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Cholera in Ukraine: propagating disaster-disease myths

Joshua Anthony30 June 2022

Author: Gina Charnley


Since the beginning of the Russian invasion of Ukraine in February 2022, there has been widespread suffering felt by the Ukrainian people. Media reports have rightly presented the truly tragic situation in Ukraine, along with several accounts of the strength of the Ukrainian people to support each other and their country.

On 17th May, WHO Europe held a news briefing on the health situation in Ukraine, which was posted on Twitter. The 20-minute briefing covered a number of health topics, with a brief mention that the deteriorating sanitary conditions in Ukraine poses a risk of cholera and that provisions of oral cholera vaccines had been stockpiled. In early June 2022, several large newspapers and media outlets wrote articles in relation to this including NBC News, the Washington Post, and CNN, to name a few.

The articles all follow a similar narrative that an increasing number of corpses and sewage are contaminating drinking water in Ukraine which could lead to cholera outbreaks. These reports are problematic and, in some instances, scientifically flawed. The WHO briefing gives no mention to dead bodies causing disease and this disaster myth has been dispelled time and time again by those working in disaster research and medicine1-3.

Diseases do not appear from nowhere and unless the deceased had an infectious disease at the time of death, the body will not contaminate the environment or cause a disease outbreak. Similarly, if sanitary conditions break down, disease will only spread if the sewage was from people who were infected or carrying a water-borne disease.

Cholera is not endemic in any European nation, due to the general widespread access to sanitation and hygiene and of the few cases that are reported, these are from travellers returning from endemic countries. For example, in 2016-18 there were 66 cases of cholera in EU/EEA countries, all of which had travel history to cholera-affected countries.

In 2011, Ukraine experienced a small cholera outbreak in Mariupol, which resulted in 33 reported cases and 26 carriers being identified. Despite this, the strain which caused the outbreak was most closely related to Haiti, Nepal, and India, with strong evidence suggesting the cause as an introduction from South Asia through associated travel. International travel to and from Ukraine is not something that Ukrainians are likely to do at the present time, therefore removing this risk.

Dissimilar to many other diseases, cholera predominantly infects humans. It does not have large animal reservoirs which can cause spill-over, and despite environmental reservoirs being possible (especially with brackish water and the presence of crustaceans), there is little evidence of a long-term environmental reservoir for cholera. Due to the characteristics of cholera, for an outbreak to occur, sustained environmental contamination is needed.

Major outbreaks have been reported in several conflict-affected countries in 2021 and 2022, including Afghanistan, the Democratic Republic of Congo, Ethiopia, and Nigeria. The difference though between these countries and Ukraine is that cholera was already endemic, and risk factors and vulnerabilities were worsened by the conflict, allowing the pathogen to spread. If cholera was to arise in Ukraine, an introduction would have to occur, which from previous outbreaks is most likely to come from international troops or humanitarians, not from Ukrainian fatalities of the war.

The most prominent example of this danger is arguably Haiti. In February 2010, a 7.0 magnitude earthquake hit Haiti and a cholera outbreak followed, which lasted nearly a decade. Haiti was a non-endemic country and many people were naive to the disease. Without any immunity, mortality was very high, and created one of the most deadly cholera outbreaks ever recorded, which could be the case if a Ukrainian outbreak was to happen. Despite the common narrative, the Haitian outbreak was not caused by the earthquake or dead bodies, but instead an introduction from UN peacekeepers which contaminated the local water sources. The truth took far too long to surface and compensation for this is still being sought by the Haitian people.

The hope, regardless of any report, is that the Ukrainian people do not suffer any more than they have already. The greatest tragedy in terms of corpses is the deprivation of the Ukrainian people to body identification and dignified burial of their loved-ones, and the importance of providing them with the basic human right of water, sanitation, and hygiene.

Propagating the dead body-disease disaster myth is dangerous, it shifts the responsibility of action and in some cases blame, naming it as an act of fate outside anyone’s control, instead of a risk that can be managed. Disease mitigation is important, including learning from previous mistakes (like those seen in Haiti) and planning for outbreaks (vaccine stockpiling). Writing reports on simple speculation though is not helpful and the focus should instead be on the current health threats affecting Ukrainians. Presently, sexual violence and mental health are serious threats in Ukraine and more needs to be done as the repercussions of these health crises will likely be felt for decades to come, increasing morbidity and straining the healthcare system as it tries to recover.


Gina is a Research Postgraduate at Imperial College London and is funded by the Natural Environmental Research Council | g.charnley19@imperial.ac.uk


  1. Morgan O. Infectious disease risks from dead bodies following natural disasters. Revista panamericana de salud pública. 2004;15:307-12.
  2. De Goyet CD. Stop propagating disaster myths. Disaster Prevention and Management: An International Journal. 2000.
  3. Morgan O, Ville de Goyet CD. Dispelling disaster myths about dead bodies and disease: the role of scientific evidence and the media. Revista Panamericana de Salud Pú 2005;18:33-6.

 

 

 

 

 

 

 

Economic Sanctions Against War: An Effective Deterrent?

Swati Sharma27 April 2022

 

Protests in London against the invasion of Ukraine. Obtained under Creative Commons CC0 1.0 Universal Public Domain Dedication.

The ongoing Russian-Ukraine war has triggered a string of economic sanctions against Russia, apparently intended to bring an end to the conflict. Let us understand the background and ramifications of sanctions.

Sanctions, in general, are a set of penal actions taken against an entity or entities, that could be adopted by courts, nations, or international bodies. Chapter VII of the UN Charter, through Article 41, also provides for non-military enforcement measures.

Ideally, preventing conflicts and enhancing international peace and security are considered a few of the prime objectives of sanctions. However, sanctions have also often been seen as political tools for settling diplomatic scores or achieving other desirable results, making their efficiency as a non-violent, diplomatic conflict resolution tool questionable.

In contrast, economic, humanitarian, and commercial sanctions typically worked better than any combination—Iran, 1979; Iraq, 1990; Haiti, 1991; and Yugoslavia, 1992, to name a few.

There are also instances aplenty when sanctions failed to accomplish their goal. In 2014, UN, EU, and US sanctions were imposed on Russia when it invaded Crimea, but still a war erupted in Ukraine. Despite UN sanctions, the Taliban strengthened and seized control of Afghanistan. Additionally, Iran, North Korea, and Cuba have all defied sanctions. Moreover, sanctions can risk spurring conflict, as in Rwanda, 1990, and Nicaragua, 1970.

In today’s age of globalisation, sanctions have become a double-edged sword. To impose effective sanctions, one must necessarily: (a) diagnose the causes of conflicts accurately; (b) design sanctions such that they decisively alter the balance of power, and (c) ensure political will among those imposing sanctions to sustain them. For, with the lapse of time, their—those sanctioning—will can be eroded, or new diplomatic factors may emerge. Therefore, it is time to reconsider the efficacy of sanctions as such and explore whether sanctions need to be supplemented by other measures to resolve conflict and reduce the risk of war.


Swati Sharma is a veteran of the Indian Army, and after successful completion of her tenure, joined the Rajasthan Home Guards Services. While she served as the Commandant, she got selected as a Chevening Scholar 2021-22. Presently, she is currently pursuing her Master’s in Risk, Disaster and Resilience at IRDR, UCL. 

Contact

swati.sharma.21@ucl.ac.uk | Twitter: @captswatis

www.linkedin.com/in/capt-swati-sharma-retd-6b69b0132


The Disaster of War

David Alexander17 March 2022

Bombs bursting on the Fortress of St. Malo, France, 1944. Photo from Lee Miller.

By convention, when we study disasters we exclude warfare. It is not easy to find a completely logical reason for this. It is more a matter of convenience and a feeling that to conflate the two phenomena would lead to problems because not all generalisations about the one are applicable to the other. At the same time, there is always the basic truth that war is a disaster in its own right because of the casualties, suffering and destruction that it causes. Moreover, as we are seeing in Ukraine and surrounding countries, it is all too often accompanied by a major humanitarian emergency.

In recent years there has been increasing interest in trying to understand the intersectionality between war and other forms of disaster. The other forms are natural hazard impacts (please do not call them ‘natural disasters’ as they, too, are largely the result of human agency), technological failures, social movements (riots, crowd crushes, unplanned mass migrations, etc.), intentional disasters (essentially terrorism) and composite events. Such is the complexity of modern life that the last of these categories predominates. We live in networked societies and disasters tend to be events with cascading consequences.

In recent days, vast numbers of women, children and the elderly have crossed international boundaries as they have fled the fighting in Ukraine in what has become Europe’s fastest mass migration since the 1940s. As a result, we have a humanitarian emergency that encompasses primarily Ukraine itself and six countries on its western borders but potentially the whole of Europe. In Ukraine the challenge is to provide basic necessities under highly dangerous conditions and via an infrastructure that is becoming more and more damaged and fragmentary. Outside Ukraine it is a matter of accommodating hundreds of thousands of refugees, most of whom come from families that have been split up by the war.

Gone are the times when war was fought on a battlefield between assembled armies. There is no room any more for a Napoleon or a Wellington. In modern warfare everyone and everything is a target. Grain, fertiliser, gas, oil and minerals are casualties as well as people, and so are those who depend on these commodities and are deprived by shortage or rising prices from accessing them.

In a world that faces grim challenges in dealing with climate change, ecological catastrophe, loss of the carrying capacity of the land and problems with the vulnerability of technology, the last thing we need is a major war. Nothing can compensate for the loss of life and destruction of people’s living conditions that it causes, but it may yet accelerate the transition towards more sustainable consumption and more rational ways of living. Amid the lies and manipulations that lie behind the aggression, there is also solidarity and rationality. Let us hope that in spite of everything these admirable qualities will prevail. We need them so that we can confront the next disaster.


David Alexander is Professor in UCL’s Institute for Risk and Disaster Reduction. He is a citizen of Britain and Italy.

Corona Wars: The Cost of Calling Disasters ‘Wars’

Patrizia Isabelle Duda4 May 2020

Written by Patrizia Isabelle Duda and Navonel Glick

War on Coronavirus poster

On March 17th, U.S. President Trump began calling the Covid-19 pandemic a “war”, to wide acclaim by supporters and scathing condemnation by critics.

The reasons for using the war metaphor are straightforward. By calling the pandemic a war, Trump is appealing to a familiar scenario that we feel we ‘know’ how to relate to. It ostensibly simplifies the crisis, mobilises the public, and calls for unity.

The war metaphor is a powerful and effective tool that is often used in politics, but it is also pervasive in the world of disaster risk reduction and response. The historical links between disaster management and the military are well-documented. Today, from operational frameworks like the Incident Command System (ICS) that were inspired by military management structures, to the extensive use of military terminology like ‘deploy’, ‘mission’, or ‘surge’ by even the most ‘military-averse’ NGOs (e.g. IRC, Plan International), the connection remains.  Even the widely revered (and much maligned) ‘logical framework’, meant to improve transparency and accountability in the aid sector, originated in planning approaches for the U.S. military.

At first glance, the war metaphor makes sense. The chaotic images from disaster areas that make the headlines are reminiscent of war zones, and the associated urgent, high-stress, life-and-death decisions demand composure, bravery, and decision-making attributes that we have learned to equate with our armed forces.

Yet, the analogy quickly crumbles. For one, as most disaster practitioners would confirm, the period immediately following a disaster which might require such an approach, at best, represents only a fraction of any disaster response effort, let alone long-term recovery or disaster risk reduction (through sustainable development).

In addition, as our experience in the field shows, armed forces are notoriously poor at interacting with vulnerable civilian populations, particularly in complex situations of unrest. More importantly, the war analogy is plagued by a core contradiction. While it can be argued that armies engage in war to ‘defend’ or ‘protect’ a population, destruction is often their main tool for doing so. This is not what disaster response or humanitarian aid are about, much less how one reduces disaster risks and builds disaster-resilient communities.

So why does the war metaphor continue to dominate the field? The simple answer may be because it works. It appeals to the pleasure-pain principle, triggers our basic fight-or-flight instincts, and provokes a reaction.

Yet, this strategy may be poorly suited to pandemics. We rightfully celebrate our health-care workers and other front-line personnel as ‘heroes’—yet another war term—and many of them may be faced with ‘war-like’ situations of urgency and life-and-death situations. But for the rest of us, “wash your hands” and “stay at home” are woefully anti-climatic ‘weapons’ to ‘fight’ the ongoing coronavirus ‘enemy’.

Photo credit: hairul_nizam / Shutterstock.com

Furthermore, the ‘war metaphor’ may succeed in the short-term during a crisis, but such bursts of energy (or adrenaline) cannot be maintained over time. Pandemics are not addressed by acute, short-term measures or bursts of adrenaline, but instead, by a complex web of systematic health and public health initiatives, drawn out over a long period of time.

The most damning trait of the war metaphor is, therefore, the focus on the disease itself, instead of the systemic issues that allowed it to become a pandemic. Diseases, much like earthquakes or hurricanes, are natural hazards. They only become disasters when we are left exposed and vulnerable to them by insufficient preparedness and poor risk reduction measures. Thus, tackling the underlying social, economic, and political systemic issues that drive disaster vulnerability should be our priority.

The analogy of a marathon instead of a sprint comes to mind, except that in this case the race has no end. In fact, it never was a race to begin with. This may be the biggest fallacy with using the war metaphor for disasters: wars are arguably won or lost; at least they (should) end. Disaster preparedness and reducing risks do not—they are an ongoing process of achieving and maintaining sustainable practices.

The war metaphor, therefore, from the very beginning, begs to disappoint, because there will not be the closure it promises. Calling our health workers and other frontline workers ‘life-saving heroes’ is an admirable title they deserve, but were they any less worthy of it before the pandemic? And will they not continue to perform the same essential role once the coronavirus pandemic has passed?

In this time of acute crisis, when the lack of preparedness and risk reduction is painfully exposed, we may be glad to have the war metaphor for the action that it catalyses. But by continuing to prioritise response over prevention, and perpetuating the myth of the ‘race’, what social habits will we continue to reinforce, and at what cost?

What would an alternative look like?