On not looking away from less visible global conflicts

Creating a healthier world must include paying attention to the many underdiscussed wars happening throughout the world.

The world has been appropriately riveted in the past few years by two very visible conflicts: the war in Ukraine, provoked by Russia, and the war in the Middle East, provoked on October 7 by Hamas’ horrific incursion into Israel and then perpetuated by Israel’s ongoing retaliatory attacks on Gaza. I have written extensively about both wars and they have captured the public’s attention, and rightly so, given both the enormous implications they have for global stability, and the tragedies they have wrought on people living in Ukraine, Gaza, and Israel. However, I have also acknowledged that our attention to these conflicts should not, must not, mean that we look away from other conflicts that are equally as devastating for the people in other areas whose lives have been upended by war. It is sometimes difficult, perhaps next to impossible, to recognize that regions that we have grown accustomed to seeing through the lens of war were once areas where, before the war, people lived their daily lives as we do, going to school, to work, playing in parks, falling in love, getting married, becoming sick, dying with dignity. All of these are aspects of living, and they have been disrupted by war and conflict in so many areas, some of which we do not think about or keep in our minds anywhere near as much as we should.

For this reason, it seems appropriate to take a moment to think about some of the conflicts, both new and longstanding, which have not received the attention they deserve. Working to create health means not turning away from suffering, and doing all we can to mitigate it when it occurs. With this in mind, let me here simply point our attention to a few of the global flashpoints where we are seeing suffering in this moment. I will then suggest what we might do, to the extent we can, to help mitigate the pain we are seeing, consistent with our mission to create health.

I will begin with the situation in Haiti. In recent weeks, Haiti has erupted into full scale violent conflict. Following decades of instability, which itself has roots in colonial conquest, slavery, and the exploitation of Haiti for its resources by France, the 2021 murder of a sitting president was part of a tumultuous series of events that led to a full scale dissolution of authority and near takeover of the country by brutal gangs. In recent days, the gangs have attacked and looted parts of Port-au-Prince, seizing much of the Haitian capital. As the situation continues to deteriorate, the legacy of colonialism and foreign intrusion in Haitian affairs has complicated attempts to shape a humane, equitable international response.

Shifting focus to Africa, Sudan has collapsed into anarchy and near-complete dissolution of civilian authority. Following the fall of long-time dictator Omar al-Bashir, two forces, the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF), a paramilitary group, have been vying for power and authority in an increasingly horrific war. Khartoum, the capital, which was named the Arab Capital of Culture in 2005, has been the site of brutal conflict as the warring groups fight for dominance. This conflict has already had a devastating effect on the region and will likely continue to do so in the years to come. Wars do not just harm populations in the moment, causing much injury, death, and destruction. Their mental and physical consequences ripple across time and generations. A little over a decade ago, I was part of a team that studied PTSD in Nimba County, Liberia, about twenty years after a civil war in the region. We found that nearly a generation after the fighting, PTSD patterns in the region roughly matched where the violence had occurred all those years ago. There is no reason to think those suffering from war in the present will not live with similar long-term consequences.

In addition to conflicts in Haiti, Sudan, Israel and Gaza, there are ongoing wars in Syria, Myanmar, Somalia, and Yemen. In Syria, a 13-year-old civil war has killed over 500,000 people and kept violence an ever-present factor in the lives of the country’s population. In Myanmar, a 2021 military coup set in motion an uprising that has become a civil war that has so far killed an estimated 50,000 people. In Somalia, the Al-Shabaab terrorist group has been at war with the Somali government, in a conflict that has killed thousands. In Yemen, fighting between Houthi rebels and a Saudi-led coalition, which began in 2014, has created conditions of violence, poor health, and famine that have led to the deaths of an estimated 377,000 people and displaced millions.

These wars have a few elements in common. First, most proximally, they represent enormous loss of life, and the disruption of daily life for millions, with attendant risk of long-term physical and psychological consequences. They also represent the limiting of opportunity for children moving into adulthood, the curtailing of ambition and hope for so many adults, the dissolution of human autonomy, aspiration and dignity, and the crushing of the spirit and the soul. Second, more distally, all of these conflicts are based on injustices, history, and competing present-day influences. Many of them have roots in colonial conquests and the influence of larger, better-resourced countries who have seen these conflicts as utilitarian means to achieve their own geopolitical ends. Third, they have all failed to capture the sustained attention of the broader world, existing largely as footnotes in US-based and western media, crowded out by other more visible wars and more parochial concerns of local and national politics and the demands of day-to-day living. 

None of this is meant as a criticism of our attention or that of the these-days-much-maligned media. There is, after all, only so much news that anyone can consume, so many stories one wants to read about suffering and injustice, and only so much that even the best intended media can keep writing about without readers—being, as we all are, human—simply turning away. But it is this very inattention in the broader public that pushes those of us in health towards our responsibility not to look away.

Not looking away means doing our bit to keep alive the presence of these conflicts in our minds, in our spaces, and, as relevant and when possible, in public spaces. The despair that can grip us with awareness of these conflicts is indeed real. Because, after all, what can we do from our spaces which are blessed not to be in the middle of conflict zones? How could we possibly do anything that makes a meaningful difference in the face of such violence and loss of life? 

Without meaning to unduly elevate our role, and recognizing indeed that our direct engagement with ending conflicts is limited, I fall back, again, on what I have previously written about what we must do when faced with rank injustice, and, in particular, with injustice that spills over into conflict and the direct devastation of so many lives.  

We can first look for ways to support those who are helping. This is often tricky, but there are organizations who are providing aid, who are being helpful on the ground, and, insofar as we are able to support them, that seems right by our responsibility as global citizens. Second, it seems central to our work to continue to bear witness within our spaces. Because we know that global action to help relieve suffering happens when the world’s attention is captured by an event, by a conflict, by narratives, and that the window of what we talk about as a world does shift when we push ideas and stories forward. And we, in health, have a responsibility to do so by leveraging the role of health to tell the stories of those whose health is being foreshortened, as it is in conflict zones. And, third, our work should centrally be about the long arc of history, about creating a world that considers what was once acceptable, unacceptable, and that requires a muscular engagement of health, and a commitment to a radical vision, yes, but also to the hard work of incremental change, so that the conversation will change and the conditions that underpin these conflicts—colonial impulses, extraction of resources from those more vulnerable, cynical advancing of narrowly focused interests—become, over time, unacceptable. And that requires all our work—our patient, determined effort—over the long-term.   

A final note: one of the challenges with thinking of these conflicts is the risk of weighing moral equivalences, of trying to decide whether one conflict, one injustice, matters more than another. While, of course, we are drawn to larger scale devastation—as perhaps we should be—we should never be in the business of comparing suffering. A life is a life is a life, whether it is ended by a conflict or has its opportunity foreshortened. I have written before that our role is to take a side—that of our shared humanity—and to reinforce, as much as possible always, that at the heart of conflict are people, just like us, who deserve, as much as we do, the chance to live full, rich lives. And that, surely, should be something we all agree on.

A version of this essay was published as a note to the Boston University School of Public Health community.

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Also this week.

I enjoyed speaking with J. Stephen Morrison during the latest episode of the CommonHealth Live! series.

A new publication in JAMA Network Open with Mohammed Abba-Aji, Angela Moreland, Salma Abdalla, Caitlin Rancher, Faraday Davies, and Dean Kilpatrick on the prevalence and risk factors of depression and PTSD after a mass shooting.

I recently had the pleasure of joining The Pulse podcast to speak with Maiken Scott about Within Reason.