Some Lessons on War and Forced Displacement

Lessons from our SSHB conference on The Human Biology of Poverty, held in Lisbon earlier this month. Thanks to Ines Varela Silva for putting together a great conference in a beautiful country.

This is not a complete list, but a copy and paste of some of the highlights from our session: 

Presentations

  • War and forced displacement: Embodiment of conflict-related experiences (Patrick Clarkin)
  • Female minor refugees: Are they underprivileged by forensic age estimation? (Bianca Gelbrich)
  • War and its effect on the changes in lifestyles: a case of Croatia (Sasa Missoni)
  • Secular trends of somatic development in Abkhazian children and adolescents for the last decades (Elena Godina)
  • Do stress biomarkers track poverty, stress, and trauma? Evaluating war-affected youth (Amelia Sancilio)
  • Refugees in Portugal: What do we know? (Cristina Santinho and Ines Varela-Silva)
  • Poster: Maya Guatemalan children in refugee camps in Mexico. How bad is their growth status? (Aya Ueno, Barry Bogin, Faith Warner and Ines Varela-Silva)

Summary of the session

Below are some reasons why our research is important and how it is relevant  for the public in general.

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Human Biology of Poverty Symposium

We just finished a symposium on “the human biology of poverty,” held at ISCTE-IUL in Lisbon, and sponsored by the The Society for the Study of Human Biology. It really was a great meeting, full of important research on the effects of various forms of deprivation on biology and health in different populations. The complete program can be found here.

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“We Are People, Human Beings” (The War in Yemen)

photo-essay of the of how war is affecting people in Yemen. Doctors Without Borders has called it a “war on civilians.”

And here is a statement from one man:

“Our nation was a poor nation even before this crisis and before this war. Can you imagine now after 14 countries in a coalition surprisingly declared war and huge airstrikes against us while we were safe in our homes? We did not expect such an action to take place, and were not prepared. We cannot prepare for that. We immediately fled to fields, to mountains, and to deserted old villages and buildings. We lived there for a while with wild animals and monkeys! We were terrified, fighting with the animals, suffering diseases and lack of food, lack of everything, lack of safety and protection.

My boy is 18 months old. Whenever he hears warplanes he shouts “Papa, Papa!” Terrified. He is traumatized. He was fat, and now…

We are human beings. We are people, human beings.”

War, Economics, & Human Development

“Nothing is more useless in developing a nation’s economy than a gun, and nothing blocks the road to social development than the financial burden of war. War is the arch enemy of national progress and the modern scourge of civilized men.”

                                        – King Hussein, Address at Tulane University, April 1976 (Link)

I don’t know much about economics and development. As an undergraduate, I took only two economics courses (both in my freshman year), and to be honest they were forgettable. 

That said, I wouldn’t know where to begin to help improve any country’s economic situation. However, I can think of a surefire way to destroy one — host a war. Earlier this month, the UN secretary-general Ban Ki-Moon said that because of the ongoing war Syria had lost the equivalent of four decades of human development. Even if the war ended tomorrow, it will likely take generations to recover. I won’t belabor this point. It should be enough to say that death and destruction are part of the logic of war, whether it be in Syria, Yemen, Ukraine, Iraq, Afghanistan, Nigeria, the Central African Republic, or South Sudan. What an enormous waste.

 

Thoughts on PTS and “Moral Injuries”  

 

Over the past five years, a good percentage of this blog has been focused on the effects of war on health. Some of these topics have included:

  • Other effects of war, such as forced displacement, food shortages, and destroyed infrastructure (here, here, here, here, here, & here)

 

I’ve largely stayed away from one of the most recognized effects of war: psychological impacts such as post-traumatic stress (PTS), perhaps with one notable exception: “Reconciliation, Biology, and the Second Indochina War.” This remains one of my favorite posts on this site. However, it dealt not with PTS per se, but with guilt and the desire for forgiveness and reconciliation, with many examples stemming from war.

I bring this up now because a few months ago I first encountered the idea of the long-term effects of ‘moral injury.’ According to Litz et al. (2009), a moral injury stems from “events, such as perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations may be deleterious in the long-term, emotionally, psychologically, behaviorally, spiritually, and socially.”

In other words, while both have long-term psychological effects, moral injury may be distinct from PTS. As Thomas Gibbons-Neff wrote “unlike post-traumatic stress, which is a result of a fear-conditioned response, moral injury is a feeling of existential disorientation that manifests as intense guilt.” Neither idea is new, though both may have been unintentionally intertwined in psychology (at least in my non-expert understanding of this).

The terminology has been fickle, and PTS has been called many different names over the past several decades including shell shock, soldier’s heart, or combat fatigue. More recently, there have been efforts to drop the word ‘disorder’ from PTSD to simply PTS, in an effort to minimize stigma as well as to shift how those suffering from stress see themselves. Vocabulary really matters, and re-framing the terminology helps everyone see people with PTS simply as fellow human beings undergoing a very difficult period, rather than as permanently damaged.   

According to one study, references to post traumatic stress may extend as far back to the Assyrians in Mesopotamia between 1300BC and 609BC. Some ancient soldiers reportedly described “hearing and seeing ghosts talking to them, who would be the ghosts of people they’d killed in battle.” However, to me, this seems more like moral injury and manifestations of guilt, rather than fear, so perhaps these would be better categorized as moral injuries. Though it is almost impossible to do this retrospectively.

Some, like the primatologist Frans deWaal (2012), have suggested that the frequency of PTS among soldiers indicates that committing acts of violence does not come easily to humans, and that war is not a deep part of human nature:

“If there were truly a genetic basis to our participation in lethal combat, we should willingly engage in it. Yet soldiers report a deep revulsion to killing and shoot at the enemy only under pressure. After these experiences, they often end up with substantial psychological damage. Far from being a recent phenomenon, haunting memories of combat were already known to the ancient Greeks, such as Sophocles, who described Ajax’s “divine madness,” now known as posttraumatic stress disorder (PTSD).”

I’m not so sure. There is evidence that some people are drawn to violence and enjoy participating in it. A recent powerful essay by Tage Rai argued that the key to understanding human violence is that people are most apt to engage in it when they believe they are morally justified:

“Across practices, across cultures, and throughout historical periods, when people support and engage in violence, their primary motivations are moral. By ‘moral’, I mean that people are violent because they feel they must be; because they feel that their violence is obligatory. They know that they are harming fully human beings. Nonetheless, they believe they should. Violence does not stem from a psychopathic lack of morality. Quite the reverse: it comes from the exercise of perceived moral rights and obligations.”

If there is any good news, perhaps it’s that individuals who suffer a moral injury must, almost by definition, have some deep reservations about certain acts of violence. After all, one’s sense of morality cannot be injured if it didn’t exist in the first place. Secondly, the concept of ‘injury’ implies that healing is possible. Marek Kopacz (2014) wrote that after trauma, military personnel often seek out “support in an effort to realign their existential beliefs and reaffirm the meaning and purpose of life.” My guess is that — evolutionarily speaking — because humans have such a long history as social primates, it is likely that a person’s moral sense is integral to their meaning of life. Therefore, it is also likely that attempts at moral healing/ re-alignment could go a long way in terms of psychological health and overall well-being.

 

References

De Waal F. 2012. The antiquity of empathy. Science 336: 874-6. Link

Litz BT, Stein N, Delaney E, Lebowitz L, Nash WP, Silva C, & Maguen S. 2009. Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review 29: 695–706. Link

Kopacz MS. 2014. Moral injury – A war trauma affecting current and former military personnel.  International Journal of Social Psychiatry  60: 722-3. Link

Visualizing WW2 Casualties

The video below is a visually stunning account of the total casualties of the Second World War. It is really hard to comprehend such staggering numbers, but by putting them into infographics like these, they have more impact. Consider setting aside 20 minutes to watch the whole thing.

Did the Atomic Bombs in Hiroshima and Nagasaki Affect Child Growth?

In 1967, James Wood and colleagues published a study on the growth of Japanese adolescents whose pregnant mothers were exposed to the atomic bombs in Hiroshima and Nagasaki years earlier. Of course, many people were killed by the bombs, although estimates vary somewhere between one and two hundred thousand in all. By one estimate, the mortality rate of people within one kilometer of the bomb’s hypocenter in Hiroshima was 86%. This rate dropped to 27% for people who were between 1 and 2.5 km, and to 2% for those between 2.5 and 5km. Comparable numbers were reported for Nagasaki: 88%, 34%, and 11% respectively. This study was about some of the survivors.

Hiroshima blast and fire damage, U.S. Strategic Bombing Survey map. From wikicommons.

Hiroshima blast and fire damage, U.S. Strategic Bombing Survey map. From wikicommons.

In all, the Wood et al. study included 1,259 seventeen-year-olds, who had annual medical examinations since 1950. They were then compared for height, weight, and head circumference by their mother’s distance from the bombs’ hypocenters. They concluded that:

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