Abstract
Armed conflicts are typically measured in deaths, injuries and displacement. Yet war also produces a less visible form of morbidity through the disruption of chronic disease care.1,2 While humanitarian response understandably prioritises acute trauma and infectious threats, many of the most consequential medical effects of war emerge gradually, through interrupted treatment, fragmented follow-up and the collapse of continuity in care.
Modern medicine has made many chronic illnesses manageable only through sustained access to medications, monitoring infrastructure and specialist care. Patients with autoimmune diseases, epilepsy, cancer, diabetes and other chronic conditions often depend on uninterrupted therapy to maintain disease control.3,4 In many cases, even brief interruptions can lead to irreversible consequences, including disease relapse, treatment resistance, avoidable hospitalisation or accelerated disability.
These harms rarely register in real time. A patient who misses a disease-modifying therapy, anticonvulsant or chemotherapy infusion does not become a casualty that day. The consequences may emerge months later as accumulated neurologic disability, uncontrolled seizures, organ damage or progression of malignancy. In this sense, war produces a delayed form of morbidity that is diffuse, difficult to quantify and largely absent from humanitarian accounting.
The medical implications are becoming more significant as chronic disease management grows increasingly dependent on complex therapeutic systems. Modern biologic therapies, immunotherapies and precision treatments require regular administration, laboratory monitoring and coordination across pharmacies, infusion centres and specialists. Disruptions in transportation, communication infrastructure or supply chains can therefore become biologically consequential events rather than logistical inconveniences.
There may also be subtler long-term effects on disease biology itself. Interruptions in therapy do not merely worsen disease temporarily; they may alter its trajectory. In neurology and immunology, treatment gaps can precipitate rebound inflammatory activity, reshape immune responses or reduce the effectiveness of future interventions. 5 Similar concerns arise in oncology, where delayed treatment may narrow therapeutic windows or permit disease progression that later becomes less responsive to therapy. What appears to be a temporary interruption may instead represent a lasting change in prognosis.
The psychological effects of disrupted care are similarly underrecognised. For many patients with chronic illness, continuity of treatment represents stability, predictability and reassurance. The abrupt loss of access to physicians, medications or monitoring can itself become a source of profound distress, particularly for vulnerable older adults or patients with cognitive impairment. In this way, healthcare disruption becomes not only a medical consequence of war but also a psychological one.
Importantly, these effects are not confined to active combat zones. Patients displaced across borders often encounter fragmented medical records, incompatible healthcare systems, insurance barriers and difficulty obtaining specialised therapies. 6 Even when patients physically survive conflict, their diseases may continue to evolve under conditions of interrupted care and medical uncertainty.
For clinicians, these are not abstract concerns but increasingly familiar realities of modern chronic disease management. Humanitarian frameworks should therefore recognise continuity of care not as a secondary consideration, but as an essential component of medical protection during conflict. The burden of war cannot be measured solely by the lives lost immediately. It must also include the futures quietly rewritten through disrupted care.
