Health: A political choice
Interview with Dan Smith, former executive director, SIPRI
How have the threats to human security increased from the rising deadly conflicts in the world since 1989?
In 1990 there were about 50 armed conflicts in the world. By 2010 there were 30, and in 2025 there are over 60. So for two decades the global zone of peace expanded: fewer wars lasting less long, and the number of people killed was declining.
In the second decade of this century, the numbers of people killed in armed conflicts and refugees from armed conflicts doubled. However, data on people killed in war is notoriously unreliable. It is exaggerated on one side, played down on another side, there’s pure fiction on the third side, and ‘who gives a damn’ on the fourth side. So we’re really dealing with factoids and estimates.
There are also the wounded and the injured. More people are injured in armed conflict than are killed, and some injuries are life changing, involving amputations or severe damage to organs including the brain. Another category is the indirect effects of armed conflicts. Hospitals, food systems, and sanitation and sewage systems are destroyed. The general health of people suffers, so other infections take a toll, during the war and in its immediate aftermath. Indirect deaths after armed conflicts match or exceed the number of people who die directly. The same is true for combat deaths.
How much have these conflicts harmed the lives and health of people?
It’s extremely difficult to think of an armed conflict that doesn’t harm civilians. Cities are often a target, so you tend to get more civilian casualties. In some wars atrocities against civilians are a deliberate weapon to cause terror or force them to move, or because that ethnic or national group is seen by some of the parties as what the war is really about. There may be a war objective to kill or rape everyone of that ethnicity.
Women and children form a disproportionately large segment of the population in refugee camps. They’re actually the ones who have successfully run away. Disproportionately fewer men are in refugee camps because they stayed behind to protect their property, joined the fighters or have already been killed. There is an enormous impact on women and children, but that doesn’t mean men get away lightly.
When you consider the psychological and sociological impacts, people live with the imprint of violent conflict for decades after the fighting has stopped. That can be because you saw something horrible or experienced something utterly terrifying. But it can also be because your chances of having a normal childhood have all been blown apart by the war. If you are in eastern Congo you may keep your children – especially the girls – home because you don’t want them getting raped on the way to school. And the physical harm can have a psychological impact, and the psychological impact can also have a physiological impact in later life, even if peace returns.
What are the particular challenges facing us today?
In those countries where –through the democratic process – it is possible for ethics and morality and international law and care for other people to be understood as a necessary part of a well-functioning international society so that we can all live in peace and prosperity, it is essential that politics starts to reorient itself back in that direction. Our political thinking and political philosophy need to shift back to understanding that we live in communities, national societies and an international society where we do better if we all do well. The environmental crisis including climate change, health issues such as the next pandemic, international crime and international terrorism, the technological revolution – these challenges can only be resolved by international cooperation.
Many middle powers are indeed democratic. If they can develop a unity in their cooperation, they can push forward on different fronts. The collapse of the plastics treaty discussions in August is terrible in terms of the natural environment and human health because micro plastics are in every organ of the body, including our brains and mothers’ milk, and they interrupt photosynthesis in plants so there could be food security shortages. It’s also damaging to international security. But if we could move forward on the plastics treaty, that would contribute to restraining the ecological crisis unfolding before our eyes, and to human health, and also to peace. There’s a unity in the problems and therefore the solutions. You can’t disentangle them completely. Climate change exacerbates the risk of violent conflict, violent conflict is bad for human health, declining human health increases the risk of violent conflict, which is bad for the environment and makes climate change worse. The interconnection is always the key.
What key political choices must be made?
Many leaders act on the basis of what they see as the national interest. If you have problems that can only be resolved by cooperation, then the national interest is the same as the global interest. So the national interest is expressed by cooperating. If we were able to generate action along those lines – of course it takes time for the positive effects to feed through – we would move forward again on the environmental crisis, on human health because we would have better reaction times when the next pandemic emerges, and on security because we would have fewer issues dividing us and more ways to work together. We would get back to where we were before.
The real message of hope is that we did it before. There’s no reason why we can’t do it again. If we manage to reconstruct that cooperation, it will have all sorts of dividends: education will improve, there’ll be more law and order, the terrorism threat will go down, and public health will improve.
