Wars and conflicts are among the most important issues of our times. In the 20th century alone, an estimated 231 million people, more than half of whom were civilians, lost their lives in conflict. [1] Between 2006 and 2016, total deaths attributable to conflict increased by 264%.2 More wars and conflicts are underway now than at almost any time since World War [2]. Many of these conflicts are intra-state, complex and protracted, with involvement of regional and international parties including state and non-state actors, rendering resolution difficult. The effects extend far beyond the battle zones and persist long after the last shots have been fired. Wars and conflicts exact a profound toll on health: in addition to direct deaths, injuries and psychological trauma, they destroy health and social systems and deprive populations of healthcare, resulting in indirect deaths, infectious disease outbreaks, and a large burden of avoidable ill health due to treatment forgone and lack of basic necessities such as food, clean water and shelter required for a life of dignity and health. With destruction of crucial civilian infrastructures and loss of livelihoods, wars and conflicts induce mass population displacement, now at an unprecedented level of 71 million worldwide, and place tremendous pressures on an overburdened humanitarian system. Furthermore, wars and conflicts are key impediments to achieving the Sustainable Development Goals (SDGs). While this is most obvious with regards to SDG 16 on Peace, Justice and Strong Institutions [3], wars and conflicts can undermine progress on every other SDG. Addressing this profound and avoidable global toll of wars and conflicts requires a global collaborative effort premised on strong and equitable partnerships and inclusive, multidisciplinary and multisectoral engagement.

Background

Many individuals, organizations, and initiatives have made several common critical observations, and identified a shared set of unmet needs, regarding the current status of war, conflict and health globally:

- There are many individual or single-centre initiatives (in research, scholarship, advocacy, and practice) from across the world in the area of war/conflict and health. Whilst increasing in number, these efforts remain insufficient and the field is underdeveloped given the sheer burden of wars/conflicts in our world today. [4]

- Crucially, many existing efforts are largely directed towards war/conflict-health dimensions, but less attention is afforded to peace-health dimensions.

- Research and scholarship on war, conflict and health is siloed. There are limited links with key related fields, e.g. conflict or peace studies.

- Researchers and institutions from the Global South are under-represented in this field, in leadership, research, publication and engagement, despite living the greatest burden of conflict. - Attention and leadership from the global health and academic communities in the area of war/conflict and health is increasing, but insufficient.

- The focus of global health in relation to war and conflict is largely related to documenting the health effects and essential lifesaving operational activities during conflict. Little attention is paid to long-term effects of war/conflict, prevention of war in the first instance, and peace-health links.

- There are no global collaborative platforms that: 1) address the full spectrum of issues regarding war/conflict and health; 2) have a broad, multi-disciplinary and multisectoral constituency; 3) bring together existing siloed functions and entities working in this field; 4) offer capacity

-building resources and a platform to amplify the voice of scholars in the Global South and young professionals.

The origins of the Alliance

The Lancet- American University of Beirut (AUB) Commission on Syria: Health in Conflict [5] (LCS) and partners have conducted background research to examine the evidence and take stock of the field, with preliminary findings validating the aforementioned observations:

- A bibliometric analysis of literature on war and health published between 1946 and 2018 shows a growth trend but the volume remains small considering the toll.

- A thematic scoping literature review shows local conflict-affected populations receive less research attention compared with veterans and active military personnel.

- A literature review exploring challenges of conducting research in/on war and conflict settings shows numerous contextual, methodological and administrative challenges, not least of which are safety considerations and ethical issues.

- A review of barriers to Global South research leadership demonstrates a range of obstacles, both internal to the Global South and related to resourcing, capacities and research infrastructures, and external factors, notably the nature of partnerships and engagement of the Global North.

- A timeline analysis of the field since 1970 shows a growth of major initiatives and scholarship collaborations. However, many such efforts have focused on specific issues and / or specific wars and several have been time-limited and short-lived.

- While globally there are a number of networks focused on war, conflict and health, many of these either address a specific issue and / or are tailored to a particular professional group or geographic constituency. The vast majority of such initiatives are headquartered in the Global North, and there are currently no global collaborative platforms with a broad focus on war, conflict and health that have a diverse, multisectoral membership.

- A mapping of current educational programs and research hubs shows the concentration in Western Europe and North America, with very few initiatives in the Global South.

- A mapping of the distribution of global health research funding reveals that major funders devote very few resources to the topics of war, conflict and health. [6]

Building on these observations and preliminary findings, in June 2018 the LCS convened an expert meeting at AUB to take stock of the field of war, conflict and health, identify critical gaps and key priorities, and outline a way forward7. Convening over 20 local, regional and international experts, the meeting culminated in a commitment by participants to launch a global collaborative platform on war, conflict and health. After extensive further discussions with a broad network of experts from across the world, a Founding Steering Group was assembled (Appendix 1). Steering the Alliance through the 2019-2021 founding phase, the Group includes representatives from both academic and humanitarian operational organisations, in addition to major journals; has strong Global South representation from all geographic regions, including women from and based in the South; and includes experts from diverse disciplines, ranging from the medical and population health sciences to international humanitarian law, humanitarian studies and conflict studies. Founding Steering Group members convened face-to-face for the first time at a meeting hosted by the Center for Global Health at Queen Mary University of London in June 20198, which was also attended by Richard Horton, Editor-in-Chief of The Lancet. This meeting initiated the process of formally establishing a new collaborative platform, the Global Alliance on War, Conflict and Health.

To ensure an inclusive, participatory approach, a number of global, regional and national consultations were convened (Table 1) with the following objectives:

- Present the initiative, explain its background, and gauge interest

- Seek input into refining the mandate, scope, priorities, and program of work of the Alliance - Review key local and regional needs

- Discuss ways in which interested individuals, institutions and organizations can engage with the Alliance

- Ensure that the Global South has a strong voice in shaping the Alliance Consultations engaged a range of individuals including academics, researchers, advocates, humanitarian practitioners, as well as organizations such as academic institutions, UN agencies, humanitarian organizations, and civil society organizations.

Date Location Host

25 June 2019London, UK Medact 26 September 2019 Amman, Jordan Eastern Mediterranean Public Health Network (EMPHNET) and Global Health Development 11 October 2019 Beirut, Lebanon Alliance Secretariat, American University of Beirut 5 November 2019 Philadelphia, USA Peace Caucus, American Public Health Association 4 December 2019 Berlin, Germany Physicians for Human Rights 21-23 January 2020 Gaziantep, Turkey Syrian American Medical Society, Bahar organization