A pandemic. And now war. A war, the UK’s Ukraine Ambassador wrote last week “on the whole of the civilised world”.
The burden of war falls mostly on women and children. Ten million children younger than 5 years died in conflicts between 1995 and 2015. Women and children will now be dying from preventable causes in Ukraine. The health and humanitarian crisis afflicting Ukraine has received far too little attention. Consider those forcibly displaced. Although hard to predict, as many as 5 million people, up to three-quarters of whom will be women and children, are likely to become refugees. European nations must allow visa-free entry for these displaced families. Delay will be lethal. But one does not have to be displaced to be at risk.
Deaths and physical injuries from direct violence are high in close combat urban settings. Protracted conflicts also bring food insecurity. Outbreaks of infectious diseases are common. Surveillance systems and vaccination programmes will be disrupted. In the midst of a continuing pandemic, with a population poorly vaccinated against SARS-CoV-2 (34% of Ukrainians have received two doses of vaccine and only 17% a third dose), the risk of local spikes of COVID-19 is likely. Destruction of safe water and sanitation facilities only adds to the danger. Continuity of care-maternity services, dialysis, chemotherapy and immunotherapy for cancers, insulin supplies, mental health care-will be derailed. The history of war teaches that sexual violence will be pervasive. Amid the talk of punitive sanctions against Russia, the basic needs of the Ukrainian people are being overlooked.
What connects this European war to a global pandemic? One word: security. This concept is not fashionable in global health. We prefer to talk about sustainability. Securitisation is seen as anathema to the values of global health-the progressive expansion of rights, equity, and social justice. Serious efforts have been made to redefine the notion of security to accommodate these concerns. The most definitive statement came from the 2003 Commission on Human Security, Human Security Now. Sadako Ogata and Amartya Sen set out a vision for security based on people, not states. A nation state’s security is necessary to protect its people. But national security alone is an insufficient guarantor of individual security. As western nations debate how to address the ongoing conflict in Ukraine, human security must be put on the security agenda-by the UN Security Council and WHO. So far, these multilateral actors have been weak in both words and deeds. Ironically, the importance of protecting individual lives has a Russian origin. Alexander Herzen, born in Moscow in 1812, embodied the tense struggle of identities between Russians and Europeans (he died in Paris in 1870). Herzen observed the failure of European revolutions in the 1840s. His conclusion, relevant today in this latest European war, was that there are no simple solutions to the problems faced by societies. Every historical moment is unique. The only fact one can be sure of is the absolute importance of the life of the individual. There can be no sacrifice of present and urgent human needs for a promise of a better future. The goal of life is life itself. There exists no clearer definition of human security.
*One final caution. Politicians are calling for Russia to be isolated-ending diplomatic relations, imposing trade embargoes, driving out oligarchs. But be careful what you wish for. Last week, WHO convened a forum to review lessons from research into COVID-19. My task was to identify the challenges to ensuring the best science was published as quickly as possible. The first challenge was that a global pandemic demanded a global science-an international network of scientists able to communicate freely with one another. A second challenge was that global science depends on global trust. And global trust depends on open collaboration with scientists in all countries. Scientists must build trust with other scientists, irrespective of their national origin. We must support one another in the face of often hostile political criticism to provide the most reliable evidence to decision-makers. As Herzenwrote “an exclusive feeling of nationality is never productive of good”. Inadvertently isolating Russian scientists and health workers will be self-defeating. Scientists must work towards a more convergent and less divided world-for national as well as human security.
Source: The Lancet
Photo Credit: Noah Eleazar | Unsplash