How can war affect people

There are times where the existence of conflict can confer protection to areas, for example by slowing unsustainable development that would otherwise have taken place in areas that are insecure, or by excluding human activities due to the presence of explosive remnants of war. But overall, and particularly because of the disruption conflicts cause to societies and to governance, the harms far outweigh the benefits. Occupations may be relatively short-lived, or can last decades. While states have an obligation to protect the occupied population, their environmental obligations are less well defined.

As with conflicts, occupations can hold back sustainable development, for example by limiting access to materials or technologies, or by acting as a barrier to investment. Pre-existing environmental programmes and projects may be curtailed, or replaced by a new incoming administration. A lack of investment and development can lead to the slow collapse of critical environmental infrastructure , infrastructure that may be damaged or degraded by periods of violence.

Measures taken by the occupied population to oppose the occupier can also lead to environmental harm. The increased military presence can impact landscapes by vehicle movements or training areas, or by the building of walls and fences that can disrupt wildlife movements, or separate people from the resources they are dependent on.

Poor waste management at military bases, whether operated by states or private contractors, can harm public health and the environment.

Meanwhile, militarised responses to security issues can create more serious environmental harm than civil responses would. Inequitable resource management is common to occupations, with resource grabs and over-extraction common, whether of water or minerals.

Environmental oversight can be limited or preferential, facilitating environmental degradation. The occupied population may be unable to enjoy the same environmental human rights as those of the occupier, and be forced to live with limited resources, poorer environmental services and higher levels of pollution.

Politically focused development is common as the occupying power seeks to make its mark on a territory. In this way major infrastructure works may be undertaken with little environmental oversight.

It is rare these days for conflicts to conclude cleanly with a peace agreement and a ceasefire. Low level conflict and insecurity can continue for long periods.

In this respect many of the forms of harm that occur during conflicts are also applicable to this phase, particularly in its early stages.

Transitions to peace are typified by weak state control , this means that environmental governance, and the capacity to provide it is often absent. Attention to environmental issues in the face of many competing social and economic priorities is usually limited.

These conditions are key to many post-conflict environmental problems. In some instances, peace and power sharing agreements have impeded governance by creating fragmented political systems. In the immediate aftermath of conflicts, states and international actors may be faced with immediate legacies , such as vast quantities of rubble and debris.

If managed poorly, for example through informal dumping, disposal can create new environmental risks. There have been instances where the looting of industrial sites has exposed communities to pollutants, and many of the environmentally harmful coping strategies that people used to survive during conflicts may continue well beyond their end. In conflicts with high levels of displacement, land rights and ownership issues are common, particularly when returnees move home.

Influxes of people can increase environmental pressures in areas from which they have been absent, particularly through agricultural conversion or expansion. This can lead to increased rates of deforestation. The presence of military forces can extend well into the post-conflict phase. The operation and ultimate closure or handover of bases are associated with pollution issues , particularly where the host nation may be unable to enforce environmental standards.

The use of practices like burn pits has exposed military personnel and communities to hazardous pollution, leaving veterans with ongoing health problems. The post-conflict clearance of landmines and explosive remnants of war can lead to soil degradation and localised pollution, and negative changes in land use when areas are released back to communities.

Yemen and Namibia have experienced conflict and are not on track to achieve the MDGs. Oman and Botswana, by contrast, have not experienced conflict and are achieving a higher proportion of the MDGs. This raises the question of whether the gap be-tween conflict countries and other countries is a result of conflict, and not a result of other factors associated with both conflict and poor development.

The additional burden of death and disability caused by the lingering effects of civil war is nearly double the immediate and direct effects. The primary reason is that internal armed conflicts increase exposure to disease, adversely affect access to the supply of medical care, and destroys health infrastructure.

In order to understand the development gap caused by armed conflict, we need to assess the counter-factual—what would the situation have been if civil war had not occurred. In an experimental sense, this implies comparing a treated case with conflict to an identical control case without conflict.

In a quasi-experimental setting, we can compare similar countries either by matching or by simulating the effects of conflict for a given country. Figure 3 compares two relatively similar countries—Burundi and Burkina Faso—over time. The upper half of the figure shows that the two countries followed a similar growth trajectory up to , while the lower half of the figure shows their conflict histories represented by bars with heights proportional to the number of battle-related deaths.

Barbara Van Dahlen, Ph. While killing an enemy combatant might be unavoidable, the act of killing is understandably troubling and potentially psychologically destructive. Understanding this reality can help warriors heal emotionally from the psychological consequences of war.

Travis Williams, on brotherhood and loss, Iraq. Note: This audio clip contains strong language. Credit: Story Corps. Credit: S tory Corps. Hartmut and Barbara Lau, on killing, sharing the experience. Drew Pham and Molly Pham, on killing and guilt.

Items gauging exposure to inhospitable conditions included questions documenting displacement due to village bombings or evacuations and questions regarding shortages of clean water and food, inability to sleep due to noise or inhospitable conditions, fearing being injured or killed, and exposure to toxic chemicals, including agent orange.

The combat experience questions—asked only of respondents with formal or informal military experience Footnote 7 —inquired about eight combat experiences. These questions assessed how many times the respondent experienced going on patrols, being ambushed, coming under artillery fire, firing at the enemy, being responsible for the death of the enemy, being nearly shot, and having friends shot near them in battle.

These asked whether the respondent had experienced a specified form of stress and how much it bothered them. Only nine questions were incorporated, in part, to reduce respondent burden. In addition, VHAS investigators removed questions that did not translate well, either linguistically or culturally, to the Vietnam context or were politically sensitive. Reduced scales, some with as few as two items, have been previously validated by scholars seeking to apply the scale internationally [ 41 — 43 ].

Lang et al. As such, we used all items available to us in the VHAS. The purpose of this study was to establish a scale quantifying stressful war experiences that is valid for veterans of both formal and informal military organizations, as well as civilians in Vietnam. Because the survey combined items from scales previously used solely with veterans assessing both combat and noncombat experiences, with items designed to assess trauma exposure in civilians, it was necessary to evaluate how these questions hang together as indicators of stressful war experiences.

To that end, we conducted exploratory factor analysis EFA , comparing results across civilians, informal military, and formal military, followed by confirmatory factor analysis CFA. To account for the fact that some items were binary while others contained multiple categories, we recoded all into binary indicators, which reduces method effect biases [ 44 , 45 ].

To account for the fact that some questions were not asked of civilians, we tested separate models for civilians, informal military, and formal military. The unique VHAS sampling approach required that we use survey estimation methods and apply sampling weights.

Footnote 8 However, many statistical operations limit the application of survey-estimation techniques and sampling weights. In addition, binary variables require special treatment in factor-analytic models, specifically, analysis based on tetrachoric correlations. Thus, our analysis proceeded in three broad steps: 1 preliminary inspection of the tetrachoric correlation matrix, 2 estimation of weighted tetrachoric EFA using the iterated principal factors IPF Footnote 9 method with oblique rotation, Footnote 10 3 examination of survey-adjusted CFA with sampling weights.

Footnote 11 All analyses were conducted in Stata version Tetrachoric correlations were used to compensate for the artificially-binary structure of our scale items [ 51 ]. We engaged in multiple iterations of weighted tetrachoric EFA, step two, to assess item clustering and make a preliminary determination regarding the appropriate number of factors via eigenvalues, scree tests, and parallel analysis.

When clear factor structures were not apparent, we compared alternate model specifications, preferring models with the cleanest factor loadings i. Table 1 details our retention criteria.

Finally, we used survey adjusted, weighted CFA to refine and confirm the relational structure of the factors e. Our goodness of fit GOF criteria are shown in Table 2. To confirm the appropriateness of scales derived from our factor analysis, we evaluated reliability and validity using coefficient omega, Footnote 12 composite factor reliability CR , Footnote 13 average variance extracted AVE ,.

The purpose of each measure and the criteria for establishing reliability or validity are shown in Table 2. The analytical sample for this study included men and women.

Sixty-nine percent experienced at least one war-specific stressor exposure. Table 3 summarizes war-related stressor exposures. The weighted tetrachoric correlation matrix showed strong correlations above 0. Several of the combat and nearness to death items also correlated with shortages of clean water, exposure to toxic chemicals, and experiencing fear of death, indicating potential cross-loading items, requiring clarification via factor analysis.

Inhospitable living conditions and war-related migrations also demonstrated the expected correlations plus potential cross-loading correlations. When computed separately for civilians, informal military, and formal military, the correlation matrices showed that correlation patterns varied between the three groups, potentially warranting separate analyses.

In preliminary tests using EFA models, we discovered that although death and disability of family members clustered strongly into two respective factors, the factors were largely unrelated to other stressful war experiences. Additionally, the death and disability of family members items are conceptually and chronologically distinct from the other major war-related stressors i.

As a result, we removed these items from all models. In EFA, the eigenvalues and the scree test indicated two factors. Footnote 16 However, the two-factor model had cross-loading items indicating either that more factors were needed or that the cross-loading items were not relevant to the factors.

We tested models with 1, 2, 3, and 4 factors. The 3-factor model was the only model to meet all factor composition criteria. Figure 1 shows the relational structure of these factors. The war violence factor included seeing dead or seriously injured Vietnamese and foreign soldiers, seeing dead or seriously injured civilians, and being wounded in the warzone.

Knowing people who were injured was removed from the factor during CFA due to its high unique variance. This factor captures experiences related to being the victim of violence, witnessing violence, or witnessing the effects of violence. The inhospitable conditions factor included experiencing shortages of food and clean water, and the inability to sleep due to noise and other inhospitable conditions.

The migration factor included three items: moving due to bombings and evacuations , and exposure to toxic chemicals. The wartime environment factor encompasses both displacement and inhospitable living conditions confirming the close relationship between these two sets of items. Table 4 presents factor loadings. All factors also exhibited convergent validity with AVE values greater than 0.

See Table 5 for reliability and validity statistics. Also, correlations between predicted factors and PTSD indicate that the factors are indeed associated with the theoretically-related phenomenon, PTSD, demonstrating construct validity. The second set of models, analyzing informal military respondents, yielded two factors: exposure to combat conditions and related violence COMBAT and inhospitable conditions and displacement COND.

Footnote 17 However, the two-factor model had cross-loading items indicating either that more factors were needed or that the cross-loading items were not relevant to the factors. We compared models with 1, 2, 3, and 4 factors. None of the models improved the factor composition statistics. Moreover, the 2-factor model made the most sense theoretically. We revised the 2-factor model, removing Know people who were injured due to low loadings and high uniqueness, and removing Saw dead Vietnamese soldiers and Saw dead civilians due to cross-loading with nearly equivalent values on both factors.

Figure 2 shows the final structure of these factors for respondents with an informal military background. The combat factor included being wounded in the warzone, going on combat patrols, being ambushed, coming under artillery fire, shooting at the enemy, nearly being shot, and having a friend shot near them in battle. This factor primarily captures experiences related to engaging in the formal activities of war. The inhospitable conditions factor included moving due to bombing or evacuation and experiencing food shortages.

Exposure to toxic chemicals, shortages of clean water, and the inability to sleep failed to load on the factor in CFA. See Table 4 for factor loadings. See Table 6 for reliability and validity statistics. In addition, correlations indicate that the predicted factors were again associated with PTSD, exhibiting construct validity. In EFA, the eigenvalues and the scree test indicated three factors. Footnote 18 The 3-factor model had one item Moved due to bombings with a negative uniqueness value, indicating that this solution was a Heywood Case.

We tested alternate 1- and 2-factor solutions. The 1-factor model exhibited high uniquenesses on all items related to moving and inhospitable conditions, making it a less appropriate solution. While Exposed to toxic chemicals had a somewhat low loading on Factor 1 0.

In CFA models, Moved due to bombings exhibited problematic uniqueness levels, Footnote 19 and when removed, Moved due to evacuation had a very high unique variance 0. Saw dead civilians and Exposed to toxic chemicals also demonstrated high unique variances above 0.

Removing the four problematic items improved all goodness of fit statistics. Figure 3 shows the relational structure of these factors.

The COMBAT factor included a mix of variables related to being the victim of violence, witnessing violence and its effects, and engaging in combat activities.

However, the factor failed to include war-related displacement. The goal of this study was to explore a set of war-related stress exposures to identify items that, together, act as a scale quantifying exposure to war-related traumatic events in a sample of older Vietnamese men and women currently residing in Northern or North Central Vietnam. Our intent was to develop a scale that is valid in the Vietnam context and would allow future researchers to investigate the long-term effects of said war-exposure for civilians, formal military, and paramilitary alike.

In pursuing this goal, we integrated insights of two scholarly domains: trauma research focusing on veterans and that focusing on refugees and other civilian residents of warzones. As a result, our study yields novel information on the content of war-related stress for survivors of war in diverse post-conflict contexts outside of the widely studied U.

Four findings are important to highlight: 1 Some common predictors of PTSD, which may occur during wartime, are not components of war-related trauma exposure; 2 Items from prior instruments did not operate as distinct factors or subscales, rather they clustered with items from other instruments; 3 The contributions of both domains of trauma research—veterans studies and refugee studies—are relevant for studying trauma in residents of warzones; and finally, 4 Civilians, members of militias and other less formalized military organizations, and members of formal military organizations, experience war events differently, indicating the need for distinct measurement approaches.

One common predictor of PTSD, witnessing or learning of the violent or accidental death or severe injury of a family member s , is a likely occurrence among those who live in warzones.

Prior research has shown a strong correlation between these experiences and PTSD or other forms of mental distress [ 63 , 64 ]. However, in the VHAS sample, the correlation is very weak, ranging from 0. Our study found that while the death and disability of family members may contribute to PTSD, this form of exposure does not cluster with other war-exposure items. This may indicate that death and disability of family members, however linked to war, is distinct from other war-related trauma exposures and should not be included in scales designed to measure war-related trauma exposure.

Alternately, it may reflect the secondary as opposed to first-hand nature of these traumas or the fact that they do not co-occur with other exposures in a patterned way. Consequently, researchers should not ignore this predictor of PTSD, especially in contexts where the violence of armed conflict results in loss of life beyond those engaged in the military.

However, they should assess its association with PTSD and other mental health indicators separately from other war-related traumatic events. This unique composition of items allowed us to identify new factor structures for exposure to traumatic events and conditions in contexts of armed conflict. Prior psychometric testing of war-exposure scales identified three or more factors depending on the scale , with varying item compositions.

For example, U. However, they acknowledged poor discriminant validity. In other words, the three factors were not discernably distinct from one another. The DRRI identified five war-related factors, including combat experiences, the deployment environment, chemical exposures, deployment concerns, and postbattle experiences.

We found that items from previously separate instruments clustered together for this sample, but the precise configurations varied across the civilian, formal military, and paramilitary populations see Table 8. For example, items from separate factors or subscales, specifically, injury to oneself and exposure to dead or severely injured people, clustered together for civilian respondents. A similar set of items clustered with CES items for both formal and informal military respondents.

However, displacement and inhospitable conditions clustered as separate factors for our sample, and the factors exhibited excellent discriminant validity. The restructuring of item clusters from prior scales indicates the need for scholars to draw items from a variety of sources and test factor structures for each new study context.

This study integrated items previously used in two distinct trauma research domains. From studies of trauma in veterans, we incorporated nearness to death and combat exposure.

From refugee studies, we included inhospitable conditions and displacement. While prior trauma research with veterans included inhospitable conditions, the studies used conditions perceived to be inhospitable to veterans of foreign wars, such as undesirable food, climate, insects, living conditions, and other chronic, low-magnitude stressors of the deployment environment.

These conditions are unlikely to be perceived as inhospitable to populations residing in armed conflict locales. Our inclusion of inhospitable conditions such as shortages of food and water, the inability to sleep due to bombings and conflict, and exposure to toxic chemicals supports the findings of scholars taking a psychosocial approach. We found strong support for including these items as potentially traumatic events.

Future studies should examine the mediating role of post-war stressors for war-exposure and mental health. We also found support for the inclusion of displacement items, commonly incorporated in refugee studies, for both civilians and members of the informal military. For civilians, displacement clustered with exposure to toxic chemicals, functioning as a subscale within inhospitable environmental conditions, while for the informal military, displacement and inhospitable conditions clustered together in a single factor.

This finding likely reflects the co-occurrence of displacement and inhospitable conditions. Prior research has found that inhospitable conditions not only precede or induce displacement they also occur during exile [ 35 ].

Conditions of return can also be traumatizing. A study among war survivors in Kosovo investigated why displacement was so frequently listed as a source of trauma [ 66 ]. Such conditions at each stage of displacement compounded the trauma of displacement itself. These findings indicate the need for researchers to include an array of displacement items, crafting interdisciplinary instruments that draw from both veterans and refugee studies, especially when studying mixed populations e.

A central finding of this study is that the items capturing exposure to war-related traumatic events differ for civilians, formal military, and paramilitary.