When war reaches the ward

The chain of conflict has been relentless, even in the second decade of this millennium. Afghanistan’s state collapse after the Taliban takeover in August 2021 pushed its health system into a severe funding and service crisis. In February 2022, Russia’s invasion of Ukraine disrupted access to medicines and routine care across an entire region. In September 2022, conflict-ridden Syria declared a cholera outbreak, a predictable consequence of damaged water and sanitation systems. In September 2023, Azerbaijan’s operation in Nagorno-Karabakh displaced more than 120,000 people into Armenia, straining already fragile health services. In April 2023, Sudan descended into civil war, followed by cholera outbreaks in 2024. In October 2023, Gaza entered a devastating phase of war that by 2024 saw the re-emergence of poliovirus in wastewater and a paralysed child, signalling the breakdown of immunisation.

Alongside this, recurring instability across the Afghanistan–Pakistan region has continued to disrupt vaccination efforts in one of the last global reservoirs of poliovirus, while wider tensions following the United States’ and Israel’s conflict with Iran in West Asia this year, have expanded the geography of instability. These wars did not merely produce immediate casualties. They dismantled the systems that prevent disease. Water supply failures, collapsed sanitation, interrupted vaccination, and weakened surveillance allowed cholera, measles, and polio to return.

Law and breach

International Humanitarian Law, rooted in the Geneva Conventions, clearly states that hospitals, ambulances, medical units, and healthcare workers must be protected at all times. Civilians must not be targeted, and care must be provided without discrimination. Yet, in modern conflicts, these protections are repeatedly violated. Hospitals are damaged, surrounded, or rendered non-functional, and healthcare workers are killed, detained, or displaced. What should be neutral spaces of care are drawn into the battlefield. Attacking healthcare weakens entire populations and reflects not strength but a form of tactical cowardice, targeting those who heal rather than those who fight.

After the bombs

The serious consequence of war is often not immediate death but the collapse of systems that prevent disease. Water treatment fails, sewage systems break down, and safe drinking water becomes scarce. Immunisation programmes are disrupted, cold chains collapse, and disease surveillance systems fail. In such conditions, outbreaks become inevitable. Cholera resurfaces when sanitation fails. Measles spreads rapidly among unvaccinated children. Poliovirus reappears when vaccination coverage declines. War creates the perfect conditions for epidemics by dismantling the barriers that once kept them in check.

The visible violence of war masks a larger, more complex reality. Weapons do not cause most deaths in war.: deaths occur due to indirect causes such as infections, malnutrition, and lack of access to healthcare. These deaths are difficult to measure because they occur outside hospitals and often go unrecorded. In conflicts such as that in the Democratic Republic of the Congo, the vast majority of deaths were due to such indirect causes. This makes war not just a military crisis but a prolonged public health emergency.

The impact of war extends deeply into the management of chronic diseases. Patients with diabetes lose access to insulin when supply chains are disrupted. Those with hypertension miss medications and present later with stroke or heart failure. Cancer treatments are interrupted, often with irreversible consequences. Hospitals that remain functional become overwhelmed with trauma cases, forcing the neglect of routine and chronic care. Conditions that are otherwise manageable become life-threatening.

Camps and crowding

Displacement transforms war into a full-scale public health disaster. Millions are forced into overcrowded camps or temporary shelters where hygiene is poor and access to clean water is limited. In such environments, infectious diseases spread rapidly. Respiratory infections move quickly through crowded spaces. Diarrhoeal diseases flourish due to unsafe water. Vector-borne diseases increase as environmental conditions change. The breakdown of surveillance systems delays outbreak detection, allowing them to spread unchecked.

Women and children bear a disproportionate burden during conflict. Antenatal care becomes inaccessible, skilled birth attendance declines, and emergency obstetric services are delayed or unavailable. This leads to increased maternal mortality, low birth weight, and neonatal deaths. At the same time, food systems collapse, leading to widespread malnutrition among children and pregnant women. Malnutrition weakens immunity and increases vulnerability to infections, creating a vicious cycle of illness and deprivation.

Post-war scars, risks

The psychological impact of war is profound and long-lasting. Exposure to violence, displacement, and loss leads to increased rates of post-traumatic stress, depression, and substance use. Children growing up in such environments experience disruptions in emotional and cognitive development. These effects extend into adulthood, shaping the health and well-being of future generations. The end of fighting does not restore health systems. Infrastructure must be rebuilt, healthcare workers must return or be replaced, and surveillance systems must be re-established. Outbreaks that began during the conflict may continue. Malnutrition and developmental deficits persist among children. The effects of war extend across years and often generations.

War also reshapes the environment, directly affecting health. Explosions release pollutants into the air, contributing to respiratory illness. Water sources become contaminated due to damaged infrastructure and waste leakage. Land may be polluted with chemicals and debris. These environmental changes prolong disease transmission and create long-term health risks even after the conflict subsides.

Prioritising protection of healthcare

War is not only a geopolitical event. It is a systemic collapse of the health system. International Humanitarian Law provides a clear framework to protect healthcare, yet repeated violations show that these principles are not upheld. Preventing war remains the most effective public health intervention. Even during conflict, protecting healthcare systems, ensuring vaccination, maintaining water and sanitation, and safeguarding health workers are essential. The absence of headlines does not mean there is no harm. The true cost of war unfolds quietly, in empty clinics, untreated illness, and preventable deaths.

(Dr. C. Aravinda is an academic and public health physician. The views expressed are personal. aravindaaiimsjr10@hotmail.com)

Published – April 07, 2026 07:17 pm IST