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August 1, 2001

Public Health in Times of War and Famine: What Can Be Done? What Should Be Done?

Author Affiliations

Author Affiliation: Program on Forced Migration and Health, Heilbrunn Center for Population and Family Health, Mailman School of Public Health of Columbia University, New York, NY.

JAMA. 2001;286(5):588-590. doi:10.1001/jama.286.5.588

In this issue of THE JOURNAL, 2 articles and a letter to the Editor argue, yet again, that war and public health are incompatible pursuits. The article from Guinea-Bissau by Gustafson et al1 is an elegant analysis of what happens when patients with a chronic disease, in this case tuberculosis, are forced to interrupt or abandon treatment because of war, civil strife, or other societal upheaval. By comparing the experiences of patients with tuberculosis forced to flee from the capital city of Bissau because of violent fighting with those who had completed an entire course of treatment during peacetime in the year before the fighting, the authors are able to estimate a war-specific relative risk for tuberculosis mortality of 3.1 (95% confidence interval, 1.20-8.12). In other words, patients with tuberculosis whose treatment was disrupted because of war were 3 times as likely to die as those who were fully treated in peacetime.