Peace Was the Medicine We Stopped Taking

A partir de ahí, la curva no ha parado de subir.

From that point on, the curve has not stopped rising.

Y cada nuevo conflicto trae consigo el mismo catálogo de consecuencias sanitarias.

And every new conflict brings the same catalogue of health consequences.

What does that catalogue look like in practice, for people who haven't been in those places?

Primero, la destrucción física de la infraestructura sanitaria.

First, the physical destruction of health infrastructure.

Hospitales bombardeados, ambulancias destruidas, clínicas convertidas en cuarteles.

Bombed hospitals, destroyed ambulances, clinics turned into barracks.

En Gaza, en este momento, más del ochenta por ciento de los centros de salud no funcionan con normalidad.

In Gaza, right now, more than eighty percent of health centers are not functioning normally.

En Sudán, el colapso es casi total en ciertas regiones.

In Sudan, the collapse is almost total in certain regions.

And there's a specific legal framework that's supposed to protect that infrastructure.

The Geneva Conventions.

Medical neutrality.

The principle that you don't hit a hospital, full stop.

Un principio que se viola sistemáticamente.

A principle that is systematically violated.

Médicos Sin Fronteras lleva un registro de ataques a instalaciones médicas.

Médecins Sans Frontières keeps a log of attacks on medical facilities.

En 2024, documentaron más de novecientos ataques en todo el mundo.

In 2024, they documented more than nine hundred attacks worldwide.

Novecientos.

Nine hundred.

Y eso solo lo que pudieron verificar.

And that's only what they were able to verify.

Nine hundred.

I knew the number was bad but not that bad.

Y el efecto se multiplica.

And the effect multiplies.

Cuando destruyes un hospital, no solo pierdes ese hospital.

When you destroy a hospital, you don't just lose that hospital.

Pierdes los años de formación del personal que huye.

You lose the years of training of the staff who flee.

Pierdes la cadena de frío para las vacunas.

You lose the cold chain for vaccines.

Pierdes el único lugar de la región donde puedes dar a luz con seguridad.

You lose the only place in the region where you can give birth safely.

Todo eso desaparece de golpe.

All of that disappears at once.

Maternal mortality in conflict zones.

That's a number that rarely makes headlines but it's staggering.

Las mujeres embarazadas en zonas de guerra tienen una probabilidad de morir en el parto entre tres y cinco veces mayor que en países en paz.

Pregnant women in war zones are three to five times more likely to die in childbirth than in countries at peace.

Y en muchos casos, los datos ni siquiera existen porque nadie está llevando el registro.

And in many cases the data doesn't even exist because no one is keeping the record.

Hay muertes que ocurren en aldeas cortadas de todo y que no aparecen en ninguna estadística.

There are deaths happening in villages cut off from everything that don't appear in any statistic.

Which means the Uppsala numbers, as grim as they are, are almost certainly an undercount.

Sin duda alguna.

Without any doubt.

Los investigadores de Uppsala son muy rigurosos, pero trabajan con datos verificables.

The Uppsala researchers are very rigorous, but they work with verifiable data.

Las muertes indirectas, las que ocurren en lugares sin periodistas, sin ONG, sin acceso humanitario, esas no entran en el recuento.

Indirect deaths, those that occur in places with no journalists, no NGOs, no humanitarian access, those don't enter the count.

El número real es probablemente el doble, o más.

The real number is probably double, or more.

Let me push on something.

We've talked about the physical destruction.

But there's a second wave, the psychological one, that plays out over generations.

And I'd argue it's even harder to measure and even harder to treat.

El trauma intergeneracional.

Intergenerational trauma.

Hay estudios fascinantes, y perturbadores, sobre los hijos y los nietos de supervivientes del Holocausto, de los desplazados de la guerra de Bosnia, de los huérfanos de Ruanda.

There are fascinating, and disturbing, studies on the children and grandchildren of Holocaust survivors, of those displaced by the Bosnian war, of the orphans of Rwanda.

El trauma no termina con la firma del armisticio.

Trauma doesn't end with the signing of an armistice.

Se hereda de maneras que aún no entendemos del todo.

It is inherited in ways we still don't fully understand.

I interviewed a psychiatrist in Sarajevo in 2009, fourteen years after the siege ended, and she told me her waiting list was longer than it had been during the war.

People had been surviving for so long they didn't have space to fall apart until it was over.

Eso tiene un nombre clínico.

That has a clinical name.

Se llama respuesta diferida al trauma.

It's called delayed trauma response.

Y es especialmente común en conflictos prolongados, donde la supervivencia exige una represión constante del sistema nervioso.

And it's especially common in prolonged conflicts, where survival demands constant suppression of the nervous system.

El cuerpo literalmente pospone el colapso para cuando percibe que ya puede permitírselo.

The body literally postpones the breakdown for when it perceives it can finally afford it.

And the infrastructure for treating that, the psychiatrists, the psychologists, the community mental health workers, that's usually what gets cut first when a country's health system is overwhelmed by physical casualties.

Porque la salud mental sigue siendo invisible en muchos sistemas, incluso en tiempos de paz.

Because mental health is still invisible in many systems, even in peacetime.

En guerra, directamente desaparece de la agenda.

In war, it simply disappears from the agenda.

Y luego te preguntas por qué las sociedades posconflicto tienen tasas de violencia doméstica desorbitadas, adicciones disparadas, una incapacidad colectiva para construir instituciones estables.

And then you wonder why post-conflict societies have sky-high rates of domestic violence, soaring addiction, a collective inability to build stable institutions.

There's an argument I've heard made, and I find it compelling even if it's uncomfortable, that the international community has essentially outsourced the cost of these conflicts.

The wars happen in the Global South.

The health bill gets paid over decades by populations that had nothing to do with the geopolitical decisions that started the fighting.

Es más que un argumento.

It's more than an argument.

Es una realidad documentada.

It's a documented reality.

Los países que financian los conflictos, que venden las armas, que apoyan a las facciones, no son los que luego construyen los hospitales ni tratan el trauma.

The countries that finance the conflicts, that sell the weapons, that back the factions, are not the ones who later build the hospitals or treat the trauma.

Hay una disociación total entre quienes toman las decisiones y quienes soportan las consecuencias sanitarias.

There is a total disconnection between those who make the decisions and those who bear the health consequences.

And yet when you look at something like the Strait of Hormuz situation right now, eleven million barrels a day off the market, the knock-on effect on medicine supply chains in countries that can barely afford medications at normal prices is something nobody's talking about.

Y eso toca algo que la gente no suele asociar con el petróleo: la fabricación de medicamentos.

And that touches something people don't usually associate with oil: drug manufacturing.

Una gran parte de los fármacos genéricos que llegan a países de renta baja dependen de materias primas y rutas de transporte que pasan por esa zona.

A large share of the generic medicines that reach low-income countries depend on raw materials and transport routes that pass through that area.

Un conflicto en el Estrecho de Ormuz no solo sube el precio de la gasolina en Texas.

A conflict in the Strait of Hormuz doesn't just raise the price of petrol in Texas.

Interrumpe el tratamiento del VIH en Mozambique.

It interrupts HIV treatment in Mozambique.

That connection never gets made in the coverage.

Ever.

Porque requiere pensar en cadenas largas de causa y efecto, y el periodismo de conflicto, con todo el respeto para los corresponsales de guerra que conozco, tiende a lo inmediato.

Because it requires thinking in long chains of cause and effect, and conflict journalism, with all due respect to the war correspondents I know, tends toward the immediate.

La bomba.

The bomb.

El muerto.

The dead.

El ministro que declara.

The minister who makes a statement.

Lo estructural se queda fuera.

The structural gets left out.

I spent twenty-five years being that correspondent, so I'm going to accept that critique and sit with it for a second.

He's not wrong.

No es un ataque, Fletcher.

It's not an attack, Fletcher.

Es una limitación estructural del oficio.

It's a structural limitation of the profession.

Cuando estás en el campo bajo fuego, no tienes tiempo de pensar en las cadenas de suministro de fármacos.

When you're in the field under fire, you don't have time to think about pharmaceutical supply chains.

Pero alguien tiene que hacerlo, y ese alguien tendría que estar en los ministerios de salud globales mucho más presente de lo que está.

But someone has to, and that someone should be far more present in global health ministries than they currently are.

So where does that leave us?

Sixty-five conflicts, record fatalities, healthcare infrastructure being systematically destroyed.

What would an actual serious global health response to armed conflict even look like?

Yo creo que habría tres piezas fundamentales.

I think there would be three fundamental pieces.

Primera: hacer cumplir el derecho internacional humanitario de verdad, con consecuencias reales para quienes atacan hospitales.

First: actually enforcing international humanitarian law, with real consequences for those who attack hospitals.

Segunda: financiación específica para salud mental posconflicto, no como un extra, sino como parte esencial de cualquier acuerdo de paz.

Second: specific funding for post-conflict mental health, not as an add-on but as an essential part of any peace agreement.

Y tercera: sistemas de alerta temprana que identifiquen el colapso sanitario antes de que sea irreversible.

And third: early warning systems that identify health collapse before it becomes irreversible.

That first one, enforcement, is where the whole architecture falls apart.

Because the countries with the power to enforce it are often the ones supplying the weapons.

Sí, y ahí está el nudo gordiano.

Yes, and that's the Gordian knot.

No hay solución fácil.

There's no easy solution.

Pero lo que sí podemos hacer, lo que ya se está haciendo en algunos lugares, es documentar.

But what we can do, what is already being done in some places, is document.

Nombrar.

Name names.

Llevar a los responsables ante la Corte Penal Internacional aunque sea décadas después.

Bring those responsible before the International Criminal Court even if it takes decades.

Ruanda tardó años en tener justicia, pero la tuvo.

Rwanda took years to get justice, but it got it.

Eso importa.

That matters.

That's a longer game than most politicians are willing to play.

But you're right that it's probably the only game there is.

Oye, y hablando de documentar, me fijé en algo que dije antes y que quiero comentar contigo, porque es una expresión que me parece interesante para los oyentes.

Hey, speaking of documenting, I noticed something I said earlier that I want to go over with you, because it's an expression I find interesting for listeners.

Dije que los datos «arrojan» que las muertes indirectas multiplican a las directas.

I said the data 'arrojan' that indirect deaths multiply the direct ones.

No dije «muestran» ni «demuestran».

I didn't say 'show' or 'demonstrate'.

¿Lo notaste?

Did you catch that?

I did catch it, actually.

«Arrojar».

It's the verb for throwing, right?

As in tossing something.

So data «throws» results at you?

Exacto.

Exactly.

«Arrojar» literalmente significa tirar o lanzar, pero en español tiene este uso figurado muy extendido: «las cifras arrojan un resultado preocupante», «el análisis arroja luz sobre el problema».

'Arrojar' literally means to throw or hurl, but in Spanish it has this very widespread figurative use: 'the figures arrojan a worrying result', 'the analysis arrojan light on the problem'.

Arroja luz, de hecho, es otra expresión fija.

Arroja luz, in fact, is another fixed expression.

Significa aclarar algo, iluminar una cuestión oscura.

It means to clarify something, to illuminate a dark question.

So you have «arrojar datos», to yield data, and «arrojar luz», to shed light.

In English we'd say the data «shows» or «reveals» something.

We shed light too, actually.

Same image.

Sí, hay un puente entre los dos idiomas ahí.

Yes, there's a bridge between the two languages there.

Pero cuidado: «arrojar» tiene también una connotación de fuerza, casi de violencia, que «mostrar» no tiene.

But be careful: 'arrojar' also has a connotation of force, almost of violence, that 'mostrar' doesn't have.

Cuando dices que una investigación «arroja» datos, estás diciendo que esos datos salen con cierta contundencia.

When you say a study 'arroja' data, you're saying those figures emerge with a certain force.

No es una revelación suave.

It's not a soft revelation.

Es algo que te golpea.

It's something that hits you.

That's actually a really precise distinction.

«Arrojar» carries weight.

And frankly, given what we've been talking about today, the numbers from that Uppsala study don't just show anything.

They land like something thrown hard.

Bien dicho.

Well said.

Y con ese verbo bien colocado, lo dejamos aquí por hoy.

And with that verb properly placed, we'll leave it there for today.

Sesenta y cinco conflictos, los datos arrojan un panorama oscuro, y ahora por lo menos sabes cómo decirlo en español.

Sixty-five conflicts, the data throws a dark picture at us, and now at least you know how to say it in Spanish.