Survival rates of battle casualties have steadily improved over the past 150 years thanks to the better care provided once an injured soldier reaches medical services. The conflicts in Iraq and Afghanistan differ in one respect from the past: for the first time there has been a significant increase in the proportion of injured being successfully treated at the point of injury. Adapted from the source document.
Abstract: The Nepal civil war (1996-2006) opposed a rural Maoist insurrection and a succession of monarchical regimes and governments. Despite a shift in perception of the conflict post 9/11, the conflict remained largely internal to Nepal with limited international involvement. Over that same period, health indicators in most domains recorded significant improvements including in the areas most affected by the conflict. Building on human rights datasets of violent incidents and systematic oral history in three regions affected to varying degrees by the conflict, this article argues that the health care facilities were instrumentalized by both sides of the conflict as one element of their political and military strategy, while medical practitioners had to juggle the demands of insurgents and security forces. Through 80 interviews conducted in 2020-2021 in situ, this article engages with the apparent paradox of a conflict which did not have detrimental effects on health care overall despite its violence. It then considers how the war, violence and mental health consequences of a decade of terror are now recalled and made sense of some fifteen years after the end of the war. With the former insurgents now running the new republic, grassroots militants remember the war in sometimes nostalgic ways when it comes to their centrality in the Maoist objectives and vision. The healthcare provisions arising from the war sometimes do not match some of the wartime resources deployed by insurgents and counterinsurgents keen to demonstrate their commitment to health provisions as a common good that needed to be made more accessible. Finally, this article reflects on the absence of the concept of attacks on healthcare in contemporary analyses, at a time when the concept was gathering support internationally. In this sense this article charters a paradox of violence and resourcing of health care as well as a pre-paradigm shift analysis of a seemingly outmoded political insurgency.
BACKGROUND: A key purpose of the International Health Regulations (IHR) is to prevent unwarranted interruptions to trade and travel during large and/or transnational infectious disease outbreaks. Nevertheless, such outbreaks continue to disrupt the travel industry. This aspect of the IHR has received little attention in the academic literature despite its considerable impact on affected States and commercial activity. This article outlines the challenges and gaps in knowledge regarding the relationship between outbreaks and the travel sector and discusses the opportunities for further research and policy work to overcome these challenges. METHODOLOGY: We conducted a literature review on the relationship between outbreaks and travel restrictions, with a particular focus on the 2014-16 Ebola epidemic in West Africa. This review was complemented by an expert roundtable at Chatham House and further supported by case studies and qualitative interviews. RESULTS: Numerous travel stakeholders are affected by, and affect, large-scale infectious disease outbreaks. These stakeholders react in different ways: peer pressure plays an important role for both governments and the travel sector, and the reactions of the media and public influence and are influenced by these stakeholders. While various data sources on travel are available, and World Health Organization is mandated to work with States, there is no recognized coordinating body to disseminate timely, consistent, reliable and authoritative information and best practices to all stakeholders. CONCLUSION: This article highlights the interdependent relationship between various travel stakeholders. The reasons for interruption of travel during the 2014-16 Ebola outbreak were complex, with decisions by States only partly contributing to the cessation. Decisions by non-state actors, particularly the travel industry itself, contributed significantly and were based on a variety of factors. Further research, analysis and policy development are required to mitigate the health and economic consequences of infectious disease outbreaks. Any further research will also need to take account of COVID-19 travel-related issues.
BACKGROUND: Since March, 2011, the Syrian civil war has lowered life expectancy by as much as 20 years. We describe demographic, spatial, and temporal patterns of direct deaths of civilians and opposition combatants from conflict-related violence in 6 years of war. METHODS: We analysed conflict-related violent deaths with complete information on date, place, and cause of death and demographic group occurring from March 18, 2011, to Dec 31, 2016, recorded by the Violation Documentation Center (VDC). We included civilian and combatant deaths in all Syrian governorates, excluding government-controlled areas. We did not include detainees and missing persons, nor deaths from siege conditions or insufficient medical care. We categorised deaths based on VDC weapon type. We used chi(2) testing to compare deaths from different weapons in civilian men, women, boys, and girls and adult and child combatants. We analysed deaths by governorate and over time. FINDINGS: The VDC recorded 143 630 conflict-related violent deaths with complete information between March 18, 2011, and Dec 31, 2016. Syrian civilians constituted 101 453 (70.6%) of the deaths compared with 42 177 (29.4%) opposition combatants. Direct deaths were caused by wide-area weapons of shelling and air bombardments in 58 099 (57.3%) civilians, including 8285 (74.6%) civilian women and 13 810 (79.4%) civilian children, and in 4058 (9.6%) opposition combatants. Proportions of children among civilian deaths increased from 8.9% (388 of 4254 civilian deaths) in 2011 to 19.0% (4927 of 25 972) in 2013 and to 23.3% (2662 of 11 444) in 2016. Of 7566 deaths from barrel bombs, 7351 (97.2%) were civilians, of whom 2007 (27.3%) were children. Of 20 281 deaths by execution, 18 747 (92.4%) were civilians and 1534 (7.6%) were opposition combatants. Compared with opposition child soldiers who were male (n=333), deaths of civilian male children (n=11 730) were caused more often by air bombardments (39.2% vs 5.4%, p < 0.0001) and shelling (37.3% vs 13.2%, p < 0.0001) and less often by shooting (12.5% vs 76.0%, p < 0.0001). INTERPRETATION: Aerial bombing and shelling rapidly became primary causes of direct deaths of women and children and had disproportionate lethal effects on civilians, calling into question the use of wide-area explosive weapons in urban areas. Increased reliance on aerial bombing by the Syrian Government and international partners is likely to have contributed to findings that children were killed in increasing proportions over time, ultimately comprising a quarter of civilian deaths in 2016. The inordinate proportion of civilians among the executed is consistent with deliberate tactics to terrorise civilians. Deaths from barrel bombs were overwhelmingly civilian rather than opposition combatants, suggesting indiscriminate or targeted warfare contrary to international humanitarian law and possibly constituting a war crime. FUNDING: None.
