Global conflict a ‘fundamental determinant’ of health

GPs can expect to see the impact of global conflicts and violence in their consulting rooms this year, with a new editorial saying it could become the ‘most pressing health challenge of 2026’.
 
Published in The Lancet earlier this month, the ‘No health without peace‘ editorial said climate change, artificial intelligence, pandemics and non-communicable diseases will continue to shape health and medicine.
 
But it added that, increasingly, ‘conflict is a fundamental determinant of people’s health and of the functioning of health systems’.
 
The editorial says that in Ukraine, more than 2000 attacks on health facilities have been documented since 2022, while in Sudan, there have been more than 200 attacks on health facilities and health workers since 2023.

In Gaza, at least 94% of hospitals have been damaged or destroyed, as well as ‘the collapse of essential health services, widespread food insecurity, and repeated attacks on care providers’.
 
‘The burden of armed conflict and violence worldwide is unusually high, and its effects extend far beyond battlefields, with harm in war zones and in civilian settings increasingly normalised,’ it said.
 
‘Conflict is too often treated as an externality of health; in reality, it cuts across every major health agenda, shaping risks, responses, and the feasibility of progress.
 
‘Peace is not adjacent to health – it is foundational.’
 
In 2024, the number of state-based conflicts in the world reached a historic high of at least 61, the editorial explains. 
 
And for all the millions of people impacted directly by war, there is also evidence to show that people watching such events unfold indirectly, through mass media coverage, are also affected. 
 
‘The mental health ramifications of war extend beyond immediate participants, refugees, or directly involved parties,’ wrote authors of an article published last year in BMC Psychiatry.  
 
‘Psychological distress caused by war events, as portrayed in media coverage or witnessed by individuals worldwide, generates anxiety, uncertainty, and lasting effects on mental health.’ 
 
For Dr Karen Spielman, a Jewish person working in Bondi and Chair of RACGP Specific Interests Psychological Medicine, the health impacts of conflict and violence are at the forefront of her mind, in the aftermath of the 14 December Bondi attack.
 
‘We’re reeling from the effects, and that’s why I’ve been busy today, because I’ve been in community meetings, and talking to case managers, and trying to get protocols for managing people that are impacted,’ she told newsGP.
 
‘There are loads of people doing it, who are picking up people on the frontline who may be more at risk of long-term problems and making sure that they’re the ones that are getting evidence-based treatment as soon as possible.
 
‘I saw patients who didn’t have their own GPs, who’ve got acute stress disorder that I’m writing referrals for to access appropriately trained therapists, and we’ll keep following up on them to make sure that if they aren’t improving functionally, that we get them into care as soon as possible.
 
‘It’s really making sure that people are connected to the care that they need, and we’re just desperate to prevent PTSD and to triage people who are going to be more vulnerable.’
 
The Lancet editorial comes at a time when 71% of practising GPs report mental health as a top reason for patient presentations – a 10% increase since 2017.
 
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