War and conflict escalation in the context of the COVID-19 pandemic, natural disasters, food, and economic crises: A critical public health issue

Climate issues over public health

About 7.6 billion people — or 96% of humanity have experienced a global warming effect on temperature in the past 12 months. The World Bank says more than 1 billion people could be displaced globally by 2050 due to climate change and natural disasters [Figure 3]. And more than five million extra deaths a year can be attributed to the disease burden associated with climate change, which is at least 30 times higher compared to 20 years ago [Figure 3]. In those years, the lion’s share (more than 96%) of disaster-related deaths had taken place mainly in developing countries, which has greatly shifted across 19 countries in North America, Europe, and the Asia-Pacific region that label global climate change as a major threat. Global warming is influencing weather patterns, causing heat waves, heavy rainfall, droughts, cyclones, and wildfires. According to the CRED, floods, storms, and draughts caused losses to the global economy of more than $224 billion in 2021 and could cost $5.6 trillion by 2050 [Figure 3]. Less than 3% of the Earth’s surface water is suitable for human consumption, and less than half of it is potable. About 90% of the agricultural sector in least developed countries is affected by water scarcity. History records 1300 conflicts over water 2500 years before the birth of Christ, 187 of which were armed conflicts. Disastrous shrinking of rivers has been reported in the US, Europe, Asia, and the Middle East, while nearly a quarter of the world’s population is at risk of flooding — 10 times more rain in Sindh province and 10 times faster melting of Himalayan glaciers are reported by the European Space Agency and Scientific Reports journal, respectively. Temperature extremes can deteriorate chronic illnesses such as malnutrition, auto-immune diseases such as arthritis and diabetes, cardio-respiratory symptoms, certain cancer types, as well as spread contagious diseases such as mosquito-borne illnesses, COVID-19, and fungal or bacterial infections [Figure 4]. For instance, a 1°C increase in global temperature may result in more than 100,000 new cases of diabetes each year in the USA alone and 6 times more premature deaths among respiratory patients compared to the general population [Figure 3]. Furthermore, occupational heat-related mortality is 35 times higher among agricultural workers compared to workers from other industries [Figure 3 and Supplement 1].

Close

Figure 3:

The present climate issues are of great concern.

Export to PPT

Close

Figure 4:

Present multiple crises over global health.

Export to PPT

The global economy and public health are being impacted by a pandemic

The US government issued a new alert in May 2022, stating that the upcoming fall and winter could potentially see 100 million COVID-19 infections in the US. According to Worldometer data, during the course of the manuscript’s editing, globally more than 673 million people were already affected, and 67 million had already died, as of January, 2023. As the world becomes more interconnected, the economic impacts of the COVID-19 pandemic become more serious. The pandemic has the potential to spark and intensify armed conflict due to its negative economic consequences or, at the very least, worsen already precarious situations by escalating grievances, increasing mistrust, discrimination, and perceptions of injustice among vulnerable populations in war or conflict zones. However, the fuel crisis induced by Russian aggression in Ukraine, supply chain disruptions, climate disasters, and the continued economic fallout of the COVID-19 pandemic are pushing approximately 345 million people around the globe into food insecurity. “Hunger leads to one death every four seconds”—more than 200 NGOs from 75 countries were calling on global statesmen gathering at the 77^th UN General Assembly to take decisive action [Supplement 2]. According to the UN, a record $51.5 billion is required in 2023 to assist 230 million of the world’s most vulnerable people in nearly 70 countries [Figure 5]. Already, the cost of illiteracy to the global economy has exceeded $1 trillion, and UNESCO estimates that close to 900 million learners have been affected by the closure of educational institutions, and 100 million children would fall below the minimum reading proficiency level [Figures 4 and 5]. Globally, 3.3 billion people, which constitute 81% of the world’s workforce, were affected by the lockdown, and the world incurred a loss of 9% of global working hours, followed by 4.4% of the global gross domestic product (GDP) in lost labor incomes. Economically and socially disadvantaged populations were twice as likely to present with COVID-19 symptoms to the emergency department and were more likely to require re-hospitalization within 30 days of discharge. During the pandemic, child marriage, gender-based, or domestic violence increased; routine health services were jeopardized; and routine vaccinations were halted for 80 million children in 70 countries [Figure 5].

Close

Figure 5:

The pandemic pushed the world into a deep mess.

Export to PPT

Man-made catastrophes

The massive amount of greenhouse gases emitted by major oil companies’ oil fields is not disclosed: Blood pressure (BP), Eni, ExxonMobil, Chevron, and Shell emit millions of tons of gas from their oil fields. According to the WWF, as a result of deforestation and ocean pollution, the world’s wildlife populations have decreased by more than two-thirds since 1970. Man-made catastrophes such as mountain destruction, deforestation, and pollution not only hamper food, fuel, and habitat but also cause the spread of acute infections, chronic conditions, and communicable diseases. For example, cardiovascular disease accounts for more than 60% of pollution-related disease and death; each kilometer square of Brazilian Amazon deforestation results in 27 new malaria cases. This is particularly important as, from California to Germany and China, droughts have shrunk the rivers that drive huge hydroelectric plants. As global energy supplies tightened last year, India, China, Australia, and many European Union (EU) countries increased their reliance on coal-fired power — along with the Russia-Ukraine conflict [Figure 5]. The world’s consumption of coal is taking it back to the record level it reached nearly a decade ago, says an IEA press release. In its recent publication, the Nature Food journal says, “We estimate more than 2 billion people could die from a nuclear war between India and Pakistan, and more than 5 billion could die from a war between the United States and Russia — underscoring the importance of global cooperation in preventing nuclear war.”

Present global economic crisis: Fact is stranger than fiction

The three largest economies in the world — namely, the US, Eurozone, and China — are facing impediments due to higher than expected inflation or lockdown. For example, the UK economy is being battered by rising energy costs, rising interest rates, tax increases, and Brexit. Global central banks continued to raise interest rates in response to the Federal Reserve of America’s decision to prevent the fastest rate of inflation in decades, but have so far failed. Inflation reaches 41-year highs in the United States, the United Kingdom, Japan, and Germany; 37-year highs in France and Italy; and 20-year highs in Russia and Turkey, owing primarily to the fuel crisis, food crisis, currency devaluation, and a drop in business confidence over panic [Supplement 3]. China’s factory inflation hits 25% in 2021, the economy is slowing down due to the adoption of the “zero-COVID strategy,” and there is a risk of 1 million deaths in the “winter wave.” Eurozone inflation averaged 2.12% from 1991 until 2022 and climbed close to 11% in October 2022. Nearly half of the countries of the EU, 40% of the countries of Africa, and 30% of the countries of Asia declared bankruptcy during the previous two centuries. However, according to the statement from the head of the UNDP at the 27^th Conference of the Parties to the United Nations Framework Convention on Climate Change (COP27), held in Egypt, 54 countries with the poorest development are currently in danger of bankruptcy [Figure 6]. Lebanon, Sri Lanka, Russia, Suriname, and Zambia are already in default. In addition to increased employer healthcare insurance costs, currency depreciation, a reduced labor force or a lack of skilled labor, a fuel-power crisis, and transportation freight costs, these factors have wreaked havoc on the supply and demand chain, causing manufacturers to lay off workers or postpone economic activities to avoid further losses.

Close

Figure 6:

The Ukraine’s aggression is making an impact elsewhere, too.

Export to PPT

Global conflicts over health economics: Adding insult to grave injury

Conflict was responsible for more than 10 million deaths of children under the age of five between 1995 and 2015 worldwide. From 2021 to 2022, more than 100 million people will have been driven from their homes by war, violence, persecution, and human rights abuse, according to the UNHCR. Ukraine, Afghanistan, the Democratic Republic of the Congo, Ethiopia, Sudan, the Syrian Arab Republic, and Yemen are the countries with the highest numbers of internally displaced persons. Since 2017, more than one in every six children has lived in a conflict zone (they were <50 km from the actual fighting); the highest number of women and children living in conflict zones has occurred twice since 2000. Armed conflict, in its various forms and manifestations, is prevalent throughout the world and often results in forced migration, an energy crisis, capital flight, and the destruction of societies’ infrastructure, which includes a lack of access to food, health care, housing, employment, clean water, and sanitation, as well as a loss of community and homes. And the resulting stress or unrest has been shown to fuel violent extremism, perpetuating conflict cycles. Global expenditure on military weapons exceeded $500 billion in 2020, and military spending had already surpassed $2 trillion by now [Figure 5]. After seeing 50–100 million deaths in the 1918–1919 flu pandemic and more than 34 million deaths in World War II, the incorrigible world is thirsty for another great war in the midst of the COVID–19 pandemic. Whoever wins the war, humanity loses.

The Nagorno-Karabakh conflict (Between Armenia and Azerbaijan)

Heat waves, droughts, and war left Nagorno-Karabakh losing over 80% of its access to water during the war last year. The conflict became even more relevant for Azerbaijan in terms of its drinking water, irrigation, and hydropower. Between 20,000 and 30,000 people were killed in military operations during the Armenia-Azerbaijan clashes. Ballistic missiles, drones, and other heavy artillery have been used, including the use of internationally banned cluster bombs. Among the series of clashes, 50,000 people were injured or disabled, 700 medical institutions were destroyed, and the damage to the healthcare system was estimated to be $1.2 billion [Figure 7]. Only 15% of the Armenian population was found to be doubly vaccinated until October 2021. They were found to have the lowest vaccination rates in the Caucasus region as the pandemic has been politicized. Vaccine skepticism and being seriously hit by the COVID-19 pandemic have also been reported. Both Azerbaijan and Armenia faced a GDP shrinkage of nearly 5% due to the pandemic outbreak. Azerbaijan’s Caspian Sea, the world’s largest landlocked body of water, is already rising, threatening the country’s major urban centers and industrial resources along the coast. With an increase in the frequency of extreme weather events, worsening desertification, and worsening land degradation, climate change is making Armenia more vulnerable. Agriculture, human health, water resources, forestry, transportation and energy infrastructure, and human health are the most at risk.

Kyrgyzstan-Tajikistan border conflicts

Kyrgyzstan-Tajikistan border tensions erupted into a brief open conflict in September 2022, and there have been more than 230 border clashes over the last 20 years between the two countries. The two landlocked countries share an approximately 1000-km long border, a third of which is disputed. As a result of the COVID-19 pandemic, both of these countries have seen a precipitous drop in migrant laborer remittances from Russia. Both of these countries’ progress in Western-style public health education and science has been found to be slow.

Sanctions and anti-regime protests in Iran

The current anti-regime protest in Iran is a perpetuation of the previous one, sparked by the government’s subsidy cut decision that caused price hikes by as much as 300% for a variety of staples. Almost half of Iran’s 82 million population is now below the poverty line. The annual rainfall is less than one-third of the global average, and climate changes have severe consequences for food and health. Iran’s economic woes have sparked several waves of protests in recent years. The UN human-rights chief has urged Iranian authorities to stop the “disproportionate use of violence” that has reportedly killed over 50 children and injured many more during Iran’s public unrest. Many Iranians injured by security forces during the protests are afraid to seek medical attention because some protesters seeking medical assistance have been detained. Iran has long been subject to severe international economic sanctions, which have limited their access to healthcare and are thought to be a contributing factor to their suffering. Iran’s ability to import drugs and medical equipment has been constrained by the majority of pharmaceutical companies being wary of getting into trouble due to US sanctions. Patients with thalassemia, hemophilia, cancer, epilepsy, and multiple sclerosis who need medical care have been severely hampered by sanctions. According to the 2018 statistics, among those who inject drugs in the Middle East and North Africa (MENA) region, more than 45% of them were from Iran.

The war-weary Afghanistan

The US Armed Forces completed their withdrawal from Afghanistan on December 31, 2021, ending 20 years of war and leaving 13 million children facing malnutrition and one-third of the people’s food unsecured. The IMF says the long-run war in Afghanistan lowered yearly national income by roughly 50% in 2016. Inflation began to rise in early 2021 as strengthening oil prices increased food transportation costs by as much as 50% in some areas. Since the USA’s withdrawal, the World Bank, one of the project’s main funders, has stopped funding the country’s largest health project, which constituted nearly 80% of the country’s total health expenditure. This has created ripple effects for the healthcare system, as hospitals operate with minimum resources. The country has gone through four waves of COVID-19, and trading economics data show that the vaccination rate has just touched 30% as of December 3, 2022. According to the WHO, deaths due to environmental risks and pollution constitute 26% of overall mortality in Afghanistan. More than 30% of children under the age of five are malnourished, and 60% of children are malnourished. Drug abuse prevalence is close to 13% among those who are 15 years and older, and the country is known as the world’s largest producer of opium, with an estimated 85% share of the total global supply in 2020.

Ethiopia’s Tigray conflict

Ethiopia, a landlocked country in the Horn of Africa, is a federal democratic republic. In Ethiopia, the pooled level of poor COVID-19 prevention practice was 51.60%. Inadequate COVID-19 knowledge, a negative attitude toward COVID-19 management, low educational attainment, living in a rural area, and being female were all significantly associated with poor COVID-19 prevention practices. The Ethiopian military and the Tigrayan Defense Force engaged in armed conflict in northern Ethiopia on November 04, 2020, displacing over 3 million people and killing approximately 500,000 in the last 2 years. Armed militants destroyed crops, killed people, looted and vandalized hospitals, clinics, health posts, and ambulances, as well as ransacked and destroyed schools. Rape, gang rape, sexual enslavement, torture, beatings and killings of friends and family, and derogatory ethnic slurs have all been reported. According to the United Nations WFP, nearly half of Tigray’s six million residents are classified as “heavily food insecure,” with nearly 90% lacking regular access to food. According to the UN, nearly one in every three children under the age of five is malnourished. Among patients with severe illnesses, the COVID-19-related mortality rate went up to 40.3%. Fistula is raging in Tigray as a result of obstructed labor, limited or absent maternal care services, under-nutrition growth, birth difficulties, trauma, and sexually transmitted diseases (STDs) caused by conflict-related sexual violence. According to an MSF assessment of 106 health facilities in the Tigray region between mid-December 2020 and early March 2021, “nearly 70% had been robbed, and more than 30% had been disrupted; only 13% were operating normally.” The ongoing conflict resulted in the destruction or damage of more than 1500 health facilities in Ethiopia in 2021, according to the country’s health ministry [Figure 7]. However, a surprise deal has been reached in the Ethiopian civil war, with both sides agreeing to halt their 2-year conflict.

Democratic republic of the Congo–Rwanda conflict

On April 23, 2022, the Democratic Republic of the Congo’s Ministry of Health declared an Ebola virus outbreak (mortality rate of 30–90%), which was declared over in West Africa by 2016 and claimed over 11,000 lives. It witnesses 45% of the deaths of children fewer than 5 years old due to malnutrition. According to the United Nations, the most recent fighting with Rwanda, which started in October 2022, has forced nearly 300,000 people to flee their homes. On multiple occasions, Rwandan forces have been seen fighting alongside Congolese rebels while crossing into the Congo. The same number of individuals were displaced by ethnic conflict in the Ituri Province in 2019 during a second Ebola outbreak. Six years of conflict in the DR Congo resulted in a total death toll of six million people. The majority of deaths were caused by illness and malnutrition.

Poor food handling and a lack of population control threaten public health and safety

Globally, close to one-third of agricultural produce is lost annually due to insect pests, diseases, weeds, and rodents. The US CDC confirmed more than 11,000 food-borne infections caused by only a few types of bacteria. According to the WHO, 600 million cases of foodborne diseases are recorded each year, affecting nearly 10% of the world’s population, and food safety is associated with 7.5% of deaths annually. Furthermore, adulterated and contaminated foods cause 60% of all foodborne illnesses. Food adulteration affects almost all food commodities, and the main enticing factors are high population demand and the desire for fraudulent gain. Only 11 years after passing seven billion, the United Nations declared that the world population had surpassed eight billion. Climate change is making the Egyptian government ask parents to have fewer children. Uncontrolled population growth not only creates food insecurity but also threatens health safety. High population density appears to be associated with cancer, cardiovascular, and respiratory diseases, a higher risk of transmission of COVID-19, particularly the Delta variant, and poor living conditions, such as insufficient access to healthy food and drinking water, and poverty-related diseases with limited access to healthcare. Furthermore, food vulnerability and price volatility are an explosive combination for certain types of conflicts.

Malnutrition is still a world health crisis

Global acute malnutrition increased dramatically and staggeringly from 10% in 2019 to 28% in 2019, and household food security significantly decreased from 59% in 2019 to 15%. According to the 2018 World Innovation Summit for Health, 60% of chronically food insecure and malnourished people globally, including 75% of all children with stunted growth, live in conflict-affected countries [Figure 7].

Poor health literacy still prevails in wealthy and dominant countries

Unfortunately, many European citizens lack health literacy, limiting their ability to make decisions about their own, their families’, and their communities’ health and well-being. Even low health literacy [Figure 1] is reported in nearly 40% of US and UK adults, 50% of the EU population, 60% of the adult populations in Canada, Australia, the UAE, and more than 70% in China [Supplement 4]. Despite long-term improvements in health indicators like mortality and morbidity, there are still problems with the provision of healthcare in many low- and middle-income countries. Poor health literacy is a sign that health promotion techniques are not being used properly, and it is linked to the population’s deteriorating health status and low compliance with disease prevention initiatives.

“Net-Zero carbon” delayed by decades due to “collaboration gap”

Approximately 80% of global carbon emissions are attributed to energy, according to the IEA. Current trends in global food systems would prevent the 1.5°C target from being met and put the 2°C target by the end of the century in jeopardy, even if fossil fuel emissions stopped now. According to an Oxford University study, decarbonizing the energy system by 2050 could result in enormous cost savings, but it will require a massive increase in private investment in renewable energy and sustainable infrastructure around the world. Estimated annual private investment in these sectors until 2050 ranges from US$4.4 trillion to $9.2 trillion. Not surprisingly, America and China, two major polluters (40% of total CO₂ emissions), were hesitant and noncommittal on the issue at COP27. The IEA estimates that global nuclear capacity will need to double by 2050 to meet net-zero targets,^[314] but obstacles remain. In the aftermath of the Fukushima disaster in Japan, Germany, for example, was required to close its nuclear power plants by 2022.

Pandemic hits on health-care system

The pandemic’s longest and most deadly surge has posed risks to the quality of care and left medical professionals exhausted. Various studies on health professionals show work-related stress, sleep disturbances, and burnouts in 60%; and hospitalization within 6 months of the pandemic starting at 15%. Furthermore, the WHO assumes that more than 1,15,000 health professionals may have died in the period between January 2020 and May 2021 and that illnesses kept at least 500,000 health workers out of the US labor force alone. Nearly 20% of the 1000 American allied health workers (nurses, assistants, etc.) who responded to the survey stated that the pandemic was one of the main reasons they quit their jobs. According to a cross-sectional study conducted by the US Bureau of Labor Statistics and the University of Minnesota Data Service, pandemic-induced physician turnover was 4 times that of allied professionals. Lack of personal protective equipment, medical supplies, and adequate compensation has been reported in several studies.

Humanitarian crisis over treatment guideline adherence and drug misuse

Migration and displacement are social determinants of health problems for refugees and other migrants. Healthcare may be low on the list of priorities for children and adolescents who face severe pressures ranging from overcrowded camps or asylums to deep anxiety about their future. Humanitarian crises are associated with increased short- and long-term cardiac morbidity and mortality, as well as elevated BP. Hypertensive patients with diabetes mellitus were twice as likely to exhibit poor BP control, as found in war-torn Palestine. Furthermore, a US-based survey of re-settled Rohingya refugees from Myanmar shows a higher trend of chronic diseases such as diabetes, hypertension, and obesity. A huge increase in benzodiazepine (sedative) dispensing is reported in Canada, and abuse of similar drugs doubled in Italy among people suffering from anxiety and stress caused by COVID-19 between the years 2020 and 2021 [Figure 7]. An announcement from authorities on “simple possession of cannabis” to thousands of convicted citizens before the US midterm elections exploded recreational drug abuse in both the US and the EU.

War and terrorism hits on healthcare system

A terrorist attack on a hospital is not uncommon. In just 2017, there were at least 188 hospitals and clinics that were destroyed or damaged [Figure 4]. More than 60 people were kidnapped, and 64 healthcare workers were killed; 203 patients died and 141 were injured. Health facilities have been forced to close in Afghanistan, Burkina Faso, the Central African Republic, Egypt, and Turkey. Research finds 454 terrorist attacks against hospitals were identified in 61 different countries over a 50-year period by the Global Terrorism Database, where more than 50% of the attacks took place in the Middle East, Northern Africa, and South Asia [Figure 7]. And in more than 50% of cases, attacks targeted medical personnel. Two other similar studies show that close to 70% of those attacks involved bomb explosions and that close to 60% of those attacks took place after 2001. Attacks on hospitals may have long-term consequences: hospital units may be unavailable for an extended period of time, and replacing staff may take several months, further complicating hospital operations. In addition, hospitals are houses of resources (drugs, toxins, radioactive elements, and biological cultures) and information that could be used for nefarious purposes, making them a tempting target for terrorist groups. A full-fledged war and siege can have devastating consequences for patients who require constant care and well-functioning health infrastructure, especially in resource-limited settings where providing optimal care is already difficult.

Global transition or a massive work-force redistribution

The pandemic has accelerated job redistribution across sectors, with an estimated 25% of workers worldwide choosing or being forced to change occupations by 2030. Interestingly, the small and medium-sized enterprises seeking to recover are now confronted with skilled labor shortages, whereas big tech giants (Apple, Alphabet, Microsoft, Netflix, Meta, Twitter, Hewlett-Packard, Stripe), media giants (The Guardian, BBC, CNN, Bloomberg), finance giants (JPMorgan Chase and Co, Goldman Sachs, Morgan Stanley, Citigroup, Barclays, Hongkong and Shanghai Banking Corporation), retail giants (Amazon, Tesco, Walmart), and fashion chain giants (Gucci, Nike, Hennes and Mauritz AB) have seen mass layoffs in recent years, mostly in 2022.

Healthcare workforce shortage and transition

The redistribution of the workforce and the shortage of workers could lead to a unique situation in health-care systems around the world. The Eurozone is dealing with severe healthcare shortages [Figure 7]. There are fewer doctors in France today than there were in 2012. In Germany, there were 35,000 unfilled positions in the care industry last year, a 40% increase from 10 years prior. More than 700,000 people in Spain were awaiting surgery. By 2030, Finland will require 200,000 additional workers. At least 40% of doctors in one-third of the Eurozone’s nations were close to retirement age. Because of the physician shortage in general practice (GP), clinical pharmacists are working in GPs across England. According to a recent Lancet study, the Middle East and North Africa are lacking 636,000 doctors, with South Asia having the biggest gaps. Furthermore, turnover intentions have been reported for close to 50% of physicians in emergency departments, resident physicians, and village doctors in China; more than 50% of health professionals in Ethiopia; more than 55% of doctors in Iraq; and 30% of doctors in South Korea. Burnout among healthcare workers and deteriorating care quality are the immediate effects. Furthermore, globally, more than 20% of health professionals are located in areas where there are many care gaps, which is a major determinant of job dissatisfaction. Some 30–60% of nurses leave their first job in less than a year due to work-related stress, job satisfaction, and better opportunities elsewhere. And it is estimated that the cost is 4–5 times higher as productivity decreases with new hires. Altogether, the motivation of health workers towards their professions has declined at a time when it is already projected that the world will face an 18 million healthcare workforce shortage by 2030. And the WHO says more than 40% of them, or 7.6 million, will have nursing shortages. Moreover, there is a 6.5-fold difference between high-income and low-income countries.

Fears of nuclear war or biological weapons are not entirely false

Invaders from Ukraine launched projectiles at the Chernobyl nuclear facility and the active Zaporizhzhia complex, causing international concern and raising fears of an Eastern European nuclear disaster. The pandemic, hunger, discrimination or racism, climate change, rising inflation or an economic crisis, imperialism, political turmoil, and nuclear war share a common thing — conflict. In the last 100 years, human civilization has experienced multiple acts of bioterrorism, chemical warfare, and nuclear explosions that have targeted civilians; all of them were borne out of conflicts. Despite the fact that the Geneva Protocol, signed in 1925 and still in effect today, forbids the development, production, and use of biological weapons in armed conflict. However, already Switzerland, Sweden, Finland, Germany, the US, Russia, Italy, Belgium, the UK, Japan, and Israel/ Occupied Palestinian Territory have spent billions on nuclear shelters [Figure 7]. And no nuclear-armed state is currently disarming or engaged in nuclear disarmament negotiations. Furthermore, SARS-CoV-2 has already demonstrated its ability to start a pandemic, and, in spite of efforts made around the world, it still poses a serious threat to use as a bioweapon [Figure 7].

Future recommendation

Working on the current study required multidimensional research. The pandemic alone has changed the world and been noticed by all. Its malign effects have changed the healthcare system around the world. The economic and climate crises have similar effects — individually, they have both direct and indirect effects on health and economics. The escalation of conflicts is still not as imminent as projected by the media and researchers. There are many more things to come. Basically, the study is just a beginning. Armed conflict, economic crisis, climate change, and pandemic crisis are all interconnected issues. The present study highlights facts only from those studies that correlated, projected, or calculated any of the one or two issues related to the healthcare system or its sustainability. They will, however, collectively impose how much pressure on people, their way of life, distress, and health — a time-sensitive issue for which no such studies have yet been found. Furthermore, if highlighted on an appropriate platform, similar studies may change global leaders’ views or priorities, potentially slowing down political turmoil or bringing about a shift in polarization or more people-oriented political decisions. Nonetheless, it is obvious that in the future, similar types of research should include more factors and not be limited to journals, articles, or research communities. The present study is written in such a way that any mediocre person with simple English literacy can get ideas about concurrent issues. Furthermore, it is expected that future studies, their outcomes, and their inferences should be discussed and presented on public platforms or higher platforms that pull down conflicts, arms deals, and military expenditure and compel leaders to take more people-oriented decisions.

Research highlights

The current study presents 50 facts indicating that the world can no longer withstand further injuries from war and conflict:

1. “Hunger leads to one death every four seconds”

2. Close to 1 billion global population is facing severe food insecurity, UN warns

3. More than 11,000 food-borne infections caused by only a few types of bacteria

4. Only around 2% of the earth’s water can be used for daily necessities and less than half of it can be used for drinking

5. Up to two-thirds of the world’s extremely poor will reside in unstable and conflict-affected areas by 2030

6. Ukraine crisis accounts for 25% of food insecurity in African countries

7. Every year, one-third of agricultural produce is lost; additionally, adulterated and contaminated foods cause 60% of all foodborne illnesses

8. 54 countries with the poorest development are currently in danger of bankruptcy

9. About 25% of the world’s population lack access to essential medicines and 50% of them are deprived of essential health services

10. About 7.6 billion people — or 96% of humanity have experienced global warming in the past 12 months

11. 10 times more rain in Sindh province and 10 times faster melting of Himalayan glaciers are reported

12. Natural disasters caused losses to the global economy of more than $224 billion in 2021 and could cost $5.6 trillion by 2050

13. Occupational heat-related mortality is 35 times higher among agricultural workers compared to workers from other industries

14. Natural disaster deaths are now 30 times higher than they were 20 years ago

15. Climate change and natural disasters may cause more than 1 billion people to be displaced globally by 2050

16. A 1°C increase in global temperature may result in more than 100,000 new cases of diabetes in the United States alone each year, as well as 6 times more premature deaths among respiratory patients worldwide

17. Cardiovascular disease accounts for more than 60% of pollution-related diseases and death

18. Global wildlife populations have been cut by more than two-thirds since 1970

19. Healthcare costs pushed more than 500 million people to extreme poverty just before the COVID-19 outbreak

20. About 80% of all humanitarian needs are also influenced by conflicts

21. Inflation has reached 40-year highs in the US, UK, Japan, and Germany, 37-year highs in France and Italy, and 20-year highs in Russia and Turkey

22. China’s factory inflation hits 25% in 2021

23. China-Taiwan tension threatens the supply of chips, major components of medical equipment

24. War, violence, persecution, and human rights violations will have driven more than 100 million people from their homes between 2021 and 2022

25. COVID-19 affected more than 662 million people and claimed around 67 million deaths by December, 2022

26. More than 80% of the world’s workforce, were affected by the lockdown, and the world incurred a loss of 9% of global working hours

27. The US has officially recorded more than 100 million COVID-19 cases; one-third of the US population can be affected by the running winter cold wave

28. The cost of illiteracy to the global economy has exceeded $1 trillion, 100 million children would fall below the minimum reading proficiency level

29. Poor health literacy has been reported in 40% of US and UK adults, 60% of the EU’s older population, and 60% of adult populations in Canada, Australia, and the UAE, and more than 70% of Chinese adults

30. The world will face an 18 million healthcare workforce shortage (20% of the workforce needed to keep health-care systems going) by 2030

31. Middle East and North Africa are lacking 636,000 doctors, with South Asia having the biggest gaps

32. Palestine occupiers/Israel has launched over a thousand airstrikes in Syria and dropped 5,500 bombs in Arab countries since 2017

33. Half of a million died in the last two years due to Ethiopia’s Tigray conflict

34. Among terrorist attacks against hospitals in 61 different countries, more than 50% of the attacks took place in the Middle East, Northern Africa, and South Asia

35. More than 1500 health facilities were damaged in Ethiopia during 2021 conflict, 800 in Ukraine due to ongoing Russian aggression, 700 in the NagornoKarabakh conflict between Armenia and Azerbaijan

36. 117 attacks on healthcare facilities in Gaza and the West Bank in just 13 days in May 2021

37. America and China, two major polluters (40% of global CO2 emissions), were noncommittal on Climate finance at COP27, mainly due to trade war-related privations

38. India, China, Australia, and many EU countries increased their reliance on coal-fired power due to tightened global energy supply

39. Despite severe healthcare shortages the Eurozone have increased arms purchases by nearly 20%, in fear of Russian attack

40. Around 30% of the Lebanese population is made up of Syrian refugees

41. Over 80% of all deaths in Libya are due to long-term breakdowns in health services and policymaking processes

42. Iran, once known as the home of 80% of the world’s medicinal herbs, now faces a shortage of life-saving drugs due to sanctions and spiraling unrest

43. Conflict was responsible for more than 10 million deaths of children under the age of five between 1995 and 2015 worldwide

44. Since 2017, more than one in every six children has lived in a conflict zone

45. Conflict-affected countries are home to 60% of the world’s chronically food insecure and malnourished people, including 75% of all children with stunted growth

46. The Eurozone is home to 12.5% of the world’s HIV patients—to date, approximately 25% of Ukraine’s displaced population has sought refuge in EU countries

47. Along with many other conglomerates, big tech giants (Apple, Microsoft), media giants (The Guardian, BBC, CNN), finance giants (JPMorgan Chase, Goldman Sachs, Morgan Stanley), retail giants (Amazon, Walmart) have seen mass layoffs recently

48. 2 billion people could die from a nuclear war between India and Pakistan, and more than 5 billion could die from a war between the United States and Russia

49. In the past 100 years, bioterrorism, chemical warfare, and nuclear explosions have targeted civilians

50. Between 1970 and 2019, there were 41,837 attacks in the Middle East, making up almost 25% of all terrorist attacks worldwide.