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Wars can give rise to disease outbreaks. This poses potential risk to public health in the U.S. too

Smoke rises following an Israeli airstrike in the Gaza Strip, moments before the start of a temporary cease-fire between Hamas and Israel, as seen from southern Israel, Friday, Nov. 24, 2023.
Leo Correa
Smoke rises following an Israeli airstrike in the Gaza Strip, moments before the start of a temporary cease-fire between Hamas and Israel, as seen from southern Israel, Friday, Nov. 24, 2023.

Hundreds of thousands of people have been killed in the Russia-Ukraine War and now thousands more are killed and millions face a humanitarian crisis as Israel’s war in Gaza rages on. But war doesn’t just spread death by conflict –– it can also kill by allowing diseases to spread with consequences that can cross borders.

Side Effects Public Media’s Farah Yousry spoke with health reporter Stephen Langel at member station Ideastream Public Media in Ohio about this.

The transcript of the interview has been edited for style and clarity.

Farah Yousry: What are some of the public health concerns related to these ongoing wars?

Stephen Langel: War zones create environments that can lead to disease spread. For instance, day-to-day infrastructures are damaged during wars. So, people are unable to normally use roads, transportation, or other resources they need to reach medical help. And there's also the physical danger associated with movements. So, people may delay medical treatment when they need it, which can lead to long term medical problems, but also can lead to the transmission of potentially drug resistant infections.

“With people being crowded together, people are often malnourished or at least inadequately nourished people not having access to both medical care and public health services. These diseases can spread very rapidly and easily,” Dr. Barry Levy, the former president of the American Public Health Association, said.

Also, wars affect the health care infrastructure like hospitals and health care workers, as well as aid organizations working on the ground. You know, we're seeing this play out again in Gaza and Ukraine.

Some of the diseases public health experts are especially worried about are infectious diseases, which are contagious and spread rapidly between people, like measles and tuberculosis. These diseases can be deadly according to infectious disease expert Lawrence Kingsley.

“Globally, the leading cause of death is infectious diseases,” said Kinglsey of the University of Pittsburgh. “In the United States, [infectious diseases] is something like number three or four behind heart disease cancer.”

He adds that the transmission rate of measles is 90%, making it a particularly dangerous threat.

FY: So, obviously, these conflicts are happening thousands of miles away –– why should local communities in the Midwest worry about that?

SL: Well, the obvious thing is travel. When people commute between the U.S. and these regions, this can cause diseases to spread. For example, in Northeast Ohio, where I'm based, there's a big Ukrainian refugee population. And it's too early to know if we're going to see a similar influx of people coming from the Middle East to the U.S., including to states in the Midwest.

But then there's the local issue we're dealing with as well.

Right now in the US, we're seeing the lowest vaccination rates among kindergarteners in years. The U.S. Centers for Disease Control and Prevention recently released data showing that vaccination rates dropped a whole percentage point last school year compared to before the pandemic.

Then, there's the newly released data from the CDC and the World Health Organization that showed something truly alarming. In 2022, the number of measles cases worldwide rose by 18% and measles related deaths were also up by 43% Compared to 2021.

Dr. Amy Edwards, an infectious disease specialist at UH Rainbow Babies and Children's Hospital, said this is a perfect storm of issues.

“For instance, if the person with incubating measles were to fly here from wherever and happen to be housed near other unvaccinated people, then, yes, we could see an outbreak, absolutely,” Edwards said.

FY: The U.S. plays a role in providing aid to countries at war. A lot of it seems to be used for military purposes. Is the U.S. also doing enough to get ahead of disease outbreaks in these countries?

SL: The White House is asking for billions of dollars in aid, and part of it will go towards military purposes. But part of it is also set aside for humanitarian aid which may include public health needs.

However, there are many potential issues at play here. First, many lawmakers oppose aid to Ukraine. But even if the White House has the votes for the funding, some public health experts say the bill is not specific enough. They're calling for this legislation to mention exactly how the funds should be spent, or else they fear it may not actually get ahead of these potential crises overseas.

“After 18 months and multiple supplementals, that maxim about repeating the same action and expecting a different result comes to mind,” public health expert Dr. William Pewen said. “Unfortunately, expressions of intent aren't sufficient.”

FY: So, obviously, the answer shouldn't be that we do not accept refugees or, you know, people traveling from war torn regions. So, Stephen, what do public health experts say that local communities should be doing?

SL: According to these experts, it's important to provide public health support for these populations through vaccination efforts and screenings. This also means that we need to ensure local public health departments have the resources to do that job.

Infectious disease specialists also stress that there's a lot of work to be done locally when it comes to ensuring children are getting their full vaccination doses. That includes battling vaccination hesitancy that can leave communities vulnerable to outbreaks.

Edwards spoke to the challenge of convincing parents about the dangers involved.

“Most of us assume that we're going to have to wait for people to see kids hospitalized and dying before they realize that the stove really does burn if you touch it,” she said.

According to Edwards, an outbreak of infectious diseases can lead to sickness and potential death amongst thousands of people, including children. But she made the point that even one life lost is one too many, which only goes to show, as far as she and Pewen and the rest of the experts are concerned, how incredibly important this is.

Side Effects Public Media is a health reporting collaboration based at WFYI in Indianapolis. We partner with NPR stations across the Midwest and surrounding areas — including KBIA and KCUR in Missouri, Iowa Public Radio, Ideastream in Ohio and WFPL in Kentucky.

Stephen Langel is a health reporter and producer at Ideastream Public Media, focusing on health coverage across 22 counties in Northeast Ohio.