by Susan Hammond is the Founder and Executive Director of War Legacies Project and Sera Koulabdara is the CEO of Legacies of War. Susan and Sera are co-chairs of the War Legacies Working Group
World Health Day is meant to celebrate and protect human health. This year, it unfolds amid a war in Iran that is doing the opposite — killing civilians, destroying health systems, and setting the stage for suffering that will last generations. The U.S. war in Iran has already claimed 1,500 civilians, including 217 children. We are once again reminded of the huge cost of war on human health. Since 9/11 there have been between 905,000 – 940,000 direct deaths in war in Afghanistan, Pakistan, Iraq, Syria, Yemen and other war zones. Nearly half of these deaths were civilians and this calculation does not even include those killed in Israel and Palestine since October 7, 2023 or Russia’s war in Ukraine.
Indirect deaths — from economic collapse, food insecurity, destroyed health systems, environmental contamination, trauma, and displacement — are estimated to be at least four times higher than combat fatalities. They arise through disease, malnutrition, injury, and reproductive complications, and leave many more living with chronic conditions.
Past wars prove that environmental contamination from toxics and unexploded ordnance has multi-generation impacts on combatants and civilians. The Veterans Administration (VA) recognizes 19 cancers and other health conditions as presumed to be due to exposure to Agent Orange (AO) – and more than 20 conditions due to exposure to burn pits and other toxic exposure in the Gulf War and post 9/11 veterans. As of 2024, 6.5 million veterans or their dependents were receiving $163.1 billion in disability benefits from the VA.
More than fifty years after the U.S. war in Vietnam, the effects of AO are still emerging. While it is difficult to prove a causal effect in humans, there is the biological possibility that dioxin, an endocrine disrupting chemical, could impact human fetal development. US researchers recently learned that children in southern Vietnam, where AO was sprayed, have significantly higher rates of congenital heart defects than children born in the northern part of Vietnam or other parts of Asia.
The VA only provides benefits to children who have spina bifida if their parents served in Vietnam, Thailand or along the DMZ of South Korea. As a result, tens of thousands of children of U.S. veterans that believe their birth defects are associated with AO do not receive any support from the VA.
The Vietnamese Association of Agent Orange (VAVA) estimates that 187,000 people have birth defects associated with AO in the second, third and fourth-generations. Surveys in areas of Laos where AO and other toxins were used have also found children born with birth defects associated with dioxin exposure. Their care puts great stress and financial burdens on their families which further impacts the health of their caregivers and their siblings.
Like the U.S. wars in Laos, Cambodia, and Vietnam, where at least 12.7 million tons of bombs were dropped during carpet bombing campaigns, the U.S. and Israel are also relying on aerial bombardment in Iran. As of April 1, more than 13,000 bombing runs have been carried out in Iran, many near densely populated areas. Despite obligations under international humanitarian law to protect civilians and avoid critical infrastructure, strikes have reportedly hit at least 130 civilian sites, including dozens of health care facilities, residential buildings, and schools — among them a girls’ school where at least 168 children were killed. The destruction of health infrastructure in particular will have lasting public health consequences, as seen in Ukraine and Gaza.
Another echo of the U.S. war in Vietnam in Iran is in a NY Times report that states that U.S. manufactured anti-tank cluster munitions were found in an Iranian neighborhood. It is not clear who is responsible for the use of this weapon that is banned by more than 110 nations, though not by the U.S., Israel and Iran, that was reportedly recently in Tel Aviv. Cluster munitions have also been used by Russia in Ukraine and the Biden administration transferred U.S. cluster munitions to the Ukrainian military.
Cluster munitions are inherently indiscriminate. Although the U.S. maintains they can self-destruct and use GPS targeting, these safeguards often fail. Any use of the 5.5 million cluster munitions in its inventory would leave lasting harm to both land and people. The evidence is clear: more than 50 years after the U.S. wars in SE Asia, unexploded cluster munitions continue to kill and injure civilians — most of them children.
These human health costs are ignored in the calculus of war, and the U.S. is rarely held accountable for them once the damage is done. The imbalance is stark: the United States is spending at least $1 billion a day on its war in Iran, while decades of funding to clear unexploded ordnance worldwide amount to less than six days of that cost. Support for addressing the legacy of AO in Vietnam since 2007 equals less than a single day.
World Health Day calls on us to stand with science, and the evidence is clear: war is a public health catastrophe with consequences that span generations. It is visible in children born with health impairments, in communities poisoned by toxic remnants, and in health systems left in ruins long after the fighting ends.
If we truly value human health, these costs can no longer be ignored or excluded from policy and budget decisions. A nation that can spend a billion dollars a day on war has both the capacity and the moral obligation to prevent its long-term human and environmental damage, and to address the conditions that lead to war in the first place.
