Yara M. Asi is a non-resident fellow at DAWN and the author of How War Kills: The Overlooked Threats to Our Health. She is an assistant professor at the University of Central Florida in the School of Global Health Management and Informatics, and a visiting scholar at the FXB Center for Health and Human Rights at Harvard University, where she is co-director of the Palestine Program for Health and Human Rights.
By 2030 about half of the people living in extreme poverty around the world will live in a territory that is experiencing conflict. Social media has ensured that, from the comfort of your kitchen in Hamburg or Miami or Sydney, you can see the most horrific images of war in ways we never have before: a young boy's body washed up on the beach; an emaciated infant girl suffering from famine; a shell-shocked child sitting in an ambulance, face still matted with dirt and blood from the attack he survived.
Although these images are real representations of war, they can obscure other effects of war that are not as visibly traumatic. It is natural to see such physical trauma and feel moved by its presence. It is much more difficult to relate to the trauma of, for example, a statistical model showing a country losing its access to safe drinking water because of conflict-related actions. If we even happen to come across such a story, we feel sad, frustrated, even sympathetic—but these stories do not tend to go viral, and they rarely seem to drive policy decisions. As a result, so many things that we could do to make life better for so many people are not being prioritized.
Let me tell you a story about my family.
Ibrahim was, unmistakably, the family patriarch in a society where that still meant something. (I changed his name here to protect his privacy.) He knew everyone, he was quick and persuasive, and he knew how to get things done. In the West Bank, one of the two territories that make up the occupied Palestinian territories, knowing how to get things done has always been a vital skill for success. His father had died decades before, but even when his father was alive, Ibrahim was the son who went abroad to study, living first in France and then in the United States. Ibrahim was the one who pushed his father to allow his younger sister to be able to attend college in a different country—unheard of for women at the time. Ibrahim was a highly respected college professor, then a college administrator, and even briefly worked in government, in the education ministry. He had been married for decades to a successful architect, raising five children in an apartment building that his wife had designed. He could not walk down the streets of the city without hearing greetings from colleagues, friends or former students. By all accounts, Ibrahim was a success story in an environment where success was by no means guaranteed.
For conflict-affected populations, war is the ultimate determinant of health.
- Yara M. Asi
That sister whom Ibrahim had pushed to go to college abroad so many years before—my mother—was now sitting on her bed almost 7,000 miles away, crying. "How can this be happening?" she asked, distraught. "Not Ibrahim. No." I asked her if she knew what was wrong. She said that he had been feeling weak for a few days and then had suddenly collapsed. A stroke? A heart attack? "They don't think so," she told me. "Guillain-Barré syndrome. Do you know what that is? Do you know anything about it? What is it?"
I had just finished a master's program and had been planning to go to medical school or maybe train to be a physician's assistant, but I had never heard of Guillain-Barré. I googled it on my phone. It sounded bad, but I noted the words treatable and full recovery. I held up the phone for my mother, willing her to read the information through her tears. "It's okay, Mom, it's treatable." She tsked, and said, in a tone I recognized immediately, "Mush fi Falastin." Not in Palestine.
Today, more than a decade later, my uncle is fine. The patriarch lives on. Yet my mother was right: he wasn't going to get healthy in Palestine.
Without the special permits he obtained to enter a hospital in Israel, he might not have recovered. Had my uncle stayed in France or the United States, he would likely have undergone a scary, but short-lived, period of diagnosis and treatment. He wasn't from an elite or rich lineage; he grew up in a one-room stone home, sleeping on the floor with his two brothers, three sisters (including my mother), and their parents. They washed their own clothes by hand and chased down the chickens they planned to eat on the one or two days a week they could afford meat. Like so many born into an unforgiving environment, my uncle went abroad to pursue his education. But to build a life, he eventually chose to move back to a place that had been experiencing violence, restriction and deprivation for his whole life. He does not think he will live long enough to see it get any better.
When my uncle fell ill, I of course knew that my home country was technically undergoing what most people called conflict, although fortunately there weren't many active bombing campaigns in the West Bank anymore. I'd written several papers about it for school history fairs—even making it to the county history fair once—and gotten raised eyebrows from several teachers when I proudly presented my middle-school mind's understanding of what was, even then, one of the longest and most polarizing settings of armed conflict in modern times.
We went back to the West Bank regularly during summer breaks, in true diaspora fashion. I'd been stopped on the street by soldiers and questioned during my visits; border agents had leafed through my Baby-Sitters Club books, tucked carefully into my pink "Going to Grandma's" suitcase. (This was pre-iPad and before planes had installed an individual TV for every seat—you needed a lot of books for that plane ride.) I'd been stopped at countless checkpoints, been questioned by hostile soldiers holding rifles, seen military jeeps racing through the streets of my grandmother's village. From these occasional experiences, I thought I knew what war could look like.
In the early 2000s, during the second Intifada (Arabic for "uprising"), we took a few years off from visiting. Even then, I didn't fully understand why. Each summer during that period, I'd ask my mother if we were going. She'd tsk in that way of hers: "It's bad there right now." That was usually the end of the conversation.
What I've learned in the years since I was a child—split between what seemed like two different planets—is that war is the greatest threat to human health and well-being, even in places where the wars themselves are not fought.
- Yara M. Asi
My book How War Kills: The Overlooked Threats to Our Health is my effort to capture the multifaceted effects of war and conflict on the health of civilian populations, focusing on contemporary conflicts but also drawing from recent and distant history to help us understand how we got to this moment. What I've learned in the years since I was a child—split between what seemed like two different planets—is that war is the greatest threat to human health and well-being, even in places where the wars themselves are not fought. The most obvious effects of war on health arise from what we might refer to as direct violence: bombing, shooting, kidnapping, torture and so on. In addition to this direct violence, I highlight the structural barriers to health that are almost purely political: the physical or administrative blocking of the movement of patients, providers or medical goods; the inability of civilians to secure nutritious food or engage in healthy behaviors; and the heightened risk of infectious disease as vulnerable populations cluster or move into new areas.
For conflict-affected populations, war is the ultimate determinant of health. Yet even in developed and mostly peaceful societies, overly militarized perspectives on defense and security have shifted trillions of dollars toward maintaining and expanding a military presence. These funds could instead be used to fill gaps in housing, food and water security, education and direct health services. As long as the relationship of health to war is one of response—that is, ministering to physical or mental trauma only after the fact—we will miss out on the potential of health care and health system stakeholders to not only prevent war, but reduce human suffering more broadly.
Editor's note: This essay is adapted from How War Kills: The Overlooked Threats to Our Health by Yara Asi. Copyright 2024. Published with permission of Johns Hopkins University Press.
