Module 11: Women, Children, War, and Health

Health Effects of War

Throughout the developed and developing world, conflict is a constant threat to psychological and physical well-being.  Not only does it funnel limited resources and funding away from health care and disease prevention, it creates new and severe health problems. (1)  For example, in Bosnia, the proportion of military and civilian surgeries due to war related trauma rose from 22% to 78% in the city’s major hospital during the first 6 months of the war in 1992. This substantial increase overwhelmed the medical services. In the same period, infant and child mortality nearly doubled, and newly diagnosed tuberculosis cases quadrupled.(2)

“When conflict is extended, public health activities, including immunization and surveillance systems, can be substantially reduced, dismantled and destroyed, as happened during recent conflicts in Rwanda, Sudan, Liberia, Chechnya, and Iraq.” (3)

In fact, during the 20th century, forty-four of every one thousand people died of direct and indirect war-related causes.(4)   Such large casualties may be the result of recent warfare tactics—civil conflicts within countries have no distinct boundaries, and fighters target civilians to kill, rape, and terrorize.(5)   These tactics have been witnessed throughout the world, particularly in conflicts in the Congo, Sierra Leone, and Rwanda.

It is essential to consider the diverse factors that impact health during war.  The World Health Organization defines health as not only the absence of disease but also the presence of social wellbeing, and physical and mental health.(6)  This holistic notion implies that environmental and social factors such as housing, food, education, and a sense of safety from sexual and physical violence are important determinants of health and well-being.(7)  Thus, the health effects of war extend beyond reported mortality and morbidity figures.

“It takes us out of the clinic to look for evidence of physical, mental, sexual, spiritual, and social harm within the multiple environments of deprivation and violence that accompany war and that can fester and worsen during post-conflict periods.”(8)

Child Soldiers

The phenomenon of child soldiers has exploded in areas of political instability and civil warfare in the developing world, and there have been devastating consequences.  Human Rights Watch outlines important facts: (9)

• The exact figures are unknown, but hundreds of thousands of children under the age of 18 serve in government forces or armed rebel groups.

• The majority of the world's child soldiers are involved in a variety of armed political groups.

• Some child soldiers are as young as eight years old and most child soldiers are aged between 14 and 18.

• While many enlist "voluntarily," research shows that such adolescents see few alternatives to involvement in armed conflict. Some enlist as a means of survival in war-torn regions after family, social and economic structures collapse, or after seeing family members tortured or killed by government forces or armed groups. Other children join because of poverty and lack of work or educational opportunities. Many girls have reported enlisting to escape domestic servitude, violence and sexual abuse.

• Forcible abductions, sometimes of large numbers of children, continue to occur in some countries.

“Their tasks can vary, from combatants to cooks, spies, messengers and even sex slaves. Moreover, the use of children for acts of terror, including as suicide bombers, has emerged as a phenomenon of modern warfare. Each year, the UN receives reports of children as young as 8 or 9 years old associated with armed groups.

No matter their role, child soldiers are exposed to acute levels of violence – as witnesses, direct victims and as forced participants. Some are injured and have to live with disabilities for the rest of their lives.” (10)

In addition to physical injuries and a variety of other health problems such as malnutrition and poor hygiene, child soldiers are emotionally and psychologically affected. (11)   For example, a study in Nepal showed that former child solders were more likely to have severe mental health problems (posttraumatic stress disorder, depression, etc.) than other children in Nepal who were not forced into military service.(12)  As children continue to be abducted and exploited all over the world, there is an increasing need for mental health interventions for child soldiers.

Women, War, and Rape

Many aspects of war affect women and girls disproportionately.  According to recent studies on life expectancy among unarmed civilians caught in armed conflict, women are the primary adult victims of war. (13)  For example, a unique harm of war on women is the trauma inflicted by military brothels, rape camps, sex trafficking for prostitution, and increased domestic violence.  In addition, widows of war and women refugees of war are particularly vulnerable to poverty, prostitution, and higher illness and death following armed conflict.  Furthermore, it has been documented that senior officers of war have commonly accepted and sanctioned the sexual exploitation of local women by military men. (14)(15)(16)

“Rape and sexual exploitation in war have been systematically disregarded (even when documented) as war atrocities and crimes until the recent revelations of the genocidal rape of Muslim women during the conflict in the former Yugoslavia and of Tutsi women in Rwanda.” (17)

Reasons Why Militarism is Bad for Women (18)

A publication by the Population and Development Program at Hampshire College outlines the severe and significant consequences of war on women:

• Massive numbers of women civilians are killed and injured in modern warfare.

• Widows of war are displaced, disinherited, and impoverished.

• Women and children are the majority of war refugees.

• Rape, sexual torture and sexual exploitation are fueled by war.

• Women and girls are sexually exploited by aid workers and UN peacekeepers in post-conflict areas.

• Women and girls are at higher risk of STDs, including HIV infection, from soldiers and peacekeepers.

• Poor women and their children lose health, housing, education and welfare services due to war-related pressures on services and the priorities of the military budget.

• Women suffer higher rates of domestic violence from military husbands and partners.

• Women are exposed to toxic chemical weapons and environmental contamination during and after war and from military activities.

In order to reduce these negative consequences, it has been suggested that more female candidates be present in post-conflict elections, that there be a greater role for women in peace-making and post-conflict reconstruction efforts, and there should be more appointments of women to peacekeeping and diplomatic posts. (19)

Footnotes

(1) Eban K. (2002). Waiting for bioterror: Is our public health system ready? The Nation, 275(20), 11 –18.

(2) Toole M, Galson S., Brady W. (1993). Are war and public health compatible? The Lancet, 341, 1193– 1196.

(3) Hynes, H. P. (2004, November). On the battlefield of women's bodies: An overview of the harm of war to women. In Women's Studies International Forum (Vol. 27, No. 5-6, pp. 431-445). Pergamon.

(4) Garfield R., & Neugut A. The human consequences of war In: Barry S. Levy and Victor W. Sidel, Editors, War and public health, American Public Health Association, Washington, DC (2000), pp. 27–38.

(5) Renner, M. (1999). Ending violent conflict. Worldwatch Institute.

(6) Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.

(7) Wilkinson R., Marmot M. (Eds.) (2003). Social Determinants of Health: The Solid Facts. Geneva, NY7 World Health Organization.

(8) Hynes, H. P. (2004, November). On the battlefield of women's bodies: An overview of the harm of war to women. In Women's Studies International Forum (Vol. 27, No. 5-6, pp. 431-445). Pergamon.

(9) Human Rights Watch. "Facts about Child Soldiers." (Dec. 3, 2008) https://www.hrw.org/news/2008/12/03/facts-about-child-soldiers#. See also, United Nations Office of the Special Representative to the Secretary-General for Children and Armed Conflict. "Child Recruitment and Use." https://childrenandarmedconflict.un.org/six-grave-violations/child-soldiers/.

(10) United Nations Office of the Special Representative to the Secretary-General for Children and Armed Conflict. "Child Recruitment and Use." https://childrenandarmedconflict.un.org/six-grave-violations/child-soldiers/.

(11) Lorey, M. (2001). Child soldiers: Care & protection of children in emergencies, a field guide. Save the Children.

(12) Kohrt B., Jordans M., Tol W., Speckman R., Maharjan S, Worthman C, Komproe I. The Comparison of Mental Health Between Former Child Soldiers and Children Never Conscripted by Armed Groups in Nepal JAMA. (2008). 300[6]: pp. 691-702.

(13) Ashford, M. W., & Huet-Vaughn, Y. (1997). The impact of war on women. War and public health, 186-196.

(14) Barry K. (1995). The prostitution of sexuality: The global exploitation of women. New York; New York University Press.

(15) Brownmiller S. (1975). Against our will: Men, women and rape. New York; Simon and Schuster.

(16) Moon K. (1997). Sex among allies: Military prostitution in U.S.–Korea relations. New York; Columbia University Press.

(17) Hynes, H. P. (2004, November). On the battlefield of women's bodies: An overview of the harm of war to women. In Women's Studies International Forum (Vol. 27, No. 5-6, pp. 431-445). Pergamon.

(18) Hynes, H. P. (2003). 10 Reasons Why Militarism is Bad for Women. Population and Development Program at Hampshire College.

(19) Rehn E., & Johnson Sirleaf E. Women, War and Peace: The Independent Experts' Assessment on the Impact of Armed Conflict on Women and Women's Role in Peace-Building. United Nations Development Fund for Women. 2002.