The most unnatural cause of death and disease in the less developed nations (and elsewhere) is war. Political and economic instability, combined with environmen- tal degradation, have made the less developed nations particularly vulnerable to war. Wars not only can wipe out a generation of soldiers but also can take astound- ingly high tolls among civilians. For example, during the seven years after coali- tion forces led by the United States invaded Iraq in 2003, around 450,000 Iraqi civilians—many of them women and children—were killed by military forces.

Civilians are killed not only by bombs and guns but also by forced labor; malnutrition after soldiers burn crops, kill farm animals, and force farmers off their lands; and diseases that spread when refugees are forced into overcrowded, unsanitary camps and when soldiers destroy water, sewage, and health care facil- ities. During six years of warfare in Darfur, for example, 80% of those who died were killed not by guns or bombs but by diseases that spread when warfare led to economic, social, and ecological destruction.

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Survivors, too, pay a huge price, often including both long-lasting disability and the psychological trauma of losing one’s family, community, and work. The traumas are particularly high for victims of mass rape, a common tool of warfare that has been used extensively in recent years; those who survive can find themselves not only infertile or permanently disabled by their injuries but also stigmatized and sometimes abandoned by families and neighbors. Finally, an estimated 300,000 chil- dren in more than 30 less developed nations are serving as soldiers. Mortality rates are extremely high, as are the health risks experienced by those who survive. These children are exposed to all the horrors and dangers of warfare and to increased risks of malnutrition, disease, injuries from land mines, sexual abuse, and substance abuse, while losing opportunities for education and normal family life that might protect their mental and physical health as adults.

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