Barry Levy

• Doctor of Medicine
• Professor (Associate) at Tufts University

Background Russia’s invasion of Ukraine in February 2022 ignited the largest armed conflict in Europe since World War II. Ukrainian government agencies, civil society organizations, and international agencies have gathered an unprecedented amount of data about the impact of war on the environment, which is often the silent victim of war. We review...

By the time Jim Cobey began his orthopedic surgery practice in the mid-1970s, he had more public health and preventive medicine experience than most physicians have during their entire careers. As a college student in the 1960s, Jim volunteered on a pediatric nutrition and rehydration project for refugees in the Gaza Strip. As a medical student, he...

Amy Hagopian and Evan Kanter direct the “War & Health” course at the University of Washington (UW), one of the few courses on war in schools of public health. During the 1990s, Dr. Hagopian was employed by the UW School of Medicine to support rural hospitals in the five-state region served by the school. Over time, she became increasingly involved...

As Rohini Haar, an emergency medicine physician who has worked extensively on war-related and human rights issues in many low- and middle-income countries, will tell you, there is no standard career path for doing this work. But finding inspiring mentors and finding—and creating—opportunities to participate are critically important....

In 1971, Deane Marchbein was in France, studying French and art history, when Médecins Sans Frontières (MSF, or Doctors Without Borders) was established. Then and for many years afterward, she thought that she might work for MSF someday. And she did. She became an anesthesiologist and, for 19 years, practiced at Lawrence Community Hospital in Massa...

This chapter describes contamination of the physical environment during war, the preparation for war, and the aftermath of war. With regard to air contamination, it covers airborne exposure to chemicals, greenhouse gas emissions, and nuclear weapons production and testing. With regard to water contamination, it covers contamination of oceans and ot...

Each week for almost 40 years, Ira Helfand, an internist based in western Massachusetts, has worked treating patients with medical emergencies. And he has also spent much time helping to prevent the most terrifying global emergency: nuclear war. In 1977, Dr. Helfand was inspired by a book that raised his awareness about threats posed by nuclear pow...

This chapter defines categories of human rights and describes United Nations documents on which many human rights are based. It covers Just War Theory and other aspects of the justification for war. It also covers justified conduct during war, based on the Geneva Conventions and other international humanitarian law. It covers the concept and the or...

War and humanitarian assistance during war raise complex medical and ethical issues. They defy simple narratives. And journalists have the challenging task of objectively documenting and describing war in its many complexities—searching for the historical truth. Few people are more capable for performing this task than Sheri Fink, physician, former...

From Horror to Hope: Recognizing and Preventing the Health Impacts of War presents how war causes illness, injury, and death and what can be done to prevent these health impacts. Written by a public health physician who has studied these issues for 40 years, it describes injuries and assaults, malnutrition, communicable diseases, mental disorders,...

Denis Mukwege, an obstetrician-gynecologist in the Democratic Republic of the Congo (DRC), has made extraordinary contributions to diagnosing, treating, and preventing sexual violence, both locally and throughout the world. After completing his residency training in obstetrics and gynecology, he focused much of his work on reducing extremely high m...

When Robert (Bob) Gould and Patrice Sutton grew up in New York City, their families were on opposite sides of the political spectrum. But, by the mid-1980s, they had a shared passion for peace, health, and justice for all, which led them to the American Public Health Association (APHA) as a vehicle for advocacy....

War and other forms of armed conflict cause many adverse effects on health and the environment, including morbidity and mortality due to weapons; damage to the health-supporting infrastructure of society; contamination of air, water, and soil; forced displacement; violation of international agreements and human rights; diversion of resources; and p...

This chapter describes the adverse impact of social injustice on environmental health. Environmental pollution is a social injustice for all people, with a disproportionate impact on low- and middle-income countries and, within countries, low-income people, minority groups, and other marginalized populations. The chapter describes the evolution of...

Social injustice leads to profoundly increased rates of illness and premature death in low- and middle-income countries related to inadequate public health services and medical care, internal factors such as extreme poverty and unaccountable governments, and external factors such as debt, structural adjustment policies, and trade barriers. This cha...

The interrelated factors of climate change, decreased access to freshwater, and forced displacement are heightening the risk of armed conflict. Higher temperatures and extremes of precipitation are contributing to food and water insecurity, forced displacement, and sociopolitical tensions. Health professionals can help to address these problems thr...

Access to water is a basic human right. Per‐capita availability of and accessibility to fresh water is decreasing in many parts of the world due to population growth, industrialization, urbanization, climate change, and other factors. Conflicts over water have sharply increased, especially within nations. Most of these conflicts have occurred in th...

Climate change is causing environmental consequences, including increased temperature, extremes of precipitation, sea level rise, and extreme weather events. Climate change is also causing direct consequences on public health, including heat-related disorders, respiratory and allergic disorders, infectious diseases, and injuries from extreme weathe...

Climate change is causing increases in temperature, changes in precipitation and extreme weather events, sea-level rise, and other environmental impacts. It is also causing or contributing to heat-related disorders, respiratory and allergic disorders, infectious diseases, malnutrition due to food insecurity, and mental health disorders. In addition...

War and other forms of armed conflict have profound adverse effects on population health. It is important to document these effects to inform the general public and policy makers about the consequences of armed conflict, provide services to meet the needs of affected populations, protect human rights and document violations of international humanit...

The 40th anniversary of the end of the Vietnam War is a useful time to review the adverse health consequences of that war and to identify and address serious problems related to armed conflict, such as the protection of noncombatant civilians. More than 58,000 U.S. servicemembers died during the war and more than 150,000 were wounded. Many suffered...

Three types of violence—self-directed, interpersonal, and collective—have been defined by the World Health Organization in its efforts to urge public health workers to consider violence prevention as an important public health issue. This chapter deals with collective violence, which includes war and terrorism as well as their health consequences,...

The environmental and health consequences of climate change, which disproportionately affect low-income countries and poor people in high-income countries, profoundly affect human rights and social justice. Environmental consequences include increased temperature, excess precipitation in some areas and droughts in others, extreme weather events, an...

The weight of scientific evidence indicates that climate change is causally associated with collective violence. This evidence arises from individual studies over wide ranges of time and geographic location, and from two extensive meta-analyses. Complex pathways that underlie this association are not fully understood; however, increased ambient tem...

Music brings people together and makes them feel greater than the sum of their parts. Music can empower and inspire people to work together to accomplish goals and achieve visions unimagined by individuals acting alone. Music can be used in a number of ways to prevent conflict and promote peace. This presentation will highlight three ways in whic...

Weapons of mass destruction (WMD) is a term commonly used to refer to nuclear, chemical, and biological weapons, but the precise meaning of the term is unclear. There is no treaty or customary international law that contains an authoritative definition. Instead, international law has generally been applied to specific categories of weapons and not...

To the Editor: In the Clinical Practice article on mild asthma, Bel (Aug. 8 issue)(1) gives little attention to occupational (work-related) asthma, which accounts for approximately 9 to 15% of asthma cases in adults.(2),(3) Physicians can play vitally important roles in diagnosing and preventing occupational asthma by obtaining detailed occupationa...

This resource codifies the knowledge base and offers an authoritative and comprehensive guide to the important new field of children's environmental health. Edited by two internationally recognized pioneers in the area, it presents up-to-date information on the chemical, biological, physical, and societal hazards that confront children in today's w...

Armed conflict takes a profound toll on non-combatant civilian populations. Over the past century, an increasing percentage of deaths during armed conflict have been to non-combatant civilian populations. Civilians also suffer from much morbidity as a result of armed-conflict-related injuries and physical and mental disorders due to breakdown of th...

This second edition of Social Injustice and Public Health is a comprehensive, up-to-date, evidence-based resource on the relationship of social injustice to many aspects of public health, and it documents the adverse effects of social injustice on health and makes recommendations on what needs to be done to reduce social injustice and thereby impro...

The adverse health consequences of the Iraq War (2003-11) were profound. We conclude that at least 116,903 Iraqi non-combatants and more than 4800 coalition military personnel died over the 8-year course. Many Iraqi civilians were injured or became ill because of damage to the health-supporting infrastructure of the country, and about 5 million wer...

War and its aftermath have profound impact on public health. War and the aftermath of war claim many lives, with civilian noncombatants accounting, over time, for an increasing percentage of deaths during wartime. In recent decades, civil noncombatants have been increasingly targeted during war for assassination, abduction, sexual violence, and oth...

War has a profound impact on children's health. Many children die during war as a result of wounds or other injuries, but many more die from diseases resulting from damage to the health-supporting infrastructure, including damage to agriculture and food supply systems, water and sanitation systems, and medical and public health services. Many child...

United States military policy violates human rights in a number of ways. This presentation will describe four of them: (a) The use of armed drones to assassinate persons labeled as "terrorists", and the resultant deaths and nonfatal injuries to others; (b) diversion of human and financial resources away from programs and activities that support hea...

Kudos to Keck and Reed for their excellent article on Cuba's National Health System.(1) Their well-researched comprehensive review highlights the progress that Cuba has made-with limited resources over the past 60 years-in setting and implementing appropriate health priorities, promoting primary health care, focusing on vulnerable groups in the pop...

Because medical students and residents receive inadequate education and training in public health and preventive medicine, they will miss many opportunities, as they practice medicine, to improve the health of individual patients and populations. Although there is an ongoing need to expand the number and improve the specialist training of public he...

War and the preparation for war cause serious damage to human health and the environment. Several biologic agents can be weaponized, but biologic weapons have been rarely used during war or in terrorist attacks. Of much greater concern is the increased occurrence of infectious diseases during war and its aftermath due to damage to medical care and...

Since 1991, there have been significant developments pertaining to armed conflict and the roles of public health workers in addressing the health and human rights issues related to armed conflict. This session will address the following six issues and their evolution during this 20-year period: the impact of non-state actors in an asymmetric world...

War accounts for much morbidity and mortality among noncombatant civilians, primarily women and children. Civilians are not only "caught in the crossfire" during war, but they are also increasingly targeted during war. Noncombatant civilians are also adversely affected indirectly during war by damage to the health-supporting infrastructure of socie...

The economic costs of the wars in Iraq and Afghanistan have been huge. The operational costs of these wars exceed $1 trillion and are likely, including interest on debt, to be well over $3 trillion, exceeding every other war the United States has waged since World War II. This presentation will analyze these expenditures, as well as the human costs...

Introduction Availability and Accessibility of Water Access to Water as a Basic Human Right Conflicts Over Water Health Consequences of Violent Conflict Preventing Armed Conflicts Over Water Conclusion References

In response to the attacks on Sept 11, 2001 (9/11), and the related security concerns, the USA and its coalition partners began a war in Afghanistan and subsequently invaded Iraq. The wars caused many deaths of non-combatant civilians, further damaged the health-supporting infrastructure and the environment (already adversely affected by previous w...

Competition for resources between or within nations is likely to become an increasingly common cause of armed conflict. Competition for petroleum is especially likely to trigger armed conflict because petroleum is a highly valuable resource whose supply is destined to contract. Wars fought over petroleum and other resources can create public health...

In April 2010, an explosion on an oil rig in the Gulf of Mexico killed 11 workers, injured 17 workers, and spilled an estimated 185 million gallons of crude oil into the Gulf. Adverse effects on the health of cleanup workers, fishermen, and others as well as on the ecosystem are being studied. This paper reviews published studies of the adverse hea...

Scarcity of freshwater is an increasingly critical public health problem in many parts of the world. World leaders, including United Nations Secretary-General Ban Ki-moon, have urged that this issue be given high priority. Inadequate access to safe freshwater contributes to waterborne disease, malnutrition, poverty, economic and political instabili...

This roundtable discussion will explore research and advocacy needs relating to prevention of war, war and public health, and the structural causes of conflict. Discussion will include ideas for interdisciplinary collaboration on research on these issues. Opportunities for advocacy in relation to war prevention will be discussed.

Despite assurances by the U.S. military to minimize the adverse health consequences of war on noncombatant civilians and despite international conventions to protect noncombatant civilians during armed conflict, there have been similar patterns of civilian morbidity and mortality in both the Vietnam War four decades ago and the current Iraq War. Wh...

This presentation will summarize the profound adverse health consequences of war on civilians and what public health workers can do to minimize these consequences. Increasingly, war-associated morbidity and mortality affect civilian populations, in part because civilians are increasingly targeted during war. Much civilian morbidity and mortality du...

Due to population growth, urbanization, industrialization, and climate change, access to freshwater is an increasingly urgent issue in many parts of the world. The problem is especially severe in arid and semi-arid regions in developing countries in the Middle East, Africa, and South Asia. However, the problem also affects people in some areas of t...

As the world's population grows from 6.5 billion people now to 9.0 billion by 2050, as countries modernize, and as climate change evolves, there will be increasing conflicts, including armed conflicts, over the finite supply of fresh water. Already, during the past two decades, there has been a substantial increase in the number of international an...

There have been many improvements in national policies and programs concerning war and public health under the Obama Administration. Nevertheless, areas of concern remain. This presentation will explore the current status of Obama Administration policies and programs concerning the wars in Iraq and Afghanistan, nuclear weapons, and other relevant i...

The aim of this book is to offer a comprehensive approach to understanding social injustice and its impact on public health. Part I explores the nature of social injustice and its adverse effects on public health. Part II describes in detail how the health of ten specific population groups is affected by social injustice. Part III explores how soci...

This book addresses terrorism and public health, and presents a balanced approach to strengthening systems and protecting people. It provides up-to-date, science-based expert information on, and a systematic practical approach to a wide range of relevant public health issues as they relate to terrorism. The book is designed to assist public health...

The Oxford Textbook of Public Health is the ultimate resource on the subject of public health and epidemiology. With contributors drawn from across the world, offering perspectives from vastly different health systems, with ranging public health needs and priorities, this book offers a globally comprehensive picture of modern health.

Armed conflict damages health in many ways. These include death and disability directly caused by war, destruction of the societal infrastructure that supports health and safety, forced migration of people both within their own country and as refugees to other countries, promotion of violence as a method to settle conflicts and disputes, and the lo...

The current global economic crisis seriously threatens the health of the public. Challenges include increases in malnutrition; homelessness and inadequate housing; unemployment; substance abuse, depression, and other mental health problems; mortality; child health problems; violence; environmental and occupational health problems; and social injust...

Armed conflict causes an enormous amount of death and disability worldwide. It destroys families, communities and cultures. It diverts scarce resources. It disrupts the societal infrastructure that supports health. It forces people to leave their homes and become internally displaced persons or refugees who have fled to other countries. It violates...

This book addresses terrorism and public health, and presents a balanced approach to strengthening systems and protecting people. It provides up-to-date, science-based expert information on, and a systematic practical approach to a wide range of relevant public health issues as they relate to terrorism. The book is designed to assist public health...

This chapter describes in depth the direct health consequences of the Iraq War as well as adverse effects on health services, damage to the infrastructure that supports health, refugees and internally displaced persons, violation of human rights, diversion of resources, and impacts on the physical, sociocultural, and economic environments.

This chapter describes the roles and ethical dilemmas for military medical care workers, including obligations to enhance military strength versus obligations to meet the needs of individual military personnel, the ability to override the patient's wishes for "the patient's benefit," obligations of medical care workers to serve those in need of car...

This chapter provides an overview of war and its public health consequences. It describes how civilians have been increasingly affected, and often targeted, in war. It also describes vulnerable populations, diversion of resources, cycles of violence, and the adverse impacts of war on the physical environment. The chapter describes the brutality of...

Barry S. Levy, MD, MPH has written and spoken extensively on war and terrorism and their impact on public health. He has coedited, with Victor W. Sidel, the books Terrorism and Public Health, War and Public Health, and Social Injustice and Public Health and has written many journal articles on war, terrorism, and related subjects. He is an Adjunct...

Armed combat (also termed war or armed conflict) has profound direct and indirect impacts on the long-term physical and mental health of both military personnel and noncombatant civilians. Although most research has focused on immediate and short-term health consequences of war, an increasing number of studies have focused on the long-term health c...

Social injustice has profound impact on many aspects of health. Public health professionals can do much to alleviate social injustice in its many forms and to reduce the health consequences of social injustice. Progress in the attainment of the Healthy People 2010 Objectives for the Nation and the Millennium Development Goals are measures of the al...

Critically important issues related to war and public health will face the new administration. These include the wars in Iraq and Afghanistan, other international crises, control and ultimately abolition of nuclear weapons, strengthening international organizations to prevent war, improved services for military veterans and their families as well a...

The apparent suicide in August of anthrax researcher Bruce Ivins and the release by a U.S. federal judge of sealed records of the FBI's 7-year investigation have opened new controversies about the anthrax mailing that killed five people in 2001 and the U.S. response to it. These questions go far beyond the questions raised about the technical evide...

Nuclear weapons pose a particularly destructive threat. Prevention of the proliferation and use of nuclear weapons is urgently important to public health. “Horizontal” proliferation refers to nation-states or nonstate entities that do not have, but are acquiring, nuclear weapons or developing the capability and materials for producing them. “Vertic...

Elsevier Science refused to publish a study of IBM workers that IBM sought to keep from public view. Occupational and environmental health (OEH) suffers from the absence of a level playing field on which science can thrive. Industry pays for a substantial portion of OEH research. Studies done by private consulting firms or academic institutions may...

This chapter describes challenges that terrorism poses to public health. It defines terrorism as "politically motivated violence or the threat of violence, especially against civilians, with the intent to instill fear," and it explores other definitions of terrorism. It provides an overview of the terrorist events in the United States in 2001. It d...

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The chapter describes how social injustice leads to profoundly increased rates of illness and premature death in developing countries and discusses both internal factors, such as poverty, discrimination, failure to protect human rights, and external factors, such as high external debt, trade barriers, export of hazardous substances from developed c...

This chapter describes the nature of social injustice and its impact on public health. It defines social injustice in two ways: as the denial or violation of economic, sociocultural, political, civil, or human rights of specific populations or groups in a society based on the perception of their inferiority by those with more power or influence; an...

Newborn health indices were measured before, during, and after a demonstration nurse-midwife program introduced to relieve a health manpower shortage at a county hospital in rural California. During the program, prenatal care increased, and prematurity and neonatal mortality rate decreased at the county hospital. After the 3 year program, prenatal...

War has profound adverse effects on public health. War leads to death for military personnel and especially for civilians, long-term physical and psycho- logical consequences to survivors, destruction of sociocultural and ambient environments, and diversion of needed resources. In addition, war legalizes and promotes violence as a mode of solving p...

These are times of great change and upheaval in health care. More and more people are uninsured, consumers and employers pay substantially higher health insurance premiums for care, there is a shortage of nurses, and doctors go on strike. And these facts don't take into account that hospitals are going bankrupt while searching for their roles in th...

Manganese, which enters the body primarily via inhalation, can damage the nervous system and respiratory tract, as well as have other adverse effects. Occupational exposures occur mainly in mining, alloy production, processing, ferro-manganese operations, welding, and work with agrochemicals. Among the neurologic effects is an irreversible parkinso...

Kill one person, and it is considered murder. Kill ten thousand person, and it is considered foreign policy. -Anonymous