INTRO
Global Partners for Development proudly presents: What Do You Understand? Deep dive into the many facets of philanthropy and development. We will have conversations about what really works and what really doesn’t. Do we know yet how to solve poverty? Are big ideas the answer or do we need to look for small grassroots solutions?
Experts in their field will discuss an aspect of their work that they understand particularly well. We will delve into how their work addresses global inequity with an honest conversation about impact. Let’s talk about big bets, innovation, social enterprises, large-scale humanitarian aid, and the fixation on ending things or solving humanity’s greatest problems and the issues that arise while tackling it all.
I am your host Ria Pullin, and my co-host is the Executive Director of Global Partners for Development, Daniel Casanova.
RIA
Our guest today is Barry Levy. He is a physician and epidemiologist and an adjunct professor of public health at Tufts University School of Medicine. He has written and spoken extensively about the health impacts of war. He wrote the book From Horror to Hope: Recognizing and Preventing the Health Impacts of War, which was recently published by Oxford University Press.
Dr. Levy is a past president of the American Public Health Association and a recipient of its Sedgwick Memorial Medal, its highest award. Dr. Levy, thank you so much for joining us.
BARRY
Great to be with you and your listeners today.
RIA
Yeah. And kind of like, this is what, a time for you from all of your experiences, you know, going through middle school, medical school and all of that, but having a global pandemic at the same time, like you said, there are wars going on, but one so heavily publicized are I, I, I would assume, a lot of people are coming to you for your expertise in handling not only the epidemiologic, epidemiological side of it, but also, you know, the impacts that are going on currently in Ukraine. Could you speak a little bit to the current status of the last couple of years?
BARRY
Let me focus in particular on Russia’s war in Ukraine, which began on February 24. There have been widespread attacks on civilians and civilian infrastructure, and it’s not just hospitals and health workers, but it’s the food distribution system — Russia’s been bombing grain storehouses and they have been stealing wheat and they have been planting landmines, making it impossible for the farmers to grow crops. These widespread attacks on civilians and civilian infrastructure have violated human rights and international humanitarian law.
There has been a huge amount of displacement — roughly one-third of the Ukrainian population has been displaced from their homes and communities.
RIA
Wow
BARRY
About 6 million people have been displaced to other countries like Poland and Hungary and Romania, and about 8 million are internally displaced. And these people are in some ways worse off than the refugees who have made it to relatively safe havens in other countries.
Food and water have been restricted. For many people, there is little or no medical care. Physicians are appropriately focusing on the people who are wounded and whose lives are threatened from the fighting.
Many people have been killed by attacks from bombs and bullets and cluster munitions. But probably many more people have died or become ill from damage to the infrastructure.So again, that’s hospitals, clinics, food distribution, water systems, but also the electrical grid. For example, think of people on dialysis who depend on electricity, transportation, and ongoing medical care.
DANIEL
Or refrigeration for medicines.
BARRY
Refrigeration to keep food safe, of course, depends on electricity. People also depend on communication, which many of them do not have with the Internet and cell phones not functioning.
These indirect effects probably cause many more deaths than the direct effects of bombs and bullets. From 1990 through 2017, the number of indirect deaths during wars far outnumbered the direct deaths from bombs and other explosives.
RIA
Oh my goodness.
BARRY
When the infrastructure is destroyed, people die of starvation and from drinking contaminated water. They can’t get medical care or they run out of medicines. As a result, some people with hypertension develop heart attacks and strokes because their blood pressure is not controlled.
RIA
Right, and those humanitarian borders that are, you know, being attacked when those humanitarian borders are specifically for getting in supplies that need to come in, that they can’t produce on their own there within the country.
What is the impact of that? If not having the, the ways to get humanitarian aid into the places that need it?
BARRY
There have not been safe corridors to provide humanitarian assistance or enable those people who want to leave to have safe passage. Many people, in fact, have been killed or injured while attempting to leave as Russian forces have fired on them. It’s hard to find words that describe the enormity of the humanitarian catastrophe occurring as a result of Russia’s war of aggression in Ukraine.
DANIELI’d just be curious to hear about, you know, in the, in however form you want to talk about it, how you came to get involved in public health, and I assume that’s, you know, in track of being an MD, but I’m just curious your, your narrative for the theology of your life.
BARRY
Soren Kierkegaard, the philosopher, said, “Life can only be understood backwards, but it must be lived forwards.”
I always wanted to be a doctor, but I was also interested in preventive medicine and the broader sociological, societal impact of medicine and public health. Early on in my career, I had several experiences in public health that pointed me more in that direction for a major part of my career.
I’ve also spent a considerable part of my career working in occupational and environmental medicine — the diagnosis, treatment and prevention of work-related environmentally related diseases.
I had two summer experiences, both in California, one in a community setting and one in an epidemiology training program, which were wonderful experiences. They opened my eyes to not only the problems of public health, but what you could do from an epidemiological point of view to characterize those problems and to see opportunities for prevention.
I took off a year between my third and fourth years of medical school to study public health at the Harvard School of Public Health for a year and got a master’s degree in public health. I learned as much from the courses as I did from my classmates, many of whom were well advanced in their careers. One of them was Deputy Director of the Center for Disease Control.
RIA
Oh wow.
DANIEL
Okay.
BARRY
I spent three years with the Epidemic Intelligence Service of the Centers for Disease Control, as a shoe-leather epidemiologist investigating infectious diseases and other public health problems.
Two of the most interesting experiences I had involved exposure to asbestos in city water in Duluth, Minnesota, and a lead smelter in St. Paul, which was exposing not only the workers, but indirectly their children because they were bringing lead home on their workclothes.
Those experiences pointed me in the direction of public health. My first position after my training was as an Assistant Professor at the University of Massachusetts Medical School, where I was asked to set up a program in occupational and environmental medicine. An important part of what we did was outreach to companies and labor unions in central Massachusetts to see what we could do to help address existing problems and to study them epidemiologically in order to prevent further cases of work-related diseases and injuries.
In 1980, I had the opportunity to work in a Cambodian refugee camp for two months.
DANIEL
Where, and what, where were you, where in Cambodia?
BARRY
It was near a town called Aranyaprathet in Thailand. There were over a hundred thousand Cambodian refugees who crossed the border a few months before. They helped to build this camp with supplies from aid agencies. I was part of a team from the International Rescue Committee and Cornell Medical College. I was there for two months. Our group consisted of physicians and nurses as well as medical and nursing students. We operated the emergency ward in the camp. We also performed outreach activities, to track disease within the camp and also to train public health workers, many of whom were doctors and nurses back in Cambodia. They comprised the public health department within the camp. It was an eye-opening experience for me.
The people in the camp were survivors of the Cambodian genocide, in which one and a half million of seven million people in Cambodia, between 1975 and 1979, died or were killed by Pol Pot regime. Many persons in the camp had lost family members. They had lost their communities. Many of them were malnourished or had chronic diseases that had been untreated for several years. Yet they had tremendous resilience.
DANIEL
Yeah. In terms from a public health perspective.
RIA
Yeah
BARRY
In medical and nursing schools, but even more notably in schools of public health, there are relatively few courses on war and terrorism.
DANIEL
Yeah.
BARRY
It is impossible to avoid awareness of the war in Ukraine. But there are about 40 other wars being fought in the world, which receive very little recognition — in places like Yemen and South Sudan and other places that are hard to find on a map. In all of these wars, civilians are attacked, women are raped, men are abducted in the middle of night, never to return. There are many attacks on hospitals and clinics and health workers.
DANIEL
Yeah. Well, so one, the one thing I’d be curious to know is so, in your book, you talk about documenting war crimes as a, a means for mitigating the impacts of, you know, public health on populations affected by war. I’m,I’d be curious, your thoughts in the comparison, cuz you talked about Yemen and Sudan and I, I always always tell people pre Ukraine war.
I’m like, you know, there are these places that are like hell on earth where people have to go about their day to day lives and it it’s right. Like it’s, there’s Syria, it’s Yemen. It’s these places that no one cares about. And I think that. When I watched some of the current trials right now that Ukraine’s doing on Russian soldiers, I think, okay, this is getting documented and because there’s so much meat in Ukraine, but I’m curious, like, I don’t think that’s happening in Yemen or in Syria or in Sudan at the same extent.
And it might be longer played out like what happened with Rwanda, but I’m just curious if you, your thoughts and how that’s playing out right now, right now.
BARRY
It is important to document war crimes. The war itself is a war of aggression that violates international humanitarian law. These violations need to be documented and the perpetrators of these violations and their leaders need to be held accountable. Forensic investigations, which involve examining and interviewing people who, for example, may have been tortured or whose rights have been otherwise violated can provide evidence to document these violations. Sometimes, the remains of people who have died need to be studied to document torture, cruel or inhuman punishment, or other violations of human rights.
In my book, I profile several individuals who have done inspiring work to prevent war, promote peace, or document violations of human rights. One of them is a physician named Vincent Iacopino, who has worked for many years in documenting, and developing systematic methodologies to document violations of human rights law. He and many international colleagues have developed, under the auspices of the United Nations, a book that describes standard methodologies to document war crimes by performing forensic investigations. Their book, now in its second edition, is called the Istanbul Protocol. Evidence gathered by forensic investigations can be used to hold people accountable for war crimes.
DANIEL
Well, we can hold everyone accountable, but the US. We just don’t wanna hold the US government accountable. Right?
The US doesn’t want to participate though in that way. Yeah.
BARRY
On February 19, five days before this war began, I participated in a webinar that was sponsored by the International Physicians for the Prevention of Nuclear War. In preparing my talk, I asked myself when had a major superpower invaded a low- or middle-income country. There have been many instances, but the instance that came to mind was the Iraq War in 2003, when the United States invaded and occupied Iraq. At that time, I thought there could be some parallels between the Iraq War and the war that was about to happen in Ukraine.
RIA
That’s fascinating. Another thing you spoke to that kind of spoke to me, especially my mama heart is all of the unseen injuries. Some things that go internally, whether it be trauma. And the thing that speaks to my mama heart are the children who are either fleeing or still there, or have seen so much loss, or even you talked about, you know, the babies in utero, like the, what what’s happening with what happens with the babies when they’re born, just like the physical effects of just the stress I’ll put on the mothers.
So, the things that you said. Could you speak a little bit more to the, like the unseen physical injuries. We, we can, you know, track a lot of the, the wounded, the tortured, all of that, but the ones who have the long-lasting non-physical effects. Could you speak to that a little bit?
BARRY
Ukraine is a large country, the size of Texas with, before the war, 40 million people — more than the population of California. So the situation varies in different parts of Ukraine. In some places, there is much malnutrition with adverse effects on children and pregnant and lactating women as well as older people and other vulnerable populations. Malnutrition affects both the physical growth and the mental development of children. In addition, nutritional deprivation early in life may lead to heart disease or other chronic diseases later in life.
RIA
Wow.
BARRY
The mental health effects of war are profound, and may affect people throughout their remaining lives. They may even affect children of the next generation.
War also has profound effects on social and economic development of communities and nations. It takes many years for economic and social development to succeed, but all of this development can be quickly destroyed during war.
DANIEL
Yeah. Interesting. Well, I mean, going on that, I mean, I know we were going, um, I know that you did work in Nairobi for a little bit.
BARRY
Yes.
DANIEL
And before this, we had, you had, we had touched maybe on thinking about like what role development in terms of, uh, you know, um, public health measures or development in terms of, uh, international aid, what kind of impact, what correlation that has with public health and war, and, um, yeah, I, I’d be curious here. I mean first. I’d be like, how did you end up in Nairobi?
BARRY
In the fall of 1987, my wife, our children (then 11 and 8 years old) and I went to Nairobi, Kenya, on what I thought would be a 1-year sabbatical. We ended up staying for 2 years. During the first year, I worked mainly on occupational and environmental health issues, mainly pesticide poisoning. In the second year, I worked largely on AIDS prevention, and I also did some work for the Carter Presidential Center. It was an incredible experience. But, going back to your question about development, I think that development activities help to strengthen communities and nations, and help to prevent war and promote peace.
There are at least three ways in which development reduces the likelihood of war, or if violence does break out, makes it more likely that it will be contained and limited in some way.
One, is that development builds understanding among people within a country. And it builds trust. So disputes are often settled without violence, and there is a culture of settling disputes nonviolently.
Second, development often addresses many of the underlying factors that might lead to violence or indeed to war or civil war. Development does this by strengthening government and by strengthening civil society, the rich fabric of non-governmental organizations that we take for granted in this country. In low- or middle-income countries, such as Kenya, there has been a lot of improvement in health — longer life expectancy, less infant mortality, and better women’s health because of development. As a result, government has been strengthened, making it more responsive to the public’s needs. Non-governmental organizations, such as faith-based organizations, civic groups, youth organizations, and sports organizations have also been strengthened. This brings people together so that violence is less likely to occur among them.
Third, development addresses poverty and socioeconomic inequities. It addresses animosity among ethnic and religious groups. Development promotes human rights. It promotes the rule of law. And it promotes democracy. We in the United States should not be thinking of imposing our way of democracy in other countries. But whatever you call the form of government, ideally it should be responsive to the needs of its people. Development generally improves respect for human rights, including women’s rights, children’s rights, the rights of refugees, and, if war were to break out, the rights of prisoners of war. And so development has many benefits, including those that help to prevent war.
RIA
It’s fascinating. I never thought about that correlation.
DANIEL
Yeah. I’m gonna steal some of your language Barry.
No, it’s good. I mean, so, I mean, I think you, you just spoke really eloquently to that and I, I, so my, um, part of, one of the things we do in this podcast that I I wanna do is, especially when I have like an academic, like you is,I think that it feels for me fair.
To ask you about something you understand. Well, because you’ve spent time thinking about something a lot, that there must be some things you feel more certain about than others. And so not to put you on the spot, but I feel like it’s a little fair if someone spent their life academically studying something, they should be able to like put a coherent thought together about something they understand well.A lot of times people are like, well, I wanna say that I know that I don’t understand something very well. So, I’m not trapping you in the. In this like absolute thing, but I, I, I’m curious what that brings up for you.
BARRY
Some things are very clear, established by science, such as epidemiological studies. However, when we are talking about war and development, the relationship among various factors is complex and makes difficult to fully understand the various forces and influences that operate in causing war. Sometimes, the more questions we try to answer, the more questions we discover.
War causes environmental devastation and by using fossil fuels that create greenhouse gas emissions, war contributes to climate change. And, interestingly, climate change can contribute to war. For example, the civil war in Syria came about in part because there was a four-year drought prior to the war that led to a million farmers and their families migrating from rural areas to the large cities. This added to the preexisting political and social instability in these large cities, which became one factor that led to the start of the civil war there.
Just yesterday, another aspect of the relationship between the war in Ukraine and climate change was reported. The sanctions on Russian oil are accelerating the shift to renewables, like solar and wind energy, because Western European countries do not want to continue to be dependent on Russian oil.
As we sit here in offices, educational institutions, and elsewhere in the United States, we should recognize that people living in war zones or other challenging environments are dealing with major challenges day in and day out that we cannot appreciate or fully understand when we are remote from these situations. One of the things that really attracts me to Global Partners for Development is the fact that it relies so much on local perspectives on people’s needs and how these needs can be supported — not telling people what you need, but asking people, what do you need and how can we support you in the ways that you think you need the support. So a danger for us in the United States is thinking that we truly understand the situations of people elsewhere, especially in low- and middle-income countries and those living in poverty or in the midst of war.
RIA
Yeah. So, with all like the bad news and even just the title of your book, like from Horror to Hope, can you leave us with some hope? What is the hope? What is the hope you see after all you’ve seen and all the dark and horrible things you were saying? Where is the hope?
BARRY
When I started working on my book, From Horror to Hope: Recognizing and Preventing the Health Impacts of War, in the middle of 2020, I recognized that I was focusing only on the horrors of war and not providing any reasons for hope. Then I began to recognize that there are many positive things that occur, such as when disputes are settled without violence because there is mutual understanding among people and intentions to cooperate in solving problems. For example, there are over 250 rivers in the world that are shared by two or more countries. There could be many wars over those rivers. And yet most of those disputes over who controls the river have been settled without violence. So that’s a success story.
Another success story is the increasing protection of human rights. Another success story concerns international treaties that have worked. Although chemical weapons have been used in Syria, the vast majority of chemical weapons in the world have now been destroyed as a result of the Chemical Weapons Convention. Although Russia has deployed landmines in Ukraine, most landmines in the world have been destroyed as a result of the Mine Ban Treaty, which more than 160 countries have signed. Another reason for hope is the improvements in humanitarian assistance during war.
In my book, I profile 18 inspiring people who have been working to protect civilians and provide humanitarian assistance during war and to help prevent war and promote peace. For example, an obstetrician gynecologist in the Democratic Republic of the Congo, after treating many women who had been sexually abused, became a global advocate for protecting women during war and preventing gender-based violence. He was awarded the Nobel Peace Prize in 2018. Another example is Vincent Iacopino, who I mentioned before, who after treating many people who had been tortured and suffered other cruel and inhuman punishment, developed a protocol for forensic investigations to document war crimes and ultimately hold accountable the perpetrators of these war crimes. Another example is an anesthesiologist who changed her work situation so that she could work with Doctors Without Borders for 4 months every year, providing medical care in war zones.
RIA
Something that I just like, all these examples you were giving us, which I think is great, that we were, you know, kind of ending on a high note is just, it reminds me of something Mr. Rogers says that says, “look for the helpers.”
And to me that just like completely reminded me of that is like all these bad things happen look for the helpers. And if anything, that’s just like a way to help, you know, cope with all of the horror going. Cause I honestly believe there’s more good than bad in this world.
BARRY
You know, I have a lot of reasons to be hopeful.
DANIEL
Yeah.
RIA
Yeah. So, one thing we always end with is what is a project you’re working on right now that you’re particularly excited about?
BARRY
I’m particularly excited about using my book as a vehicle or as a platform to talk about the issues that we have been discussing and to engage people in helping to prevent the health consequences of war, prevent war itself, and promote peace.
The public at large needs to have a broader understanding of the impacts of war not only on health, but also on human rights and the environment. People at large need to recognize the ways in which they can help reduce the impacts of war, prevent war, and promote peace. There are many ways in which people can become more engaged in addressing these challenges, such as helping refugees from war zones settle in their communities. People can create discussions about war and peace in their own communities, including the costs of war to society. The United States spends over $700 billion a year on military expenditures, more than the next 11 countries combined. One of the things that we should be discussing, in our communities and as a nation, is how this diversion of resources for military purposes might be better directed to improve the health and well-being of people in this country.
We need to have an ongoing discussion about how we set priorities in this country. Our greatest security may come from the health of our population and not from our armaments and military policies.
There is likely to be less instability in the world if we focus more on development and what can be done to support countries in improving their government and addressing poverty and socioeconomic inequities.
So I am passionate about what we, as a nation and as a global society, can do better in preventing war and promoting peace.
I don’t have all the answers about how we do that, but I know we can do better to prevent war and promote peace. Maybe, someday, we can have a world without war.
I know that’s an idealistic vision, which may seem impossible in the midst of the war in Ukraine and the existential threat posed by 13,000 nuclear weapons possessed by nine countries. But we need to have a vision of a better world and how we can achieve it.
RIA
Thank you, Doctor Levy. That is hopeful. I love that you are optimistic. From someone who knows so much, that you are optimistic and that you have hope that we can do it. Thank you so much for joining us today. This was such an enlightening conversation that I think so many people need to hear.
BARRY
Thank you so much. Great to be with you.
OUTRO
At Global Partners for Development, our mission is to advance community-led initiatives. At Global Partners for Development, our mission is to advance community-led initiatives that improve education and public health in East Africa. We envision a world in which every East African community has the capacity to implement dynamic, sustainable solutions to the challenges they face. To learn more visit GPFD.org
