Have you ever thought that the term “cease fire” can be misleading sometimes? While this term has been excessively used in an optimistic context, one may feel it implies a full solution for war and its upbrought sufferings. In fact, although it is the very first step toward a greater resolution, it is also, in many cases, the starting point in unveiling many war-related issues that should be addressed properly. Public health, for instance, is highly affected by war-induced trauma, displacement, prolonged stress, lack of basic needs, medical access, among others [1].
One of the public health issues investigated in correlation to war is infectious diseases, however less efforts are directed toward investigating the non-communicable diseases (NCD) arising by war conditions. According to the World Health Organization (2023), NCDs account for more than 70% of global deaths annually. In the Eastern Mediterranean Region specifically, both natural and manmade conflicts are causing increased mortality and morbidity rates of NCDs [2]. Looking at the conflict history of the Middle East generally and Lebanon specifically, it is shown that the discussion of such research topics is very vital.
The ways war can contribute to NCD incidence are many, with stress being one of the most known factors. Despite war, we know that a large portion of NCDs are stress-related, like coronary artery disease (CAD), diabetes, neuropsychiatric diseases and chronic gastrointestinal diseases [3]. Research conducted on the impact of stress from the Lebanese Civil War on CAD revealed a positive correlation [4]. Similar results were shown among Syrian refugee patients across Jordanian hospitals [5]. Another example is stress-induced mental disorders. The investigation of armed conflicts induced psychological disorders showed that war victims are vulnerable to developing an array of neuropsychiatric disorders like PTSD, depression and anxiety disorders [6].
In addition to stress, other risk factors of NCD may be amplified or driven through war conditions. These include alterations in diet and physical activity due to displacement, and increased consumption of alcohol and tobacco due to elevated anxiety levels [7].
On the other hand, the disruption of the healthcare systems during conflicts can exacerbate existing chronic non-communicable conditions [8]. The Lebanese healthcare system, already weakened by the country’s economic challenges, is now under extreme pressure due to the recent military escalations. The fragile healthcare system, as WHO director general described it, was seriously disrupted after the pager attack on various Lebanese governorates [9]. Today, after the great military expansions, many hospitals are either out of service or limited to emergency works, especially those in conflict areas. Unfortunately, within such circumstances the management of NCDs including detection, screening, treatment and palliative care [7] are either hard or impossible, especially for low-income patients. In cases of prolonged conflicts this may lead to increase rate of premature NCD-related deaths.
On a scientific level, expanded research on this topic is needed. More importantly, emergency humanitarian policies should be updated and implemented as soon as possible. The plan should be comprehensive, considering available resources, various stakeholders, sustainability, and ethical factors to prioritize populations and NCDs most in need [8]. Although challenging, using preexisting emergency plans developed by the Ministry of Public Health, alongside the experiences of other countries and the assistance of international health organizations, can help establish policies to mitigate current constraints as effectively as possible.
References
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Webster, P., & Neal, K. (2022). War and public health. Journal of Public Health, 44(2), 215–216.
https://doi.org/10.1093/pubmed/fdac060 -
Administrator. (n.d.). Noncommunicable diseases in fragile and conflict-hit settings. World Health Organization – Regional Office for the Eastern Mediterranean.
https://www.emro.who.int/media/news/noncommunicable-diseases-in-fragile-andconflict-hit-settings.html -
Fricchione, G. L. (2018). The challenge of Stress-Related Non-Communicable Diseases. Medical Science Monitor Basic Research/Medical Science Monitor. Basic Research, 24, 93–95.
https://doi.org/10.12659/msmbr.911473 -
Sibai, A. M., Armenian, H. K., & Alam, S. (1989). WARTIME DETERMINANTS OF ARTERIOGRAPHICALLY CONFIRMED CORONARY ARTERY DISEASE IN BEIRUT. American Journal of Epidemiology, 130(4), 623–631.
https://doi.org/10.1093/oxfordjournals.aje.a115384 -
Al-Makhamreh, H., Alkhulaifat, D., Al-Ani, A., Mafrachi, B., Saadeh, A., Al-Ani, H., Hani, A. B., & AlRyalat, S. A. (2021). The Impact of War-Related stress on coronary artery disease severity in war survivors: a SYNTAX study. International Journal of Environmental Research and Public Health, 18(6), 3233.
https://doi.org/10.3390/ijerph18063233 -
Jain, N., Prasad, S., Czárth, Z. C., Chodnekar, S. Y., Mohan, S., Savchenko, E., Panag, D. S., Tanasov, A., Betka, M. M., Platos, E., Świątek, D., Krygowska, A. M., Rozani, S., Srivastava, M., Evangelou, K., Gristina, K. L., Bordeniuc, A., Akbari, A. R., Jain, S., … Reinis, A. (2022a). War Psychiatry: Identifying and managing the neuropsychiatric consequences of armed conflicts. Journal of Primary Care & Community Health, 13, 215013192211066.
https://doi.org/10.1177/21501319221106625 -
World Health Organization: WHO. (2023, September 16). Noncommunicable diseases.
https://www.who.int/news-room/factsheets/detail/noncommunicablediseases -
Allen, L. N., Aghilla, M., Kak, M., Loffreda, G., Wild, C. E. K., Hatefi, A., Herbst, C. H., & Saeh, H. E. (2022). Conflict as a macrodeterminant of non-communicable diseases: the experience of Libya. BMJ Global Health, 7(Suppl 8), e007549.
https://doi.org/10.1136/bmjgh-2021-007549 -
Exploding radios in Lebanon disrupt its fragile health system, WHO says, Reuters.
https://www.reuters.com/world/middle-east
