guest post by Margaret Humphreys
In a recent article in the New England Journal of Medicine, Jennifer Leaning and Debarati Guha-Sapir explore the public health implications of natural disasters. At first the fact that wars and disasters kill people may provoke an eye-roll response—“Oh, gee, I didn’t know that”—but a closer reading evokes a broader perspective on the common disruptions of such events and the usefulness of pattern prediction for planning humanitarian response.
Some details will help make this approach clearer. A public health view of war predicts, for example, that food supplies will be disrupted, infectious diseases will flourish, and displaced persons, especially women and children, will be at risk. Whether the war in question happens in Virginia in 1862 or Mali in 2012, these are factors that are likely to take lives; in an ideal world, such factors may be areas in which humanitarian intervention can make a difference.
The public health analysis of warfare points out that wars often reduce the available food supply. Agricultural workers are drawn from the fields, either due to military enlistment or because the workers flee from servitude or the threat of arms. No one has recorded, to my knowledge, whether the famous wheat field and peach orchard at Gettysburg yielded any harvest in the fall of 1863. Hungry soldiers raided barns and fields, and then used rails from fences to roast their trophies. Lacking fences, the remaining livestock wandered off, and deer grazed on liberated crops. By 1864, southern civilians rioted for bread and salt, especially in war-ravaged Virginia. And, as in the novel Cold Mountain, desperate Confederate patients deserted from hospitals where they were slowly starving.
Infectious diseases did very well in the Civil War. Early on the military camp was an impromptu city with little infrastructure for clean water, sewage, or the provision of food. The number one disease category of the war, dysentery and diarrhea, flourished in this setting. The diseases that spread from one breath to another moved easily in the crowded camp conditions, leading to outbreaks of measles, smallpox, and tuberculosis. Malnutrition, especially vitamin C deficiency, meant that wounds did not heal well and gangrene sprouted in amputated arms and legs. Diseases were amplified in civilian populations as well, when soldiers disabled by disease took their fevers home with them.
The Civil War was no stranger to the displaced persons that are such a major part of modern civil conflicts, whether in central Africa or southeast Asia. Most prominent in the U.S. case were the tens of thousands of refugee slaves who fled to the Union army in hope of freedom. The men were often put to work by the northern leadership, as menial labor or, by 1863, as enlisted troops. This often left women and children to fend for themselves, with no income, no food, no clothing or shelter. Estimates of mortality in slave refugee camps range from 25 to 50%, where victims died of want or the diseases that took fire among this weakened population.
The American Civil War was not without its humanitarian response, led by state, regional, and national sanitary commissions that tried to supply soldiers with adequate food and clothing, and did what they could to help refugees. As is the case in modern warfare, it was impossible to reach some victims due to the persistence of conflict or the deliberate interference of contending forces. The United States Sanitary Commission tried to feed the Union troops imprisoned in Confederate prisoner of war camps, but they could not reliably get food into the prisons, as the southern government refused or confiscated the supplies.
Walt Whitman famously noted that the “real war” would never get in the books. He wrote of the “unending, universal mourning-wail of women, parents, orphans,” a marrow of tragedy that ran through American life by the end of the war. Seven score and ten years ago, Abraham Lincoln asked “that these dead shall not have died in vain.”
Margaret Humphreys is the Josiah Charles Trent Professor in the History of Medicine, a professor of history, and a professor of medicine at Duke University. She is the author of Marrow of Tragedy: The Health Crisis of the American Civil War and Intensely Human: The Health of the Black Soldier in the American Civil War, both published by Johns Hopkins.