War as a Disease Amplifier

Previous works have addressed the idea that infectious disease may manifest in epidemic or pandemic form through processes of amplification through ecological change.1 Despite their analytical shortcomings, Galenic perspectives which specify that chronic poverty and the inequitable distribution of resources function as the principal (if not sole) variable involved in the spread of contagion are currently in vogue.2 Poverty certainly does serve as an amplifier of pathogenic infection, however, it is not alone in this function as other variables, including ecological change, trade, migration, natural disasters,3 and war may also serve as disease amplifiers. This chapter is primarily concerned with the effects of war (both inter-state and intra-state) on the emergence and proliferation of infectious disease. In it I argue that the processes of inter-state war and civil conflict create conditions directly conducive to the emergence, proliferation, and mutation of pathogens among both combatant and civilian populations. Thus war also functions as a "disease amplifier."

Of the various factors that "amplify" disease, this particular relationship is doubtless the least understood, and it requires the development of a robust theoretical construct of probable paths of causality. The intellectual soil has not remained utterly fallow, as historians have noted this relationship for centuries, and yet such issues remain relatively unexplored within the domain of political science. This chapter explores both historical sources, and the current available empirical data, in order to develop and refine a series of testable hypotheses to inform future work in this neglected area. To empirically establish this relationship I analyze previously unpublished data from the German and Austrian archives regarding the effects of World War I on disease-induced morbidity and mortality.

The causal relationship between conflict and infectious disease is rather complex, often exhibiting both emergent properties and non-linearities. The balance of the evidence presented herein suggests that war has historically functioned as a central catalyst in the propagation of infectious diseases. Conflict spreads contagion between (and within) factions of combatants, and then from the warring parties to the civilian populations that they come into contact with, both during and after the martial engagements in question. A second question, regarding causality, deals with the issue of whether infectious disease can generate conflict within societies, or between sovereign states. There is considerable weight to the proposition that war acts to amplify disease, but there is little current empirical evidence to support the hypothesis that disease fosters war between sovereign states.

Let us engage the first proposition, namely that war functions as a catalytic agent that facilitates the "emergence" of epidemic disease in a given polity or population. What do we then mean by "war" and "conflict"? For the most part the terms are used interchangeably to denote processes of armed aggression between two collectivities or factions of combatants.4 This may manifest in war between two sovereign states (such as France and Germany) or in intra-state conflicts such as civil wars. The processes of conflict often generate the sufficient (although not necessary) conditions for the widespread diffusion of pathogens across the proximate region of conflict, and to those distal regions affected by demobilization. Thus, contagion might be passed from one force to another, and thereafter spread among the civilian populations through which the soldiers passed on their way home. At that point demobilized forces will then inadvertently spread pathogens within their own communities.

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