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As Russian troops cross into Ukraine, we need to remind ourselves of the impact of war on health

The effects of war on health are both intimate and general. Health impacts are immediate—people are wounded and killed—and then the impacts ripple outwards, in space and time. The repercussions echo through individual lives and, all too often, down the generations. In the first minutes, hours, and days of a hot war, physical trauma is primary: individual humanbodies aremutilatedby the ferocity ofmodern munitions. Lives end or are changed forever. For all the talk of “smart” weapons, and targeted attacks, the first onslaughts are seldom restricted to combatants. Recent conflicts, such those in the greater Middle East, have sucked huge numbers of citizens into the maelstrom, with devastating effect. Conflicts in Rwanda and Kosovo in the 1990s saw as much as 90 per cent of fatalities among civilians. It is difficult to comprehend the scale of slaughter unleashed by industrial and technological war: the 20th century saw an estimated 191 million conflict related deaths—approaching half the current population of Europe.1