of refugees and the impact on host countries must be taken into account. Maintaining refugee camps presents an enormous burden on state funds and security services. Providing adequate housing, education, medical, and social services could fracture public budgets. Furthermore, long-term displacement has serious social, economic, and health consequences for refugee populations. Imagine, if you will, the consequences of permanent unhappy refugee communities in several major European nations.
An honest assessment of the benefits of war is a strange activity for health researcher, but I will try to be fair. First, arms sales are good for the US economy. This is no doubt discussed in the circles of power. If the major exporters of arms, such as the United States, were to choke off the flow of weapons to the war zones, perhaps jobs would be lost, unemployment would go up, the trade deficit would worsen, and perhaps fragile economies would move toward recession. Population health suffers when economies are weakened.
Politicians also consider the public’s desire for justice or revenge after terrorist attacks. Is there any mental health benefit from striking back? Perhaps in the short-term. Perhaps not in the long-term. On the other hand, if military action successfully prevents future terrorist attacks, then general levels of stress might be lowered. Unfortunately, few pundits predict that a military victory in Syria and Iraq will result in the termination of international terrorist violence.
Successful regime change, resulting in the establishment of stable benevolent governments, might lead over the long-term to ideological changes and the gradual elimination of the desire to attack western targets. Having read the foregoing sentence, I cannot express much optimism about this result. However, I have no expertise on which to base an opinion. This clearly indicates a need for multidisciplinary teams for the study of military conflict.
More research is needed about the full impact of current military conflict on population health and medical care systems. The results of these studies should be applied to multidisciplinary, scenario-based projections of the health consequences of future actions. Medical and public health publishing has been transitioning to an open-access format that makes the findings of research reports available to all interested parties without charge. Perhaps greater dissemination of war research can be achieved as a result of this change in the publishing industry, broadening the dialogue about the health consequences of war.