Volume 19, Issue 2 , Pages 87-89, March 2008
Collateral Damages
Article Outline
“War is a cowardly escape from the problems of peace.”
—Thomas Mann (1875-1955) (n.d.)
I have recently been the recipient of a number of emails that refer me to Web sites that outline the costs of the war in Iraq. No doubt you have received similar emails. These sites invariably discuss the real and immediate costs of war: the numbers of soldiers and civilians who are killed, maimed, and psychologically traumatized by mortars, bullets, and land mines; the fallout from decimated infrastructures that can no longer provide education, health care, physical security, and political stability; and the shattered families that cannot deal with the mental and physical disabilities or deaths of loved ones.
The really interesting sites then tell you in graphic detail just how much could have been accomplished if the $2.4 trillion that has been spent on the war in Iraq had been redirected. They provide details about how illiteracy would be wiped out, about how starving people would be fed and provided with clean water, about how many diseases would be prevented or cured, about how global warming would be reversed, about how we would all get tax rebates, and about how shortages of police, firefighters, teachers, and health care workers would be addressed. It is enough to make the social liberal in me salivate: Oh, to have $2.4 trillion to spend on things that really matter! The fact that the funding would only come by de-funding violence would just be icing on the cake.
But so much for fantasy, because you have to understand that it is all fantasy. The truth of the matter is that there is no $2.4 trillion. There never was. Most of the money funding this war is “on paper.” It is deficit spending. It is not the kind of money that actually gets budgeted; deficit spending would never be used to convert 70% of the nation's energy production into renewable resource technologies or to cure cancer or to find a vaccine for HIV. There just isn't enough political will to go into debt for those “nice but not necessary” programs.
I am writing this editorial during the last week of 2007. Denver is covered in a foot of snow; the scenery is beautiful, the roads are treacherous, it is bitingly cold, and I opted to work from home today rather than brave the elements. This gave me the rare opportunity to watch the news. Today I learned that the President signed the FY (fiscal year) 2008 Omnibus Appropriations Bill. The bill is the result of compromise. Congress had to do a lot of soul searching after the first appropriations bill was vetoed. Threats of additional vetoes made them slash domestic spending increases and provide additional support for the wars in both Afghanistan and Iraq. The result is a bill with funding cuts for some important social and health programs, funding freezes (which are actually cuts in funding, given inflation and salary increases) for more programs, or funding with only a fraction of the increases needed to maintain services. Much-needed program expansions—including the ability to accurately measure outcomes—will not occur at these funding levels.
The costs of war are huge. Money and lives are terrible things to waste, but there are equally terrible, if less obvious, costs. One of these is our loss of standing in the world. It is hard to maintain moral superiority when we drop bombs on innocent people and when we appear to use torture to interrogate prisoners of war. These actions only serve to establish and expand hostility. As Jimmy Carter (n.d.) once said, “We will not learn how to live in peace by killing each other's children.”
To be honest, many war-related actions that cause the most hatred are accidental. Having once been an officer in the U.S. Air Force Nurse Corps, I know that the military does not purposefully target schools and children and hospitals and peaceful civilians. But accidents happen. They happen because we are there and we are carrying weapons, because people make mistakes, because our intelligence and technologies are not infallible, and because this is the nature of war. Innocents get in the way and are offered up as collateral damage. And every time one of those incidents happens, we recruit more enemies, more suicide bombers.
My military experience occurred during the Vietnam War. I never left the United States. In fact, I spent my entire tour of duty stationed at Nellis Air Force Base in Las Vegas. Nellis hospital did not provide the trauma or rehabilitation care required for the grievously wounded—those patients went to larger military facilities. The men (because it was mostly men in those days) who returned to Nellis were whole—no missing limbs, no gaping abdominal wounds. What I learned during those years was that people who spend time in a war zone are never spared trauma. The men that I cared for when they returned home suffered deeply. They looked fine, but the rates of alcoholism, drug use, violence, and mental health diagnoses told the larger story. In many ways, those who survived that war—those who survive any war—represent the fallout and further collateral damage.
I am of the opinion that a major war-related cost rests in the way we set priorities. Despite deficit spending, money is limited and budgets have to be discussed. The President's initial FY 2008 budget is a case in point. Although presidential budgets are really just working drafts, they tell a lot about where the country stands and where the leadership wants to go. The President's budget for FY 2008 would have required cuts to medical and other scientific research, access to health care, rural health initiatives, education, student aid, state and local law enforcement, homeland security grants, renewable energy programs, and infrastructure maintenance (Obey, 2007). The President was evidently willing to sacrifice these programs to bring budget overrides into some semblance of control. Congress did not agree; compromises were made, and the final cuts were somewhat less onerous. The problem is that this puts us into the stance of being grateful that it wasn't as bad as it could have been when what we really need is appropriate funding to meet the needs of the nation. As Congressman David Obey (D, Wisconsin, Chairman, Committee on Appropriations) wrote, “The omnibus appropriations bill is totally inadequate to meet the long-term investment needs of the country” (p. 1). And don't forget, the President also vetoed the State Children's Health Initiative Program twice before finally signing a watered down version of the bill on December 29, 2007 (Bush OKs, 2007). “Watered down” in this case means that the legislation was stripped of funding increases that would have expanded the program to 10 million children in need. The bill that was signed provides level funding only until March 2009 (Broaddus & Park, 2007). Sometimes collateral damages are less obvious than children dying in the streets of Baghdad.
An inevitable result of all of these outcomes is the way that barriers are being built. We have used up the good will of most of our allies, and we have reinforced the obstacles to peace. It wouldn't be so bad if we had actually accomplished something, but we haven't. Terrorism is now a common occurrence, and stability in the Middle East is a fading hope. This kind of collateral damage does not bode well for global peace and unity.
And what does this have to do with HIV infection and nursing? Everything. First, HIV-specific programming was not spared in these compromises. The Health Resources and Service Administration and the Centers for Disease Control and Prevention both took hits to HIV programs that were significant enough for the National Alliance of State and Territorial AIDS Directors to distribute a letter saying that it was “exceedingly disappointed in the funding outcome for FY 2008” (J. Scofield & L. Hanen, personal communication, December 18, 2007).
We also know that HIV thrives during war and instability. It is more easily transmitted when people are forced to leave homes and established sex partners to fight a war or to flee from the consequences of that war. War throws people into situations in which sex is used for temporary comfort, for violent dominance, or for survival. It is not possible to implement HIV prevention programs or to adequately provide services for HIV-infected people in the middle of a war.
The primary directive of nursing is to promote health and “a peaceful existence, which is a key part of health” (Ketefian, Donaldson, Sebastian, & Olshansky, 2006, p. 327). Many of us focus on helping individuals and families attain that peaceful existence, but we have an obligation to consider the overarching damage caused by international conflict. Santa Barbara and MacQueen (2004), in fact, have suggested that health care providers move forward from a “health through peace” perspective to a “peace through health” stance. They argue that health care providers have unique qualities and skills that can make a difference in war-related morbidity and mortality. These qualities include being able to help people see areas of common need, to heal trauma, to use altruism, to support victims of conflict, and to rely on facts to provide an evidence-based approach to the topic of war. The salient point I took from their article was that war is often defined in positive terms: it is seen as a game, a way to become a man, a competition, or a religious/ideological struggle between good and evil. It is important for health care providers to point out that war is none of those things; it is, quite simply, a disaster for the public health, the environment, and the goal of peace.
References
- Broadduss, M., & Park, E. (2007, February 22). Freezing SCHIP funding in coming years would reverse gains in children's health coverage. Center on Budget and Policy Priorities. Retrieved December 30, 2007, from http://www.cbpp.org/6-5-06health.htm
- Bush OKs Child Health Program Extension. (2007, December 29). USA today. Retrieved December 30, 2007, from http://www.usatoday.com/news/washington/2007-12-29-bush-kids-health_N.htm
- Carter, J. (n.d.). Classic quotes. Retrieved December 28, 2007, from http://www.quotationspage.com/search.php3?Search=war&startsearch=Search&Author=jimmy+carter&C=mgm&C=motivate&C=classic&C=coles&C=poorc&C=lindsly
- . The importance of nursing in promoting peace: Implications for nursing education. Journal of Professional Nursing. 2006;22:327–328
- Mann, T. (n.d.). Classic quotes. Retrieved December 28, 2007, from http://www.quotationspage.com/search.php3?Search=war&startsearch=Search&Author=thomas=mann&C=mgm&C=motivate&C=classic&C=coles&C=poorc&C=lindsly
- Obey, D. (2007, December 16). FY 2008 appropriations bill. Retrieved December 28, 2007, from http://appropriations.house.gov/pdf/FY08OmnibusSummary.pdf
- . Peace through health: Key concepts. Lancet. 2004;364:384–386
PII: S1055-3290(08)00010-1
doi:10.1016/j.jana.2008.01.002
© 2008 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.
Volume 19, Issue 2 , Pages 87-89, March 2008
