Editorial

850 www.thelancet.com Vol 378 September 3, 2011

War and peace

The cover of this week’s theme issue reproduces the War 

and Peace panels of Brazilian artist, Cândido Portinari 

(1903–62). The home of these murals, when they are not 

on tour as they are currently, is the UN headquarters in 

New York City. They are a moving and appropriate symbol 

of the events that took place in that city 10 years ago, 

together with many of the global consequences that have 

happened since.

The best description of the meaning of War 

and Peace came from former Brazilian President 

Luiz Inàcio Lula da Silva: “The suff ering seen in the mural 

that portrays war reminds us of the United Nations’ 

tremendous responsibility to prevent the threat of armed 

confl ict. The second mural shows that peace is much 

more than the absence of war. It presupposes well-being, 

health, and a harmonious relationship with nature. It 

presupposes social justice, freedom, and overcoming the 

scourges of hunger and poverty. It is not by chance that 

the mural War is positioned to face those arriving, and the 

mural Peace those leaving. The artist’s message is simple, 

but powerful: to transform affl iction into hope, war into 

peace, is the essence of the United Nation’s mission.”

These words reveal the importance of the artist’s 

symbolism for contemporary notions of health and 

wellbeing. The past decade has not been easy for those 

who believe it best to address human predicaments 

through nations working together. Too often the UN has 

been undermined or marginalised by countries preferring 

to ignore the wisdom of fellow nations—the violence 

perpetrated by the Syrian Government against its civilian 

population (a country led, in cruel irony, by a medical 

doctor) is a brutal recent example. 

One lesson of 9/11 is the importance of the UN system—

its values and procedures—for bringing countries together 

to solve global crises. WHO is part of that system, and it 

too is suff ering chronic degradation by nations indiff erent 

to its future. On this anniversary of 9/11, nations 

might think about how to strengthen an indispensable 

organisation that owes its existence to war and its future 

to peace—perhaps Portinari’s fi nal poignant message. 

■ The Lancet

Reuters UN Photo/Lois Conner

As Americans on the East Coast survey the damage caused 

by Hurricane Irene and mourn those who lost their lives in 

the storm, one small, but signifi cant, piece of good news 

has emerged. The National September 11 Memorial, with 

its two huge refl ecting pools and waterfalls where the 

twin towers stood, remains intact with, remarkably, no 

damage done to the 400 swamp white oak trees planted 

in the Memorial plaza. Due to open to the public next 

week, the bronze panels that surround the twin pools 

have the names inscribed of all the 3000 people who 

died on 9/11 and those of the six killed in the World Trade 

Center bombing in February, 1993.

This issue of The Lancet allows refl ections on the events 

of 9/11, and particularly explores some of the research, 

review, and opinion pieces on the short-term and longterm physical, mental, and public health consequences of 

the terrorist attacks. The research papers report not only US 

domestic health eff ects but also some of the international 

consequences. Respiratory illnesses and post-traumatic 

stress disorder are known to be increased in those who 

survived the World Trade Center disaster, but data reported 

in this issue show that 9 years after the attacks, rescue and 

recovery workers continue to have substantial physical 

and mental health problems. No excess overall mortality 

is shown, although high levels of exposure to injury or 

to the dust cloud are linked to increased risk of all-cause 

and heart-disease-related mortality. An excess of cancer 

cases is reported in fi refi ghters who survived the disaster, 

which could have implications for policy on eligibility 

for compensation. New data on battlefi eld ethics and 

casualties in civilians and coalition soldiers in Iraq are 

presented, while Arab-Muslim refugee health in the USA 

and public health preparedness are reviewed.

Personal accounts from doctors working in the health 

systems of Baghdad and New York City provide insights 

into what it is like to work in Iraq now, and what it 

was like in New York on 9/11. Practising medicine in 

extreme, dangerous conditions is beyond the experience 

of most doctors. But there is a message for all: fi nd time 

somehow amid the chaos to think about how you and 

those health-care workers around you feel. Medicine is 

about so much more than “just work”. ■ The Lancet

9/11—new data, reviews, and refl ections

See Comment pages 851, 852, 

854, 855, and 857

See Special Report page 863

See Perspectives pages 867, 

868, 869, 870, and 872

See Articles pages 879, 888, 

898, 906, and 915

See Review pages 925, 935, 

and 944

See Viewpoint

pages 953 and 957