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PubMed1998

Major depression and external stressors: the Lebanon Wars.

This article examines the effect of war events and pre-war depression on the prevalence of major depression during war. A total of 658 subjects aged 18-65 years were randomly selected from four Lebanese communities differentially exposed to the Lebanon Wars and were interviewed using the Diagnostic Interview Schedule (Arabic version). The individual levels of exposure to war events were assessed through a War Events Questionnaire. The lifetime prevalence of the DSM-III-R-defined major depression varied across the four communities from 16.3 to 41.9%; the final parameters predicting major depression since the onset of the wars were: depression before the wars and exposure to the wars. Both, individual levels of exposure to war and a history of pre-war depression, predict the development of depression during war.

Adult↗
PubMed2005

Acute coronary syndrome and the 1992-1995 war in Bosnia and Herzegovina: a 10-year retrospective study.

OBJECTIVE: To examine the effects of war in Bosnia and Herzegovina on the occurrence of acute coronary syndrome among civilians. METHODS: The incidences of acute myocardial infarctions (first and recurrent) and unstable angina pectoris were examined among the residents of Mostar and the nine neighboring districts. The study population was the population that lived in the area before the war (182,000 in the 1991 census). Others who immigrated into the area were not taken into consideration. Five consecutive years (1987-1991) before the war and 5 consecutive years (1992-1996) during the war were analyzed. RESULTS: In the 5-year period during the war, 267 men and 161 women suffered from acute myocardial infarctions, compared with 246 men and 119 women in the 5-year period before the war. The wartime increase in acute myocardial infarctions for the combined male-female population was statistically significant (p = 0.025). For women, the wartime increase was statistically significant only for the age group of 60 to 69 years (p = 0.007). The smaller increase among men was not statistically significant (p = 0.354). The increase to a wartime number of 52 cases of recurrent myocardial infarctions from a prewar level of 24 was statistically significant (p = 0.001). The percentage of fatal myocardial infarctions among women, however, was lower during the war (18.6%) than before the war (32.8%) (p = 0.048). During the war, 109 men with unstable angina pectoris were hospitalized, compared with 84 before the war; the cases among women were 76 and 41, respectively. The increase was statistically significant among women (p = 0.001) but not among men (p = 0.072). There was a statistically significant increase (p < 0.001) in the total number of unstable angina pectoris cases during the war (185 cases, compared with 125 prewar cases). CONCLUSION: The common population during the war in Bosnia and Herzegovina had increased numbers of acute myocardial infarctions and unstable angina pectoris cases.

Acute Disease↗
PubMed1999

[Psychosocial research during the war in Sarajevo].

War in Bosnia and Herzegovina has caused many psychic and social breakdowns. The consequences on mental health of the war which caused stress are of importance, as well as influences on psychic functioning of individuals are caused by changes in social structure of population and economic potential of the society. Project "Psycho-social aspects of war in BiH" carried out within the frame of the Academy of Sciences and Arts of Bosnia and Herzegovina and the Department of Psychiatry of Clinical Center of Sarajevo University. In this article are given the results of the Project, but only partially. The investigations showed that the number of patients visiting hospitals during the war was greatly increased in the field of stress reactions and reactive psychoses. But incidence and prevalence of alcohol psychoses decreased. Findings are the same for out patient clinics. The field investigation on the free territories of Sarajevo s communities shows enormous increase of mental disorders among the citizens: neurotic over 40%, psychotic about 20% and that is, together, more than 60% of the population of the town Sarajevo were disturbed at that time. Among the children and adolescents there was an increase of neurotic and psychotic disorders in the very beginning of the first year of the war, and decrease of the same diagnoses during the second year. This might be explained by particular adaptation of the youngsters to war conditions. When we are talking about invalidity of neurological and psychiatric disorders, the investigations showed that illness is the mostly caused by invalidity (85.1%) among the global invalidity during the war in Sarajevo. Injuries before the war were at 3%, during the war are 11% of cases. But, all those shows temporary, because war caused invalidity more and we are expecting to registration later. Our investigation among the refugee camps and population in Sarajevo shows that "life equipment" among the displaced persons was lower than domestic people. That shows that after the phase of surviving this part of the population was at risk of many psycho-social problems. Also, our investigation shows that very low socio-economical level of inhabitants of Sarajevo leads to the potential of absolutely poverty. The indicators of this trend are: low level of education, very low life standard, unemployment, bad health conditions etc. Among refugees all those indicators are worse. Criminality in Sarajevo during the war has been increased, particularly among adolescents. One fifth of contents of daily newspaper "Oslobodenje" has been during the war oriented to the health system problems.

Adolescent↗
PubMed1999

[Somatization in post-traumatic stress disorders in soldiers during the war in Bosnia-Herzegovina].

While researching psychological disorders in soldiers during the war in Bosnia, besides the psychiatric simptomatology in post trauma stress disorder (PTSD), we analyzed also expressed somatic symptoms. The sample consists of 164 soldiers from the first front lines, divided into three groups: Group A (N = 51), soldiers who during the war asked for psychological and/or psychiatric help, group B (N = 51) soldiers who are after the war on stationary or clinical treatment and group C (N = 62) soldiers who during and after the war, did not ask for psychiatric help even though they had psychiatric problems. With the trauma questionnaire and obvious PTSD symptoms the degree of the traumatic experience and the structure of PTSD was determined, and with the self-evaluation health condition questionnaire the subjective health condition evaluation during the prewar, war and the time after the war was determined with expressed physical disorders. Another important difference was determined (P < 0.01) between soldiers who had a high stress level and suffered from PTSD, who asked during and after the war for psychological and/or psychiatric help (groups A and B) and soldiers who suffered less from PTSD and who did not ask for professional help during nor after the war (group C). 60.8% soldiers in group C and 42.1% in group B during the war, and 41.3% in group A and 92.2% in group B after the war, points out their weak or very weak health condition compared with the soldiers from group C, where 1.6% during the war and 9.7% after the war pointed out their weak or very weak health condition. Somatic symptoms are mainly in conjunction with the cardiovascular system, 47.1% in group A and 78.4% in group B, also gastrointestinal system, 50.9% in group A and 37.3% in group B, followed by back pains, 31.4% in group A and 43.1% in group B. The first signs of somatic symptoms are in direct connection with first signs of traumatic experience and first signs of PTSD symptoms. The results confirm previous researches and that is that soldiers with traumatic experiences which they can hardly bare and who suffer for a long period of time from PTSD have also the biggest number of somatic symptoms.

Adult↗
PubMed2003

[Specific psychopathological reactions in the civilian population with and without experience of war trauma].

AIM: The examined differences and specificities of psychological symptoms between two groups of subject with experience and without experience under siege and war operations. METHODS: The sample includes two groups of 50 subjects. The first group experienced the trauma of siege and war operations, and the second group were living in the place without siege and war operations. The following measures were used: General Questionnaire social and demographic characteristics of the subjects before and after the war, SCL-90-R by the author Derogatis, for the registration of psychopathological symptoms, Mississippi Questionnaire by the Keane, for PTSD. RESULTS: The drop in social and economic status is much more profound in subjects who experienced the trauma of siege and war operations compared to other group without the trauma of siege and war operations. All nine SCL 90-R subscales show statistically significant difference in more pronounced psychopathological responses in subjects who experienced the trauma of siege and war operations relative to subjects without the trauma of siege and war operations. The Mississippi questionnaire shows significant differences in PTSD between the two groups and higher scores for the subjects who experienced the trauma of siege and war operations. CONCLUSION: Based on the results war is the most intense form of trauma leading to intensive psychopathological responses including chronic PTSD. Results show that the psychopathological response is most intense and most frequent in the population of subjects who experienced the trauma of siege and war operations compared to the other group without the trauma of siege and war operations.

Adult↗
PubMed2004

Psychic disorders in former prisoners of war.

AIM: To analyze the kind and the representation of psychic disorders in former prisoners of war and war veterans who were not detained in camps. METHODS: The analyzed sample consisted of 160 respondents divided into two groups. A group of 100 former prisoners of war and a group of 60 war veterans who had not been detained in camps. All the respondents are males and were psychically in healthy condition prior to the war. The modified Harvard Trauma Questionnaire was used to diagnose traumatic experience, and a questionnaire according to the DSM IV criteria was used to diagnose posttraumatic stress disorder. The Depressiveness Scale D-92 was used to diagnose depressiveness; the questionnaire STAI was used to diagnose anxiety; CAGE Questionnaire was used to diagnose alcoholism. RESULTS: The former prisoners of war had traumatic experience at a higher level as compared to the war veterans who had not been detained in camps (P < 0.05). The symptoms of PTSD were manifested by 55% of camp inmates as compared to 33.3% of war veterans (P < 0.05). Depressive disorder was diagnosed in 52% of camp inmates and 31.7% of war veterans (P < 0.05). No statistically significant difference was found among the analyzed groups relating to anxiety and alcohol drinking. CONCLUSIONS: The former prisoners of war were living through a severer stage and had a more sundry traumatic experience. Severer stage of traumatic experience conditioned statistically higher representation of psychic disorders (PTSD and depressiveness) in the former prisoners of war as compared to the war veterans.

Adult↗
PubMed2005

Psychiatric and cognitive effects of war in former yugoslavia: association of lack of redress for trauma and posttraumatic stress reactions.

CONTEXT: Although impunity for those responsible for trauma is widely thought to be associated with psychological problems in survivors of political violence, no study has yet investigated this issue. OBJECTIVE: To examine the mental health and cognitive effects of war trauma and how appraisal of redress for trauma and beliefs about justice, safety, other people, war cause, and religion relate to posttraumatic stress responses in war survivors. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional survey conducted between March 2000 and July 2002 with a population-based sample of 1358 war survivors who had experienced at least 1 war-related stressor (combat, torture, internal displacement, refugee experience, siege, and/or aerial bombardment) from 4 sites in former Yugoslavia, accessed through linkage sampling. Control groups at 2 study sites were matched with survivors on sex, age, and education. MAIN OUTCOME MEASURES: Semi-structured Interview for Survivors of War, Redress for Trauma Survivors Questionnaire, Emotions and Beliefs After War questionnaire, Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). RESULTS: The mean (SD) age was 39 (12) years, 806 (59%) were men, and 339 (25%) had high school or higher level of education. Participants reported experiencing a mean of 12.6 war-related events, with 292 (22%) and 451 (33%) having current and lifetime posttraumatic stress disorder (PTSD), respectively, and 129 (10%) with current major depression. A total of 1074 (79%) of the survivors reported a sense of injustice in relation to perceived lack of redress for trauma. Perceived impunity for those held responsible for trauma was only one of the factors associated with sense of injustice. Relative to controls, survivors had stronger emotional responses to impunity, greater fear and loss of control over life, less belief in benevolence of people, greater loss of meaning in war cause, stronger faith in God, and higher rates of PTSD and depression. Fear and loss of control over life were associated with PTSD and depression (odds ratio [OR], 2.91; 95% CI, 2.27-3.74 and OR, 2.30; 95% CI, 1.75-3.03, respectively), and emotional responses to impunity showed a relatively weaker association with PTSD (OR, 1.53; 95% CI, 1.16-2.02) and depression (OR, 1.39; 95% CI, 1.02-1.91). Appraisal of redress for trauma was not associated with PTSD or depression. CONCLUSIONS: PTSD and depression in war survivors appear to be independent of sense of injustice arising from perceived lack of redress for trauma. Fear of threat to safety and loss of control over life appeared to be the most important mediating factors in PTSD and depression. These findings may have important implications for reconciliation efforts in postwar countries and effective interventions for traumatized war survivors.

Adult↗
PubMed1994

The effect of war on tuberculosis. Results of a tuberculin survey among displaced persons in El Salvador and a review of the literature.

SETTING: During wartime, civilian populations usually experience a drop in caloric intake, disruption of housing, and a diminution in availability of medical services. These disturbances might be expected to result in increased reactivation of tuberculosis, which may result in increased transmission. Such privations occurred in El Salvador during its 1980-92 civil war, particularly among the 20% of the population, or over 1 million people, who were displaced. OBJECTIVE: (1) To estimate the rate of transmission of tuberculosis among displaced Salvadorians prior to and during the war, and (2) to compare this result with experience in the literature. DESIGN: (1) A tuberculin survey was conducted in El Salvador in July 1992 among all residents aged 1-30 years in 12 communities of formerly displaced persons. (2) The English language literature on tuberculosis during wartime was reviewed. RESULTS: (1) Overall, 21.2% of the non-BCG vaccinated had significant tuberculin reactions, equivalent to an annual risk of infection of 2.3%. The trend in the annual risk of infection was upward over the latter 6 years of the war, stable over the first 6 years, and was downward prior to the war years. The estimated incidence of smear positive pulmonary tuberculosis was 125 per 100,000 or 3 times the reported rate for El Salvador. (2) A review of the literature showed consistent evidence for increased morbidity and mortality from tuberculosis during wartime. Increased transmission was suggested by those studies showing a rise in both incidence of tuberculous meningitis during war years and excess morbidity and mortality many years after a war. Two major population-based studies found no evidence of increased transmission based on the calculated annual risk of infection; however other studies examining younger or more severely affected populations, or following more prolonged wars, detected an apparent increase in the transmission of tuberculosis. CONCLUSIONS: Conditions of war are associated with a rapid increase in morbidity and mortality from tuberculosis, which appears to result in increased transmission among populations most severely affected by war. This increased transmission will result in increased morbidity and mortality for many years, underscoring the need for improved tuberculosis control in the post-war period in countries such as El Salvador that have been devastated by war.

Adolescent↗
PubMed2005

Lessons learned and advice from Vietnam war nurses: a qualitative study.

AIM: The aim of this paper is to describe guidance for nurses today from the lessons learned by nurses who served in the Vietnam War. BACKGROUND: There is little research focusing on nurses' experiences in the Vietnam War. Lessons learned and subsequent advice from nurses who served in Vietnam may be helpful to those serving in current and future wars. METHODS: A Husserlian phenomenological approach was taken, using interviews with a purposive sample of Registered Nurses who were female, and had served in the United States of America armed forces in Vietnam during the war. FINDINGS: Seven theme clusters described the lesson learned and guidance offered by the Vietnam War nurses: advice about journaling, training, caring for yourself, use of support systems, talking about your experiences, understanding the mission, and lack of preparation for war. CONCLUSIONS: Much can be learned from the lessons learned and advice given by Vietnam War nurses. These lessons stress that nurses need to take a pro-active role in preparing themselves for deployment to a war zone, and that institutional training for war needs to be intensive and realistic. The environmental, cultural, technological, clinical and psychosocial demands of war nursing need to be comprehensively addressed before nurses deploy to a war.

Education, Nursing↗
PubMedDate not supplied

[Influence of the war events on body weight and height in children enrolling the first grade of elementary school].

Physical growth is usually estimated by body weight and height measurements. Both parameters are strongly influenced by genetic and environmental factors. The study investigated the effect of war related psychological stress and socioeconomic deterioration on growth of children who were born and grew during the war-years. We compared body weight and height in 2 groups of preschool children at time of admission to the first grade of elementary school. In the first group of children, school entry medical examination was performed in spring 1990 and 1991 (pre-war group), while the second group of children had school entry medical examination in spring 1998, 1999 and 2000 (war group). The mean body weight of children in pre-war group (n = 200; 98 girls) was M = 24.52, SD = 4.16 kg, height M = 122.50, SD = 4.71 cm, and the average age was M = 6.67, SD = 0.33 years. The war-group (n = 214; 100 girls) were of the same mean age (M = 6.67, SD = 0.34 years), but they were 500 g lighter and 5 mm lower in average. However, the differences in body weight and height were not statistically significant (t(weight) = 1.21, p > 0.05; t(height) = 1.13, p > 0.05). The two groups matched in gender (chi2-test = 0.13, p > 0.05). More educated parent of every child in pre-war group was employed, while 4 more educated parents (1.87%) in war-group were unemployed, but the difference was not statistically significant (chi2-test = 2.07, p > 0.05). We conclude that growth of preschool children in our region was not statistically significantly affected by stressful war events and war related socioeconomic situation. One could expect that these influences might be significant if we could examine the secular growth trend if there had been no war.

Body Height↗
PubMed1991

Chronic morbidity of former prisoners of war and other Australian veterans.

OBJECTIVE: This report is the first summary article from a review of studies on long-term morbidity associated with war service or internment, commissioned by the Sir Edward Dunlop Medical Research Foundation. DATA SOURCES: The Medlars database, from 1966 to the present, under the terms military personnel, veterans, veterans' disability claims, combat disorders and prisoners (matched against war); databases of the Department of Veterans' Affairs (Victoria) and the Central Library, Commonwealth Department of Defence, using the term "prisoner of war"; and the microfiche listings of the Department of Veterans' Affairs, under "prisoner of war" and "repatriation". Only studies in English or French were reviewed, reaching a total of 172. STUDY SELECTION: Forty-eight studies are considered in the present summary, presenting the most significant evidence about long-term morbidity attributable to war-time experiences. Studies concerning Australian veterans are emphasised. DATA EXTRACTION: Studies considered valid were summarised for an annotated bibliography, but only reports of major public health significance are reviewed here. DATA SYNTHESIS: The review confirms that strongyloidiasis, peptic ulcer, anxiety states, depression and hepatitis B are more prevalent in former prisoners of war than in relevant comparison groups. We have not identified further diagnoses that should be attributed specifically to war-time exposures. Attribution of long-term neurological and musculoskeletal disorders to war-time exposures remains uncertain. CONCLUSIONS: Former prisoners of war and veterans constitute a population of survivors highly selected by the rigours of war and imprisonment. Occurrence of the five conditions listed above may be reasonably attributed to war-time exposure. We recommend further research on ageing (including neurological, visual, hearing and musculoskeletal disability), family disruption and rehabilitation strategies in these groups.

Australia↗
PubMed2006

Self-reported reproductive outcomes among male and female 1991 Gulf War era US military veterans.

BACKGROUND: Following the 1991 Gulf War, some veterans expressed concerns regarding their reproductive health. Our objective was to assess whether an association exists between deployment to the 1991 Gulf War and self-reported adverse pregnancy outcomes. METHODS: Using a modified Dillman technique with telephone follow-up, we conducted a survey via a postal questionnaire from February 1996-August 1997 to compare selected reproductive outcomes among 10,000 US veterans deployed to the 1991 Gulf War with those of 10,000 nondeployed Gulf War era veterans. RESULTS: A total of 8742 individuals responded to the survey, a response rate of 51 percent. Using multivariable analyses, results showed no differences in number of reported pregnancies between Gulf War veterans and nondeployed veterans. Among 2233 female and 2159 male participants, there were no differences in birth weight of infants born to Gulf War veterans compared with nondeployed Gulf War era veterans. In multivariable models, male and female Gulf War veterans did not significantly differ in risk for ectopic pregnancies, stillbirths, or miscarriages when compared with nondeployed veterans of the same era. CONCLUSIONS: These results do not suggest an association between service in the 1991 Gulf War and adverse reproductive outcomes for both male and female veterans during the 4 years after the war.

Abortion, Spontaneous↗
PubMed2003

Children and war.

Children bear disproportionate consequences of armed conflict. The 21st century continues to see patterns of children enmeshed in international violence between opposing combatant forces, as victims of terrorist warfare, and, perhaps most tragically of all, as victims of civil wars. Innocent children so often are the victims of high-energy wounding from military ordinance. They sustain high-energy tissue damage and massive burns - injuries that are not commonly seen in civilian populations. Children have also been deliberately targeted victims in genocidal civil wars in Africa in the past decade, and hundreds of thousands have been killed and maimed in the context of close-quarter, hand-to-hand assaults of great ferocity. Paediatricians serve as uniformed military surgeons and as civilian doctors in both international and civil wars, and have a significant strategic role to play as advocates for the rights and welfare of children in the context of the evolving 'Laws of War'. One chronic legacy of contemporary warfare is blast injury to children from landmines. Such blasts leave children without feet or lower limbs, with genital injuries, blindness and deafness. This pattern of injury has become one of the post-civil war syndromes encountered by all intensivists and surgeons serving in four of the world's continents. The continued advocacy for the international ban on the manufacture, commerce and military use of antipersonnel landmines is a part of all paediatricians' obligation to promote the ethos of the Laws of War. Post-traumatic stress disorder remains an undertreated legacy of children who have been trapped in the shot and shell of battle as well as those displaced as refugees. An urgent, unfocused and unmet challenge has been the increase in, and plight of, child soldiers themselves. A new class of combatant comprises these children, who also become enmeshed in the triad of anarchic civil war, light-weight weaponry and drug or alcohol addiction. The International Criminal Court has outlawed as a War Crime, the conscription of children under 15 years of age. Nevertheless, there remain more than 300000 child soldiers active and enmeshed in psychopathic violence as part of both civil and international warfare. The typical profile of a child soldier is of a boy between the ages of 8 and 18 years, bonded into a group of armed peers, almost always an orphan, drug or alcohol addicted, amoral, merciless, illiterate and dangerous. Paediatricians have much to do to protect such war-enmeshed children, irrespective of the accident of their place of birth. Only by such vigorous and maintained advocacy can the world's children be better protected from the scourge of future wars.

Adolescent↗
PubMed1999

Is there a Gulf War syndrome?

BACKGROUND: UK veterans of the Gulf War report more ill health than servicemen who were not deployed to the Gulf War. We investigated whether the pattern of symptom reporting by veterans of the Gulf War differed from that in active servicemen who had not fought in the Gulf War or who had fought in other conflicts. METHODS: We used a population-based cross-sectional design. We sent a standardised survey that asked about 50 physical symptoms to three UK military cohorts; men who had served in the Gulf War, those who had served in the Bosnia conflict, and men who had been in active service but not deployed to the Gulf War (Era cohort). We used exploratory factor analysis to identify underlying factors and describe the factor structure of the symptoms reported in the Gulf War cohort. Confirmatory factor analysis was used to test the fit of this factor structure in the Bosnia and Era cohorts. FINDINGS: Three factors in the Gulf War cohort together accounted for about 20% of the common variance. We labelled the factors mood, respiratory system, and peripheral nervous system, according to the symptoms that loaded on to them. In the confirmatory factor analysis, the factor structure identified in the Gulf War cohort fitted reasonably well in the Bosnia and Era cohorts. INTERPRETATION: Although results from complex modelling procedures need to be interpreted with caution, our findings do not support a unique Gulf War syndrome. The mechanisms behind increased self-reporting of symptoms need further investigation.

Bosnia and Herzegovina↗
PubMed1996

Psychological distress among recent immigrants from the former Soviet Union to Israel, II. The effects of the Gulf War.

The psychological effects of the Gulf War were studied on a group of Israeli civilians particularly at risk, viz. recent immigrants from the former Soviet Union. A quasi-experimental design was used. A sample of immigrants who had already been screened for psychological distress just before the war were reassessed after the war with the same instrument (PERI demoralization questionnaire). Various parameters related to the war period were also assessed. Psychological symptoms during the war were significantly associated with pre-war level of distress and with actual physical harm from the missiles, but not with exposure to danger (proximity of residence to areas hit by missiles). Correlates of behaviour in the face of life-threatening danger during the war (change of residence and help-seeking behaviour) were also identified. Overall the level of post-war psychological distress was not found to be higher than pre-war levels. This was explained by the immigrants' feelings of shared fate, belonging and sense of cohesion, which characterize the general Israeli population during war time.

Acculturation↗
PubMedDate not supplied

Evidence for a deployment-related Gulf War syndrome by factor analysis.

To identify a syndrome unique to Gulf War veterans, the authors applied an exploratory factor analysis to the 47-symptom correlation matrix of 10,423 Gulf War and 8,960 non-Gulf War veteran respondents. A separate factor analysis was performed for Gulf War and non-Gulf War veterans, and the resulting 6 factors were compared between the 2 groups. Five of the factors were very similar in the 2 groups; however, 1 of the factors in the Gulf War group, but not the non-Gulf War group, contained a cluster of symptoms consistent with neurological impairment. Symptoms specific to this factor were blurred vision, loss of balance/dizziness, tremors/shaking, and speech difficulty. The Gulf War veterans who had all of the aforementioned symptoms (n = 277) also reported exposures to several putative risk factors at a rate 3 or more times higher than other Gulf War veterans. This finding suggests a possible syndrome related to Gulf War deployment, which requires objective supporting clinical evidence.

Adult↗
PubMedDate not supplied

The social, cultural and political dimensions of contemporary war.

There have been more than 160 wars and armed conflicts since 1945, almost all in the Third World, and more than 50 currently. More than 90% of these are internal rather than between sovereign states. There has been a sixfold increase in the number of war refugees worldwide since 1970, who now number 1% of the global population. Ninety per cent of all casualties are civilians. A key element of modern political violence is the creation of states of terror to penetrate the entire fabric of grassroots social relations as a means of control. The valued institutions and ways of life of whole populations are routinely targeted for destruction. In the 1980s many such wars were played out on a terrain of subsistence economies. The back-drop is of environmental degradation, poverty, embedded social injustice, pressure on the nation-state, a global rise in food insecurity and a widening gulf between the wealthiest 20% and the poorest 20% in the world. The World Health Organization is warning of a health catastrophe, with life expectancy in the world's poorest countries falling by the year 2000 and one-third of the world's children undernourished. Understanding a complex and evolving set of causes and effects surrounding war is a considerable challenge to the international humanitarian field, not least the health professions. In recent years there has been a burgeoning interest in the psychological impact of the atrocities of war, and in trauma programmes based on Western psychological concepts and techniques. This individualistic focus risks neglecting the core issue: the role of a social world, invariably targeted in war and yet still embodying the capacity of survivor populations to manage their suffering, adapt and recover on a collective basis. Using the example of Mozambique, Guatemala and others, this paper will discuss the way in which contemporary war damages social and cultural forms, and the range of traditions, values and understandings which these carry. However, society and culture also engage actively with war, with changes in the social order that may come to outlast the violence itself. This paper will also pinpoint the quest for justice as an issue that may distinguish the subjective experience of war from those that arise after peacetime or natural disasters. The work of anthropologists, sociologists, historians and poets in both West and Third World, allied to the voices of survivors themselves, can help the humanitarian field to acquire a more richly textured understanding of the range of responses to war and atrocity, and outcomes over time.

Altruism↗
PubMed2000

Prevalence and patterns of Gulf War illness in Kansas veterans: association of symptoms with characteristics of person, place, and time of military service.

Gulf War veterans have reported health problems that they attribute to their military service, but little is understood about the nature or extent of these conditions. To determine whether Kansas Gulf War veterans are affected by excess health problems, a population-based survey of 1,548 veterans who served in the Persian Gulf War (PGW) and 482 veterans who served elsewhere (non-PGW) was conducted in 1998. Gulf War illness, defined as having chronic symptoms in three of six domains, occurred in 34% of PGW veterans, 12% of non-PGW veterans who reported receiving vaccines during the war, and 4% of non-PGW veterans who did not receive vaccines. The prevalence of Gulf War illness was lowest among PGW veterans who served on board ship (21%) and highest among those who were in Iraq and/or Kuwait (42%). Among PGW veterans who served away from battlefield areas, Gulf War illness was least prevalent among those who departed the region prior to the war (9%) and most prevalent among those who departed in June or July of 1991 (41%). Observed patterns suggest that excess morbidity among Gulf War veterans is associated with characteristics of their wartime service, and that vaccines used during the war may be a contributing factor.

Adolescent↗