It started by accident. I got lost in Senglea in Malta.
That triggered a hunt for news in the archives of the British papers on Senglea. So great to have this resource with newspapers available from 200 years ago. The two earliest mentions of Senglea in the British newspapers were interesting. One, from the Manchester Courier June 26th 1847, concerned a lady from Senglea who was bitten by a cat and subsequently caught rabies and died of the condition.
The second was an article entitled The Sickness at Malta, from The Dublin Evening Mail on Monday 30th October 1848.
This recounted a strange sickness affecting the British troops stationed in Malta. This article talks of a prevailing disease amongst the military, but chiefly in the barracks at Fort St. Elmo. The 1st battalion of the 44th, the 1st battalion of the 69th and the head-quarters of the Royal Artillery were stationed in this area. The Lieutenant-General Ellice, in charge of these forces, ordered a change of quarters. He unwisely moved the 69th from Senglea to St Elmo and sent another battalion to Floriana and other random movements of the troops in response to the outbreak. This backfired in that the Senglea battalion, who had been previously free of disease suddenly started dying of the same complaint. Those battalions moved to various other places continued to suffer from the disease in the same numbers as before. The only result of this movement had been to spread the disease among a wider population. Dr Potelli, the chief surgeon of the civil hospital, was convinced that the disease was Asiatic Cholera but Dr Barry, the principal military medical officer, persisted in his claim, supported by other military doctors that it was no such thing.
In one day on 11th October they had seven deaths and still the disease progressed in the midst of conflicting opinions. There is a strange mention of a native, meaning a Maltese, being brought in, suffering from what appeared to be the same complaint. His illness was dismissed as being brought on by unwholesome food or possible neglected disorders of the bowels!! A curious twisting of facts making it the patient's own fault. To allay the fears of the general population the presence of stagnant water within the Fort St Elmo was blamed for the outbreak of disease. The fact that mostly military personnel were affected (they claimed) pointed to this being the case.
By 1850 despite their conviction to the contrary, Cholera was indeed found to be the culprit and yet the practice of responding to outbreaks had not improved. When a company of the 44th Regiment, stationed at San Francesco de Paolo Barracks, lost a third of its men to the disease the military reacted by sending the entire company to Gozo. Within ten days of their arrival no less that 26 men fell ill with 16 deaths. Unsurprisingly, cholera then appeared in the village of Ghajnsielem, beside the Fort and spread throughout Gozo resulting in 105 attacks and 78 deaths among the civilian population.
All of this makes one think about how disease and war could be linked in more ways than we could possibly imagine. Apart from the movement of troops which provide a perfect vector for the spread of disease throughout a population, war itself is a perfect breeding ground for disease.
Take for example Syria. The war there has resulted in millions of Syrians being displaced. High percentages of its ambulances and hospitals have been damaged or destroyed. Only 10% of its pharmaceutical need are now being met. Vaccination coverage was 91% in 2010, now a mere 50% of children born since the war broke out have been vaccinated. To put that in perspective, there were no cases of cutaneous leishmaniasis before 2008.
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| cutaneous leishmaniasis |
By 2012 there were 52,982 confirmed cases. This is just the tip of the iceberg. Poliomyelitis, measles, meningitis and scabes are all spreading among the vulnerable population. Could those parents who peddle anti-vaccine rhetoric please take note! Leave emotions and gut instinct aside and look at the facts, so many lives depend the presence of effective vaccines. Those living in refugee camps and in poverty do not have the luxury of your options. Poor diet, lack of sanitation, stress, contagions from close quarters are not choices people make. They are a result of external forces beyond their control and for those who have an excess of money, food and good healthcare to be so short-sighted is frankly inexplicable.
War and disease have a history together. During the Napoleonic wars , eight times the number of British army soldiers died from disease than from battle wounds. In the American Civil war two thirds of the 660 000 deaths of soldiers were caused by pneumonia, typhoid, dysentery and malaria.
The result of the so-called Spanish flu, following World war 1 in 1918, was a worldwide death toll of between 50 and 100 million worldwide. Recent investigative work by a British team led by virologist John Oxford of St Bartholomew's Hospital and the Royal London Hospital has suggested that the major troop staging and hospital camp in Étaples, France, has almost certainly being the centre of the 1918 flu pandemic. A significant precursor virus, harboured in birds, mutated to pigs that were kept near the front is proposed as the source.
The Second World war had its own contributions. One of which was that dengue increased in South-East Asia during the war and the immediate post-war period, due to the spread of mosquitos and different virus strains throughout the region. This disease produces a spiking fever, searing muscle and joint pain, blood seeping through skin, shock and possibly death. Today this disease threatens 2.4 million people worldwide. With such tasks facing humanity it begs the question should we be wasting valuable resources on wars?
In order to really understand why war is so conducive to disease we need to understand the various changes that contribute to the spread of disease.
- mass movement of populations
- lack of access to clean water
- poor sanitation
- lack of shelter
- poor nutritional status
- collapse of public health infrastructure
- lack of health services
More than 25 countries in Sub Saharan Africa are affected by conflict and 70% of all deaths in these countries are caused by infectious diseases.
When you have a displaced population they will have a 60 times higher mortality rate. Today there are 40 million refugees and displaced people. The figures are heart-breaking, almost too huge to take on board.
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| The Zaatari refugee camp in Jordan |
The loss of life can be quick and huge. When there was an outbreak of cholera and dysentery in Goma (formerly Zaire) in 1994, twelve thousand Rwandan refugees were killed in just 3 weeks.
In Afghanistan malaria was very well controlled before conflict began in 1979. In the past twenty years there have been 2/3 million cases every year.
In the Democratic Republic of Congo, 1930 there were more than 33 000 cases of trypanosomiasis (sleeping disease). With health care initiatives by 1959 this figure had dropped to less than a thousand cases. The conflict that erupted in the 1960s meant that by 2001 the number of cases was estimated at 40 000. It is hard not to hold your head in despair.
In focussing on physical complaints alone, of course we do not have the whole picture. It is estimated that 10% of the World's population lives with mental illness. In 2008, five years after Liberia's civil war had ended 40% of Liberians had symptoms of major depression. Conflict leaves scars that we have yet to understand fully. For example, in Northern Ireland there has been a doubling of the suicide rate since the peace agreement in 1998. Conflict, it seems leaves effects that linger and eat into the mental wellbeing of a population long after peace has been established.
What strikes one is that we cannot afford to have war. We must learn the lessons of the past. War is far too expensive in terms of human suffering, creation of disease and far too distracting from the vital tasks that lie ahead in this world of ours.
refugees in Europe Photographs that speak to the heart
