Accountability in care and cash: a call to quantify the costs of war on global health

Wars erode human dignity and global solidarity. Take famine-the worst form of death by starvation en masse-for example. Famine is particularly telling and chilling, as in the modern era, the (almost) famine in Gaza and Sudan is predominantly human-made. In addition to acute consequences like deaths, famine also causes long-term damage to people's physical health and psychological well-being, from their susceptibility to cardiovascular diseases, trauma, and suicidality. A growing body of research also indicates that, largely due to high-definition and high-fidelity media coverage of wars with high definition and fidelity, people living in non-war zones can also face prolonged, yet often overlooked, mental health challenges. While the global health community shoulders the majority of the short- and long-term burden of care and cure in armed conflicts, we often have little power to hold warring parties responsible, not least because politicians' careers are often term-based if not short-lived. Using the famine in Gaza and Sudan as examples, this paper sheds light on the imperative of holding warring parties accountable-in care and cash-for the damage they exert on lives and livelihoods worldwide. Wars might be inevitable (almost), famine, and disregard for human dignity and despair are not. Key messages What is already known on this topic? War drives famine, disease outbreaks, psychological trauma, and health system collapse, disproportionately affecting women and children. Starvation has been used as a weapon of war, despite its prohibition under international humanitarian law. What this study adds Emphasizes the need to quantify the full health and economic costs of war, particularly in settings such as Gaza and Sudan experiencing famine and health system collapse. Proposes a Global Conflict Accountability Mechanism to hold warring parties financially responsible for health impacts. Advocates for the formal inclusion of global health professionals in diplomacy and peacebuilding. How this study might affect research, practice, or policy Encourages research on the long-term health and economic consequences of war, including mental health and chronic disease. Supports integrating global health actors into conflict-sensitive humanitarian planning and peace processes to improve equitable access to care.