In his first formal Presidential address in 1953, Dwight Eisenhower said, “Every gun that is made, every warship launched, every rocket fired signifies in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed. This world in arms is not spending money alone. It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children. This is not a way of life at all in any true sense. Under the clouds of war, it is humanity hanging on a cross of iron.” There is a long tradition of doctors shining the light on the public health consequences of conflict, not just through the narrow lens of health, but also through the political lens. Medecins Sans Frontieres, International Physicians for the Prevention of Nuclear War, Physicians for Human Rights and other organisations led by doctors have been instrumental in publicising issues as diverse as inadequate access to essential medicines and human rights abuses in conflict zones. This week, I attended a launch event in Oxford by the Lancet Editor, Richard Horton, for a series of articles on the health impact of occupation and conflict in Palestine. He gave an impassioned oration, urging doctors and medical journals to engage in political issues, including war, because health can be the most powerful of advocacy tools to change political institutions. Journals such as the Lancet and the BMJ were founded with the aim of publishing and promoting health-related evidence in order to implement social change and journal editors should not be afraid of doing the same today, he argued. The Lancet has previously been outspoken about ill health in areas of conflict, including Iraq and Darfur [1-3]. The first of the articles makes sobering reading [4] The laudable collaboration between Palestinian doctors, the Lancet, Western scientists and WHO shows that detailed epidemiological studies can be conducted even in the harshest of circumstances. Importantly, the authors look beyond infant mortality, stunting in children and conventional measures of morbidity and mortality by considering health impact in the context of human suffering. They conclude that “after a period of improvement in Palestinian health in the occupied Palestinian territory, socioeconomic conditions have deteriorated since the mid-1990s, with a humanitarian crisis emerging in the Gaza Strip and intensifying as a result of the Israeli military invasion in December, 2008, and January, 2009…”. The poor health of the Palestinian people is undeniably a direct result of the socio-economic environment in which they have to live under occupation. Recent conflicts amply show that war is not only a failing means of ensuring peace and human security, it is also a direct cause of long-term ill-health and suffering.

---

1. Mortality after the 2003 invasion of Iraq: a cross-sectional cluster sample survey. Lancet 2006. 368; 1421-1428. Burnham G, Lafta R, Doocy S, Roberts L.
2. Editorial: Morbidity and mortality among families in Iraq. Lancet 2008. 371; 177.
3. Violence and mortality in West Darfur, Sudan (2003–04): epidemiological evidence from four surveys. Lancet 2004. 364; 1315-1320. Depoortere E, Checchi F, Broillet F, Gerstl S, Minetti A, Gayraud O, Briet V, Pahl J, Defourny I, Tatay M, Brown V.
4. Health status and health services in the occupied Palestinian territory. Lancet. 2009 Mar 4. [Epub ahead of print] Giacaman R, Khatib R, Shabaneh L, Ramlawi A, Sabri B, Sabatinelli G, Khawaja M, Laurance T.