The environmental health impacts of Russia's war on Ukraine.

BACKGROUND: Russia's invasion of Ukraine in February 2022 ignited the largest armed conflict in Europe since World War II. Ukrainian government agencies, civil society organizations, and international agencies have gathered an unprecedented amount of data about the impact of war on the environment, which is often the silent victim of war. We review these data and highlight the limitations of international governance for protection of the environment during time of war. METHODS: We performed an integrative review of academic, institutional, and media information resources using the search terms "Ukraine", "Russia", "war", "environment", "health", "human rights", "international humanitarian law", "international human rights law", "ecocide", and "war crimes". MAIN TEXT: Nearly 500,000 military personnel have been killed or wounded during the war, and more than 30,000 civilians have been killed or injured. Indirect health effects of the war have likely accounted for an even greater amount of civilian morbidity and mortality. The war has displaced more than 11 million people. Russia's military forces have caused extensive damage to civilian infrastructure. The war has devastated Ukraine's economy and reduced food and energy security in many countries. The war has caused more than $56.4 billion in damage to the environment. There has been widespread chemical contamination of air, water, and soil, and 30% of Ukraine has been contaminated with landmines and unexploded ordnance. Landscape destruction, shelling, wildfires, deforestation, and pollution have adversely affected 30% of Ukraine's protected areas. Russia's seizure of the Zaporizhzhia Nuclear Power Plant and destruction of the Nova Kakhovka Dam have posed risks of long-term environmental catastrophe. Most of these environmental impacts threaten human health. CONCLUSION: In addition to enormous human costs, Russia's war on Ukraine has had devastating impacts on the natural environment and the built environment. International law mandates that methods of warfare must be implemented with due regard to the protection and preservation of the natural environment. A just and lasting peace necessitates, among other requirements, rebuilding and restoration of Ukraine's natural environment and built environment. The environmental consequences of all wars need to be investigated and more effective measures need to be implemented to protect the environment during war.

"There is a fear that you will be attacked just for the act of working in health": a survey of experiences of violence against healthcare in Colombia.

BACKGROUND: Colombia has experienced decades of conflict between the government and non-state actors. Attacks on healthcare have been a grave but regular facet of that violence. In response, the Misión Médica (MM) program was developed to support, protect, and defend healthcare. Sporadic violence continues, with many recent attacks perpetrated not by armed actors but by residents. Given the history of conflict and ongoing violence, we sought to capture the perspectives of both healthcare workers (HCWs) and community members (CMs) regarding the characteristics and impacts of attacks on health in Colombia to gain insight into how to better prevent violence and mitigate its impacts. METHODS: A cross-sectional survey was conducted from January to March 2021 in seven departments in Colombia in regions that witnessed attacks on healthcare. Questionnaires were administered to HCWs and CMs via purposive sampling, probing their experiences with attacks on health with both closed and open-ended questions. The categorical responses were stratified by health worker vs. non-health worker and descriptively analyzed. Narrative responses were analyzed via a hybrid deductive/inductive thematic approach. RESULTS: Seventy-three individuals participated in the study (36 HCWs and 37 cm). Approximately 77% of HCWs believed that attacks on healthcare impacted health outcomes while 68% of CMs did not see a direct connection between violence against healthcare and poor health outcomes. Awareness of the MM program was significantly different between HCWs (83.3%) and CMs (37.8%). The survey responses explored the characteristics of attacks on health, compounded impacts of violence on the health system, personal impacts, and perspectives on mitigation efforts. CONCLUSIONS: The study demonstrates that: (1) attacks on healthcare are context-dependent and require a local lens for mitigation and management; (2) both HCWs and CMs have critical perspectives that must be considered, (3) the impacts of violence against healthcare are complex and compounded and (4) that awareness of the legal protections of the Geneva Conventions must be combined with education on the health impacts for robust protection strategies. Critically, Both CMs and HCWs experience fear and psychosocial ramifications of these attacks, suggesting the need for stronger protections and resources to support the health workforce and the local community.

Since Exposure to Mental Trauma, Especially War Trauma, Causes Personality Changes, Should Deliberate Exposure to Mental Health Trauma of Civilians Be in Itself a War Crime?

Mental trauma is a consequence of war. Here we consider whether the inflicting of such trauma, which could cause personality changes, should be considered a war crime in its own right, especially when it is civilians who are exposed to mental trauma. We make the argument based on a review of the development of personality disorders in persons exposed to mental trauma caused by war, and we make the argument that it is possible to demonstrate both physiological and anatomical changes in the brain of such persons, which could account for the observed behavioural and personality changes. Therefore we argue that deliberate exposure to Mental Health Trauma, for example by deliberate targeting of civilian areas with artillery, should be considered a war crime in its own right irrespective of whether the civilians receive physical trauma or not.

Russia's Hybrid Warfare in Ukraine Threatens Both Healthcare & Health Protections Provided by International Law.

Hybrid Warfare is on display because of the unjustified Russian invasion of Ukraine. This is characterized by numerous crimes against civilians as seen vividly during the occupation of the town of Bucha where rape, torture, murder, and looting seem to reflect Russian military policy, leadership, and command guidance. Of particular concern is the threat to hospitals and health care as well as vital life support. Numerous hospitals have been damaged and destroyed. Hospitals are not tactical military targets and targeting health care facilities and personnel ignores traditional jus in bello and ignores numerous conventions established to stabilize the global order. The Russian-proclaimed "special operation" in Ukraine has been characterized by barbarian warfare in which the Russian military uses weapons against the civilian population and civilian infrastructure. The aggressors have embarked on a purposeful terror campaign through infrastructure attacks, which are of little military value except to demoralize the nation's people. This is evident with Russian missile and drone attacks on electric, water, and health care in Ukraine. Warfare now and in the future may be increasingly aimed at demoralizing civilian populations and reducing the will of the people and their government to resist. The Ukrainian invasion clearly shows that this use of hybrid warfare should be met with a strong reaction of the international community at the earliest possible stage, especially the supposedly peace-loving neutral countries, or else the future is expanded unlawful and barbaric military conflict.

Role of forensic medicine in addressing the war crimes: Perspective from Russia-Ukraine conflict during the COVID-19 pandemic.

The International Criminal Court has recently opened an investigation into the international crimes committed on Ukrainian territory. The ongoing Russian-Ukrainian war is a tragic opportunity for a necessary critical and scientific reading of the Rome Statute. In our work, we aim to critically analyse the contents of the International Criminal Court's Rome Statute, with particular attention to the definition and listing of war crimes. Our objective is to assess whether the content of the Rome Statute and the Geneva Convention is useful to provide a correct and complete orientation of the medico-legal work in the context of war. We believe, in fact, that the forensic pathologists, and forensic experts in general, are the only professional figures specialised in providing scientific evidence of crimes compatible with war crimes. Their timely intervention and the standardisation of their work - in association with a review of the deficient content found in the Rome Statute - is essential in order to allow the prosecution of international crimes, already potentially undermined by the slowdowns associated with the COVID-19 pandemic that is the backdrop to the current conflict.

La macroviolencia encubridora y la invisibilización de las víctimas del conflicto. Estudio etnográfico de la masacre de Cienaguita-Pita (Atlántico) / Macroviolence and the invisibilization of the victims of the conflict. Ethnographic study of the Cienaguita-Pita massacre (Atlántico) / Macro-violência e a invisibilização das vítimas do conflito. Estudo etnográfico do massacre de Cienaguita-Pita (Atlántico)

Este artículo argumenta que la macroviolencia ha invisibilizado buena parte de las masacres ocurridas en regiones donde el conflicto interno fue de menor intensidad, ha banalizado sus efectos en pequeñas poblaciones, y con ello, ha provocado una relación transaccional entre el Estado y victimarios con las víctimas de masacres de menor escala. Por esta razón, por medio de un estudio de caso, haciendo uso de entrevistas semiestructuradas, grupos focales y encuestas al universo de habitantes de Cienaguita-Pita (Atlántico), se ilustrará cuáles fueron los efectos de la masacre, las entradas diferenciadas del Estado y el acceso que tuvieron las víctimas a los derechos a la verdad, justicia, reparación, no repetición y dignificación. Por último, este artículo pretende visibilizar una de las masacres ocurridas en el Caribe, que ha sido oculta por cuenta de la macroviolencia que caracterizó a la región en las décadas de 1990 y 2000, y demostrar, además, que el Estado es quien ha asumido la carga de indemnizar a las víctimas y establecer algunos insumos para reconstruir la verdad en el conflicto armado.

This article argues that macro-violence has made invisible a good part of the massacres that occurred in regions where the internal conflict was of lesser intensity, has trivialized its effects in small populations, and with it, has provoked a transactional relationship between the State and victimizers with the victims of smaller scale massacres. For this reason, by means of a case study, using semi-structured inter-views, focus groups and surveys of the universe of inhabitants of Cie-naguita-Pita (Atlántico), we will illustrate the effects of the massacre, the State>s differentiated approaches and the victims> access to the rights to truth, justice, reparation, non-repetition and dignity. Finally, this article aims to make visible one of the massacres that occurred in the Caribbean, which has been hidden due to the macro-violence that characterized the region in the 1990s and 2000s, and also to demonstrate that the State has assumed the burden of compensating the victims and establishing some inputs to reconstruct the truth in the armed conflict.

Este artigo argumenta que a macro-violência tornou invisível uma grande parte dos massacres que ocorreram em regiões onde o conflito interno foi de menor intensidade, banalizou os seus efeitos em pequenas populações, e provocou assim uma relação transaccional entre o Estado e os perpetradores com as vítimas de massacres de menor escala. Por este motivo, através de um estudo de caso, utilizando entrevistas semi-estruturadas, grupos focais e inquéritos aos habitantes de Cienaguita-Pita (Atlántico), ilustraremos os efeitos do massacre, as abordagens diferenciadas do Estado e o acesso das vítimas aos direitos à verdade, à justiça, à reparação, à não repetição e à dignidade. Finalmente, este artigo visa tornar visível um dos massacres ocorridos nas Caraíbas, que foi escondido devido à macro-violência que caracterizou a região nos anos 90 e 2000, e também demonstrar que o Estado assumiu o ónus de compensar as vítimas e estabelecer alguns contributos para a reconstrução da verdade no conflito armado.

Starvation Genocide in Occupied Eastern Europe 1939-1945: Food Confiscation by and for the Nazis.

The genocide effected by the Nazi regime during World War II, intended for the local population in Eastern Europe, took the form of allocation of daily food rations: 100% for the Germans; 70% for the Poles; 30% for Greeks; 20% for Jews. Hermann Göring, the Reichsmarschall of the Nazi Empire created a blueprint for full alimentation of the occupying German forces through theft of land and food of the Soviet Union thus forcing its "racially inferior" population to starve, adopted on 29 April 1941. In the weeks leading to the German invasion of the Soviet Union in June 1941, the Reich Minister for Food, Richard Darré, and his State Secretary, Herbert Backe, developed the "Hunger Plan", which led to death by starvation of at least seven million Soviet civilians, Jews and gentiles. This article reviews responsibility for the formulation and implementation of this form of genocide.

Violence against healthcare in conflict: a systematic review of the literature and agenda for future research.

BACKGROUND: Attacks on health care in armed conflict, including those on health workers, facilities, patients and transports, represent serious violations of human rights and international humanitarian law. Information about these incidents and their characteristics are available in myriad forms: as published research or commentary, investigative reports, and within online data collection initiatives. We review the research on attacks on health to understand what data they rely on, what subjects they cover and what gaps exist in order to develop a research agenda going forward. METHODS AND FINDINGS: This study utilizes a systematic review of peer-reviewed to identify and understand relevant data about attacks on health in situations of conflict. We identified 1479 papers published before January 1, 2020 using systematic and hand-searching and chose 45 articles for review that matched our inclusion criteria. We extracted data on geographical and conflict foci, methodology, objectives and major themes. Among the included articles, 26 focused on assessment of evidence of attacks, 15 on analyzing their impacts, three on the legal and human rights principles and one on the methods of documentation. We analyzed article data to answer questions about where and when attacks occur and are investigated, what types of attacks occur, who is perpetrating them, and how and why they are studied. We synthesized cross-cutting themes on the impacts of these attacks, mitigation efforts, and gaps in existing data. CONCLUSION: Recognizing limitations in the review, we find there have been comparatively few studies over the past four decades but the literature is growing. To deepen the discussions of the scope of attacks and to enable cross-context comparisons, documentation of attacks on health must be enhanced to make the data more consistent, more thorough, more accessible, include diverse perspectives, and clarify taxonomy. As the research on attacks on health expands, practical questions on how the data is utilized for advocacy, protection and accountability must be prioritized.

Trends and Characteristics of Security Incidents Involving Aid Workers in Health Care Settings: A 20-Year Review.

INTRODUCTION: In recent years, several high-profile attacks on hospitals providing medical aid in conflict settings have raised international concern. The International Humanitarian Law prohibits the deliberate targeting of health care settings. Violation of this law is considered a war crime and impacts both those delivering and receiving medical aid. PROBLEM: While it has been demonstrated that both aid workers and health care settings are increasingly being targeted, little is known about the trends and characteristics of security incidents involving aid workers in health care compared to non-health care settings. METHODS: Data from the publicly available Aid Worker Security Database (AWSD) containing security incidents involving humanitarian aid workers world-wide were used in this study. The security incidents occurring from January 1, 1997 through December 31, 2016 were classified by two independent reviewers as having occurred in health care and non-health care settings, and those in health care settings were further classified into five categories (hospital, health clinic, mobile clinic, ambulance, and vaccination visit) for the analysis. A stratified descriptive analysis, χ2 Goodness of Fit test, and Cochran-Armitage test for trend were used to examine and compare security incidents occurring in health care and non-health care settings. RESULTS: Among the 2,139 security incidents involving 4,112 aid workers listed in the AWSD during the study period, 74 and 2,065 incidents were in health care settings and non-health care settings, respectively. There was a nine-fold increase from five to 45 incidents in health care settings (χ2 = 56.27; P < .001), and a five-fold increase from 159 to 852 incidents in non-health care settings (χ2 = 591.55; P < .001), from Period 1 (1997-2001) to Period 4 (2012-2016). Of the 74 incidents in health care settings, 23 (31.1%) occurred in ambulances, 15 (20.3%) in hospitals, 13 (17.6%) in health clinics, 13 (17.6%) during vaccination visits, and six (8.1%) in mobile clinics. Bombings were the most common means of attack in hospitals (N = 9; 60.0%), followed by gun attacks (N = 3; 20.0%). In health care settings, 184 (95.3%) were national staff and nine (4.7%) were international staff. CONCLUSION: Security threats are a growing occupational health hazard for aid workers, especially those working in health care settings. There is a need for high-quality data from the field to better monitor the rapidly changing security situation and improve counter-strategies so aid workers can serve those in need without having to sacrifice their lives.

Rudolf Hess - The Doppelgänger conspiracy theory disproved.

The Deputy Führer of the Third Reich Rudolf Hess was captured after a controversial flight to Scotland in 1941. Hess was sentenced to life imprisonment during the Nuremberg War Crimes Trials. He was detained in Berlin's Spandau Prison under the official security designation 'Spandau #7.' Early doubts arose about the true identity of prisoner 'Spandau #7.' This evolved to a frequently espoused conspiracy theory that prisoner 'Spandau #7' was an imposter and not Rudolf Hess. After Hess's reputed 1987 suicide, the family grave became a Neo-Nazi pilgrimage site. In 2011, the grave was abandoned and the family remains cremated. Here we report the forensic DNA analysis of the only known extant DNA sample from prisoner 'Spandau #7' and a match to the Hess male line, thereby refuting the Doppelgänger Theory.

Large scale DNA identification: The ICMP experience.

The International Commission on Missing Persons (ICMP) is a treaty-based international organization with a global mandate to address the issue of missing persons. It works with governments, civil society organizations, and others, and utilizes data systems and technical assistance in forensic science. ICMP's initial work focused on the ∼40,000 people missing in the Western Balkans from the conflicts of the 1990s. A "DNA-led" approach to large-scale DNA identification of the missing was developed, based on high-throughput autosomal STR testing of skeletal remains from mass graves and other sites, and the establishment of a regional database of DNA profiles from family members of the missing. Database pairwise and pedigree kinship searching is conducted using in-house DNA matching software, the Identification Data Management System (iDMS), providing high-certainty DNA matches that are integrated in a multi-disciplinary identification process. Anthropological guidelines for sampling skeletal remains for DNA testing are based on tens of thousands of tests from a wide range of skeletal elements, allowing for prioritization based on DNA preservation. Large-scale collection of family reference samples has been conducted, resulting in a database of more than 100,000 family reference DNA profiles across all projects and delivering family DNA match reports for more than 20,000 individuals. From the 1995 Srebrenica event, ICMP provided DNA matches for 6887 of the ∼8000 missing from that event. In assistance to justice, ICMP has provided extensive evidence and expert testimony in multiple war crimes trials, including those conducted at the ICTY. This article provides an overview of ICMP's technical involvement over the last 17 years in areas of DNA testing and database matching, and training and capacity building projects with partners. It also touches on the development of massively parallel sequencing (MPS) strategies specifically tailored to missing persons applications.

Trauma Craneoencefálico por Proyectil de Arma de Fuego: Revisión Temática / Traumatic brain injury (TBI) by a firearm projectile: thematic review / Traumatismo cranioencefálico por projétil de arma de fogo: revisão temática

Resumen El trauma craneoencefálico (TCE) por proyectil de arma de arma de fuego (PAF) es una condición severa producida por alteraciones mecánicas sobre el encéfalo. En Colombia, uno de cada cinco homicidios se produce a nivel craneal. Objetivo: Realizar una revisión de la literatura para identificar los aspectos médico-legales y clínico-quirúrgicos del TCE por PAF. Metodología: Revisión realizada por medio de búsqueda en bases de datos de literatura médica y recopilación de datos publicados por entidades gubernamentales. Resultados: El TCE por PAF, es un evento epidemiológicamente constante, cuyos patrones se relacionan con la presencia de conflictos armados. Se asocia con manifestaciones clínicas y complicaciones severas asociadas con variables como el tipo de arma y munición, sexo de la víctima, región principal de lesión y mecanismo de muerte. La mortalidad de este evento es muy alta si no se realiza intervención quirúrgica; y de hacerlo, las lesiones determinan la reducción de la expectativa y calidad de vida. Conclusión: El conflicto armado actual de Colombia, hace del TCE por PAF un tema de importancia criminológica, criminalística y médico-legal.

Abstract Traumatic brain injury (TBI) caused by a firearm projectile (FAP) is a severe condition produced by mechanical alterations on the encephalon. In Colombia, one in every five killings is produced at cranial level. Objective: to do a literature review to identify the medical-legal and clinic-surgical issues of TBI by FAP. Methodology: a review conducted by means of medical literature databases searching and data gathering published by governmental entities. Results: TBI by FAP is an event epidemiologically constant; and its standards are related to the presence of the armed conflicts. It is associated with clinical manifestations and severe medical complications connected with diverse variables such as type of weapons and ammunition, sex of the victims, main region of the lesion and death mechanism. If the surgical operation is not performed, the mortality in this event is very high, but if the surgery is carried out, the lesions determine the decrease of life expectancy and quality. Conclusion: the current Colombian armed conflict makes TBI by FAP a topic of criminological, criminalistics and medical-legal relevance.

Resumo O Traumatismo Cranioencefálico (TCE) por Projétil de Arma de Fogo (PAF) é uma condição severa causada por alterações mecânicas sobre o encéfalo. Na Colômbia, um em cada cinco homicídios é producido na zona craniana. Objetivo: realizar uma revisão de literatura para identificar os aspectos médico-legais e clínico-cirúrgicos do TCE por PAF. Metodologia: revisão realizada por meio de busca em bases de dados da literatura médica e coleta de dados publicados por entidades governamentais. Resultados: o TCE por PAF é um evento epidemiologicamente constante, cujos padrões relacionam-se à presença de conflito armado. Associa-se a manifestações clínicas e complicações graves vinculadas a diversas variáveis, como o tipo de arma e munição, sexo da vítima, lugar principal da lesão e mecanismo da morte. A mortalidade, decorrente desse evento, é muito alta caso não seja realizada intervenção cirúrgica. No pós-cirúrgico, as lesões determinam a redução da expectativa e da qualidade de vida. Conclusão: o conflito armado atual na Colômbia faz do TEC por PAF um tema de importancia criminológica, criminalística e médico-legal.

The Neuropsychological Consequences of Armed Conflicts and Torture.

PURPOSE OF REVIEW: At any point in time, there are hundreds of armed conflicts throughout the world. Neuropsychological disorders are a major cause of morbidity during and after armed conflicts. Conditions such as closed and open head injuries, acute stress disorder, post-traumatic stress disorder, depression, anxiety, and psychosis are prevalent among survivors. Herein, we summarize information on the various forms of torture, the resultant neuropsychological pathology, and treatment strategies to help survivors. RECENT FINDINGS: Strategies to address the needs of individuals who experienced neuropsychological trauma due to armed conflicts and torture include pharmacological and psychological interventions. The former includes antidepressant, antianxiety, and antipsychotic medications. The latter includes narrative exposure therapy and trauma-focused cognitive-behavioral therapy. Neuropsychological disorders are major causes of morbidity among survivors of armed conflicts and torture. Treatment strategies must be affordable, applicable across cultures, and deliverable by individuals who understand the victims' psychosocial and ethnic background.

Identifying Differences Between Cut Marks Made on Bone by a Machete and Katana: A Pilot Study.

The aim of this research was to identify characteristics specific to a machete and katana on three different bone types. One machete and two katanas were used to produce cut marks on Sus scrofa rib, flat and long bones. Fifty-nine cuts were produced by the katanas and 38 by the machete. The presence of flaking, feathering, peeling, micropeeling, chattering, microcurvature, scoop defect, and exit notch was noted, and bivariate associations between each characteristic and weapon type were assessed using Pearson's chi-square tests for independence and logistic regression models developed. Significant predictors for machete cut marks are scoop defect for rib bones (correct classification 93%), micropeeling in flat bones, chattering on flat and long bones (all p < 001) and for the katana, microcurvature (p < 004) and exit notch on flat and long bones (p < 001; correct classification 96% and 100%, respectively). The identified bivariate associations and final logistic regression models may be utilized in forensic investigations when identifying hacking trauma.

Retrospective mortality among refugees from the Central African Republic arriving in Chad, 2014.

BACKGROUND: The Central African Republic has known long periods of instability. In 2014, following the fall of an interim government installed by the Séléka coalition, a series of violent reprisals occurred. These events were largely directed at the country's Muslim minority and led to a massive displacement of the population. In 2014, we sought to document the retrospective mortality among refugees arriving from the CAR into Chad by conducting a series of surveys. METHODS: The Sido camp was surveyed exhaustively in March-April 2014 and a systematic sampling strategy was used in the Goré camp in October 2014. The survey recall period began November 1, 2013, just before the major anti-Balaka offensive. Heads of households were asked to describe their household composition at the beginning of and throughout the recall period. For household members reported as dying, further information about the date and circumstances of death was obtained. RESULTS: In Sido, 3449 households containing 25 353 individuals were interviewed. A total of 2599 deaths were reported, corresponding to a crude mortality rate of 6.0/10000 persons/day, and 8% of the population present at the beginning of the recall period died. Most (82.4%) deaths occurred among males, most deaths occurred in December 2013 and January 2014, and 92% were due to violence in the CAR. In Goré, 1383 households containing 8614 individuals were interviewed. A total of 1203 deaths were reported, corresponding to a crude mortality rate of 3.7/10000 persons/day [95%CI 3.5-3.9], and 12% of the population present at the beginning of the recall period died. Most (77.1%) deaths occurred among males. As in Sido, most deaths occurred in December 2013 and January 2014, and 86% of all deaths were due to violence in the CAR. CONCLUSIONS: The results of these two surveys describe a part of the toll of the violent events of December 2013 and January 2014 in the Central African Republic.

U.S. Complicity and Japan's Wartime Medical Atrocities: Time for a Response.

Shortly before and during the Second World War, Japanese doctors and medical researchers conducted large-scale human experiments in occupied China that were at least as gruesome as those conducted by Nazi doctors. Japan never officially acknowledged the occurrence of the experiments, never tried any of the perpetrators, and never provided compensation to the victims or issued an apology. Building on work by Jing-Bao Nie, this article argues that the U.S. government is heavily complicit in this grave injustice, and should respond in an appropriate way in order to reduce this complicity, as well as to avoid complicity in future unethical medical experiments. It also calls on other U.S. institutions, in particular the Presidential Commission for the Study of Bioethical Issues, to urge the government to respond, or to at least inform the public and initiate a debate about this dark page of American and Japanese history.

Education in Medical Ethics and War Crimes Committed by Medical Scientists / 医学教育

1) Medical ethics is important in medical education. A questionnaire survey of medical ethics education was conducted at university departments of medicine and at medical colleges in Japan and Germany.<br>2) The Declaration of Helsinki and war crimes committed by physicians were included in the medical ethics education of most university departments of medicine and medical colleges in Germany but of few in Japan. <br>3) It is important to continue research into the history of physicians' participation in the 15 years of war and to prepare teaching materials, including primary sources and texts, about war and medicine that can be used in medical ethics education.

La guerra como desastre. Sus consecuencias psicológicas / War as a disaster. Its psychological consequences

En más de 100 conflictos bélicos que se han producido en los últimos diez años, más del 80 por ciento de las víctimas son civiles. Se ha producido un desarrollo acelerado en las investigaciones concernientes a las consecuencias psico-sociales de la guerra en la población civil, la cual es el blanco principal de las víctimas en la guerra contemporánea. Este trabajo constituye una revisión bibliográfica sobre la guerra como desastre, acerca de los conceptos “modernos” de “guerra total”, desastre y las consecuencias psicológicas de la guerra en la población civil, la utilización de los niños como soldados lo cual acarrea desórdenes mentales marcados y se aborda el problema de la violencia sexual como arma de guerra. Las mujeres, las jóvenes, e incluso niñas, son a menudo sometidas, violadas, secuestradas y forzadas a la esclavitud sexual o cualquier tipo de abuso sexual; son vejadas, humilladas y dañadas en lo más profundo de sus sentimientos psicológicos, y valores morales, lo que también trasciende al grupo social, comunidad, clase social o etnia a la que pertenecen. El deterioro o la destrucción de la infraestructura económica, social y política de las naciones en conflicto impide la atención de las necesidades básicas de la población. El trastorno por estrés postraumático es la entidad nosológica más frecuente en las víctimas de la guerra, pero existen otros trastornos mentales que hay que tener en cuenta.

In over 100 war conflicts that have occurred in the last 10 years, m ore than 80 percent of the victims were civilians. The scope of recent studies has been increasingly focused on psychological and social effects among civilians who are the target and main victims of contemporary wars. This article is an explanation of why war is considered a disaster, a revision of modern terms for war, disaster and the psychological effects of war on civilians, the training of children as soldiers, and the resulting mental disorders. It touches upon sexual violence problem as a war weapon. Women, adolescents and young children are often violated and forced into sexual slavery or any other type of sexual abuse, causing humiliation and psychological, ethical and moral damage, which can affect social groups, communities, social classes, or races. The deterioration or destruction of the economic, social and political infrastructure of the countries in conflict hinders the satisfaction of the citizens' basic needs. The most common psychological effect among war victims is posttraumatic stress, but there are also other mental disorders which must be taken into consideration.