MUSC panel looks at war’s toll on health care and world’s role in easing it

Beneath news coverage of missile strikes, devastation and death lies a less discussed aspect of armed conflict: its impact on health care systems, a problem that can have a years’-long effect. It’s playing out right now in Ukraine, a war that has made front-page news. But it’s also happening in other countries dealing with conflicts of their own. And a panel that spoke at the Medical University of South Carolina’s Global Health Week said people need to take notice.

Moderator Kevin O’Reilly, Ph.D., an adjunct associate professor in MUSC’s College of Medicine and a former epidemic intelligence service officer with the Centers for Disease Control and Prevention who also worked for the World Health Organization, led the discussion that focused on Syria, Ukraine and Ethiopia. The event was sponsored by MUSC’s Center for Global Health.

“We have three important prominent conflicts that are taking place in different areas of the world. They all are related in the fact that they are an affront to the human condition and they have an impact on human health and human wellbeing,” O’Reilly said.

 

The panelists showed how true that was. The first to speak, cardiologist Samer Jabbour, M.D., a professor of Public Health Practice at the American University of Beirut, co-chair of the Lancet-AUB Commission on Syria and founding chair of the Global Alliance on War, Conflict and Health, described the situation in his country of birth: Syria. It erupted in civil war more than decade ago.

“When hospitals started getting bombed just like many other civilian targets were bombed, Syrians made a passionate call saying this cannot continue and that Syrians and health care need protection.”

Up to 70% of Syria’s health care workers may have fled, according to a report in The Lancet. Doctor and drug shortages leave some people resorting to bribes to get the care they need.

“We knew from year one of the conflict that there will be huge number of casualties. Now, more than 11 years later, we are dealing with over 600,000. We don't want to see that anywhere else in the world. We can only prevent that through first acknowledging that global health has an important role to play in conflict prevention,” Jabbour said.

There are new initiatives to explore the role of health action in conflict prevention such as the World Health Organization’s Global Health for Peace Initiative.

“It's encouraging that we are seeing a resurgence of interest,” Jabbour said. “There's now more serious attention to conflict prevention, including at the UN under the secretary-general’s peacebuilding initiative. This is a big opportunity for global health to be part of this movement.”

 

Oleg Palygin, Ph.D., said his birth country needs help from the global health community, too. The associate professor in the College of Medicine at MUSC and the second panelist to speak is from Ukraine. Palygin, the SmartState Center Endowed Chair in Renal Disease Biomarkers, has family and friends there and sees the impact of Russia’s invasion on health care as dire.

“Almost all government hospitals and clinics are affected in Ukraine, and the private pharmacy sector is too, since many of the private pharmacies are closed. There’s a real shortage of medicine. This affects cancer patients. Most of the medicines for cancer patients are not manufactured in Ukraine. There are also diabetic patients who require insulin and a lot of medication. There are also people with chronic kidney diseases who are seriously affected, especially dialysis patients. They are in serious danger since they meet very often to visit the clinics.”

Palygin, who specializes in the study of kidney diseases, said there’s also a shortage of qualified health care providers and equipment as people cope with the war – and some flee. “At least 8 million or more will relocate in Europe, which probably means a humanitarian catastrophe because it’s very hard to accommodate so many people in a short time.”

And physical suffering isn’t the only concern for those people. “This impacts their mental health and their families and their future.”

But Palygin said other countries have stepped forward to strategize the best ways to help Ukraine. “And this involves two factors affecting people’s health. One is humanitarian aid. The second is supporting defensive initiatives. We have a lot of different private foundations and government foundations that will be able to help either the Ukrainian army or hospitals or refugees.”

 

Striking the right balance when it comes to aid was on the mind of the third panelist, too. Mulugeta Gebregziabher, Ph.D., is a professor and vice-chair for academic programs in the Department of Public Health Sciences at MUSC. He grew up in Ethiopia, where war broke out amid a power struggle and push for political reform in his home state of Tigray in late 2020.

Gebregziabher said people in Tigray have been cut off from the rest of the world for more than 500 days. “You have this blockade and siege that is kind of suffocating the people in that region, not to get any help, even if they get sick or get injured.”

In a commentary in a sister journal of The Lancet, Gebregziabher called war prevention and mitigation the public health imperatives of our time. During the MUSC Global Health Week discussion, he said more than 80% of the hospitals and health care sites in Tigray have been destroyed. “Can you imagine this cannot be an instance of war or a consequence of war that must have happened so deliberately. As I conclude, we need some call to action here, right?”

That call from Gebregziabher, speaking as a native of Ethiopia, went out to leaders around the world. “As you express solidarity with Ukraine and with the other wars that are going on around the world, I think it is important that we call up on our congressional representatives, we call up on senators to push for legislation to help stop the war, because civilians are really suffering from it,” he said,

“Health care is suffering from it. The government leaders are doing this with impunity – they aren’t meant to account for what they are doing. Without that, these wars are not going to stop.”

The moderator, O’Reilly, called the world a global village. “There are really no more localities. I mean, where everyone is so connected, it's really not possible to think about one issue somewhere that's not very relevant to another place, thousands of miles away.”

The conversation about the effects of war on human health was one of three panel discussions featured in this year’s Global Health Week at MUSC. The others focused on lessons learned during COVID-19 and global health equity.