War and Epidemics: A Chronicle of Infectious Diseases

War and conflict throughout history have resulted in the suffering and deaths of countless people who did not participate as combatants.Unchecked murder, pillaging, and destruction have been inflicted both as a form of terror on the conquered and as a bounty for the victors.Lack of concern for noncombatants (and those wounded in battle) also results in numerous deaths and physical and psychological trauma simply by proximity to targeted forces.War and conflict also generally result in the collapse and destruction of civil infrastructure, such as those supplying electricity, clean water, sanitation services, food, heat, and other essential services.Healthcare infrastructure relies on many of these services and is easily disrupted during war and conflict.Supplies and drugs needed for treatment and prevention of health conditions can be disrupted or diverted, and healthcare professionals can be injured or even deliberately targeted, abducted, or coerced to assist war efforts.Hospitals and clinics quickly become emergency departments solely focused on triage and life-saving surgery of patients with horrific physical injuries, also serving as morgues for mounting casualties as well as refugee camps for survivors.Public health takes a back seat under these conditions, as an afterthought to be dealt with later when hostilities are over.A wide variety of infectious diseases can run rampant under these conditions, including diarrheal diseases, respiratory infections, hepatitis, measles, rubella, and vector-borne diseases such as malaria, leishmaniasis, plague, and murine typhus.Florence Nightingale famously showed this in her graphs of mortality of English soldiers during the Crimean War.Prolonged conflict can lead to chronic malnutrition and a lapse in both surveillance and vaccination and other preventive services, which all exacerbate the impact of infectious diseases.Infectious diseases have played a role in some of the most significant wars in history.Some historians and infectious disease specialists refer to infectious diseases as the "third army" of any war.Poor living conditions, increased stress levels, and close quarters all contribute to the spread of disease.As these examples show, wars often provide the perfect conditions for spreading disease.Consequently, it is unsurprising that many significant epidemics have been linked to wars throughout history, even in recent history.