War, refugees, migration, and public health: Do infectious diseases matter?

This chapter addresses the various ways in which increasing world conflict, war, refugees, population migration, and the political and developmental inequities of these factors influence risk to infectious disease. There are many parallel factors occurring on the global front that may adversely affect capacity of public health to respond and protect the population it serves. Political violence, civil war, ethnic and religious conflicts, and in particular, the generation of millions of refugees by forced migration are obvious factors that are changing the balance between human beings and microorganisms (Pirages, Runci, &Sprinkle, 2001). Competing with public health's capacity to mitigate the effects of forced displacement are demographic and ecological factors such as increased population growth and density, urban migration and urbanization, failures of governance and the protection of public health infrastructures, human invasion of the habitats of animals and arthropods, and population induced environmental change. Furthermore, because of post 9/11 preoccupation and anxiety with what advanced biotechnology easily provides to the arsenal of militaries and to those singularly disposed to wreck havoc on an unwary population for political purposes, most of these new disease outbreaks are first thought to have been the result of a deliberate release of an infectious agent. Indeed, whether these bioevents, accidental or deliberate, result in risk to populations locally, nationally, regionally or internationally lies squarely on the capacity of public health and a nation-state's capacity to ensure public health viability. However, public health can no longer be narrowly confined to aspects of preventive healthcare. Increasingly 'public health' is understood in the context of multidisciplinary and multi-sector capacities of governance and political will, economics, judiciary, public safety, quality of public health utilities, health security, agriculture, communication, transportation, education and training, and other capacities that allow a village, town, city, and nation-states to functionally protect its citizens (Burkle, 1999).