Biopolitics: Power, Pandemics, and War

Abstract

COVID-19 and the subsequent global response have had a profound impact on the public health, economic health, and political health in nearly every country. This article examines the biopolitics of power and pandemics in war. Three case studies are presented: the Spanish influenza outbreak of 1918–1920 and responses to the COVID-19 outbreak in both Syria and in eastern Ukraine. The pandemic’s impact has been particularly acute in active warzones, undermining the ability of governments and organizations to enforce public health recommendations, provide for the care of patients, secure supplies, and transmit information.

War and disease are intimate bedfellows—and have been for as long as humans have engaged in conflict. Decades after the arrival of antibiotics, vaccines, and other forms of modern medicine, the relationship between armed conflict and disease remains as strong as ever. This relationship is defined by complex socio-political-technical factors derived from biopolitics uniquely shaped by conflict. This article focuses on the biopolitics present in times of conflict—specifically, the exercise of power, by state and sub-state actors, over the health of subjects within, and at times beyond, their jurisdictional boundaries.

Decisions and power governing life and death are more than a simple biological process. They combine to form biopower—the outcome of biopolitics, which combines political, social, technical, scientific, and economic decisions. When these decisions are constrained or enabled by the presence of conflict, the impact is felt most by those with the least say in its application. The constraints of conflict are multifaceted and enable the deleterious asymmetry of power over the health of the subjects.

This analysis focuses on how three countries—the United States, Syria, and Ukraine—have been impacted by pandemic disease during periods of conflict. The US case constitutes a historical control to compare and contrast with two SARS-CoV-2 cases involving Syria and Ukraine. The work seeks to provide further insights into how war influences the biopolitics of public health in active warzones. It contends that while there are differences of location, belligerents, and context of each conflict, there are key attributes present irrespective of the time and location.

Biopolitics and Public Health in Conflict Zones During a Pandemic

The term biopolitics is complex and connotates multiple meanings in different literatures. Notably, the term has two historical branches, among which multiple and often contradictory definitions are used. 1 This article adopts the term in a manner elucidated in Philosopher Michel Foucault’s 1978–79 lectures on the topic. 2 Biopolitics, defined as the politics associated with the life of subjects, is used to constrain the analytical scope of analysis. 3 Biopolitics here influences the associated concept of biopower, which Foucault defines as the form of governmentality that establishes control over the knowledge-power-subjectivity complex. 4 The focus below emphasizes actors both directly in conflict zones and those external to them that influence the public health of persons geographically located in countries involved in conflict. Central to this analysis is the impact of governmental or quasi-governmental entities’ influence in the public health of those over whom they exert either de jure or defacto sovereign power. The result is a hierarchy in which biopower—the exercise of power over the life and death of the person—is the result of biopolitics occurring within governmental or quasi-governmental levels at varying degrees of distance from the subject. Figure 1 , below, illustrates the structure of our argument.

Fig. 1.

Biopower Relationship of Institutions to Subject

Although Figure 1 indicates that the subject has no agency, this is not entirely the case. The subject in many public health settings does have agency. However, conditions of conflict place limits on the subject’s agency. Yet, as will be demonstrated, the agency of the subject—relative to the biopower of the actors arrayed around them—during times of conflict makes assessing this agency of limited consequence to public health outcomes.

The unique biopolitics present at each level creates biopower that—particularly in times of conflict—can be deleterious to the public health of subjects. 5 Governmentality refers to the conduct of a government to secure the “welfare of the population, the improvement of its condition, the increase of its wealth, longevity, health, et cetera.” 6 The exercise of biopower from one level to the next may have cascading impacts through successive levels of governmentality. Likewise, biopower imposed from one level to the next level of governmentality can result in conflict between levels, leading to divergent applications of biopower across, and within, governments.

Each conflict setting is unique in its root causes, its geography, and its climate, as well as many other factors that impact the public health of the subject. However, there are structural similarities in the conditions of conflict across time, space, and circumstances that arguably lead to increasing biopower that negatively impacts public health.

Basic testing, immunization programs, and access to pharmaceuticals are required for the base levels of healthcare to be effective. Human capital resources are also important in the context of public health and include medical and healthcare professionals. They play a critical role in the treatment and prevention of disease. Resources are essential for health interventions, and their lack can impede implementing public health programs.

Effective communication between the public, healthcare providers, decision makers and non-governmental organizations are critical for ensuring the accurate and timely dissemination of facts necessary to educate populations and coordinate and mobilize resources. Information flows can be fostered through partnerships where public and private organizations are allowed to work together. These partnerships often include rigorous collection and reporting of data necessary to address health emergencies. 7 Effective communication can alter behavioral, legal and policy, public health program, and individual decision-making. 8 When information is corrupted, as in the case of Ukraine, mistrust of public health interventions can negatively impact the health of subjects, 9 as well as of the care providers. 10 It can also result in wasted resources. 11 Information-system breakdowns can hinder critical partnerships between and among organizations, governments, medical providers, and the subject. 12

Diseases such as typhus, smallpox, measles, yellow fever, tuberculosis, and others have a recurrent and pernicious history of invading human populations when they are most vulnerable. The analysis below focuses on the relationship of biopolitics and disease on two respiratory viruses: influenza (H1N1) and SARS-CoV-2. These two viruses share some similarities (both are respiratory RNA viruses), but they also differ. Influenza is more complex in its structure and function than SARS-CoV-2, 13 yet both primarily attack the respiratory system. Influenza comes in 198 potential subtype combinations.

Below are three brief cases, each highlighting the way in which resources, mobility, and information impact the quality and success of public health interventions. Each case could rightly be expanded, yet the intent here is to draw attention to the unique circumstances of conflict and the resulting biopolitics that constrain the three factors under examination.

US Experience with the Spanish Flu: Brief Conflict History

More than 65 million people fought in World War I; 8.5 million soldiers and 13 million civilians are thought to have died, and 21 million soldiers were injured in the war. 14 The scale of the war makes it difficult to broadly examine challenges to resources, mobility, and information across all combatants. Therefore, this case focuses on the constraints of these variables within the United States. The United States was chosen for several reasons. First, the United States was a late entrant into the conflict. Second, fighting did not occur on any territory belonging to the United States. Yet, US participation in WWI had a significant impact on each of the meta-variables. In particular, the war altered the biopolitics of different levels of government in such a way that it exacerbated the 1918–1920 pandemic and led to an estimated 50–100 million global fatalities.

On April 2, 1917, President Woodrow Wilson sent a letter to Congress outlining a request for a declaration of war against the central powers. Two days later, he received authorization from the United States Senate and the House of Representatives. Once approved, the United States’ process of mobilization was total and encompassing. On April 6, 1917, the day the final declaration of war was approved, the US Army was a constabulary force of 127,151 soldiers and the National Guard had 181,620 soldiers. Congress authorized $3 billion ($61.6 billion in 2021 equivalent) to mobilize the nation and build a million-man army.

Mobilization for war was not isolated to the mobilizing, arming, and equipping of a military force. The US entry into the war also included the passage of several laws, ostensibly to safeguard the nation. Among those laws were the Espionage Act of 1917, the Sedition Act of 1918 (enacted May 16, 1918), the War Revenue Act of 1917, the Revenue Act of 1918, the 1^st-5^th Liberty loan acts, the Selective Services Act of 1917, and the Food and Fuel Control Act. In addition to legal statutes passed to radically alter the powers and status of the federal government, several policies were implemented at the national and local level to control and manage the everyday lives of citizens. None of these was more damaging than the creation of the American Protective League in March 1917.

Epidemiologists identified Haskell, Kansas, as the most likely point source of the Spanish Influenza outbreak of 1918–1920. 15 It begs the question of how a virus outbreak in a relatively remote corner of Kansas could spread around the world and bring death to so many millions. The answer is that US wartime biopolitics enabled the spread of disease because of an increase in the biopower exerted on American life and made the pandemic far worse than it likely needed to be.

In 1917, the United States remained a predominantly rural society, outside of the Northeast. The mobility of individuals between population centers was possible, but not frequent. Mobilization during WWI, and the passage of the selective service act, forced thousands of men into large cantonments. In these cantonments, young men were trained and turned into soldiers. The second-largest cantonment in the United States was Fort Riley Kansas, where Camp Funston was located. Camp Funsten housed the 89^th Infantry and took in draftees from Kansas, Missouri, Nebraska, and other surrounding states. The camp was a collection and training point for between 43,000 and 56,000 soldiers. 16 Camp Funston is 272 miles from Haskall, and following an outbreak of illness in Haskall, several of the men from the town reported for duty at Funston. From Funston, soldiers transited to other military cantonments and later to naval vessels headed to Europe, carrying the disease with them.

Early on, medical professionals, including the chief medical officer of the US Army, William C. Gorgas, recognized the disease’s danger and begged the Army to isolate infected cantonments and to limit or eliminate the transfer of soldiers into and from infected installations. But the Wilson administration, urged by the Commander of the US Army, General Peyton March, refused, and prioritized the rapid mobilization of soldiers for military duty. 17 The military’s mobilization for war increased the mobility of the virus as a direct result of the biopolitics of the state. It thus privileged wartime mobilization over the health and safety of both the soldiers and the communities they moved between. Between 20 and 40 percent of all personnel were sickened with influenza, 18 and the rapid construction and close quarters at the cantonments served as a natural experiment for the spread of the virus. 19

The reality of waging a global war during an emergent pandemic altered the biopolitics of the state. It also privileged the mobilization and deployment of military forces to Europe over the health needs of the nation and the soldiers themselves. The result was that everyone—soldiers, civilians, and sailors involved in the mobilization—became subject to the biopolitics of the state’s desire to build a military force. Keeping the manpower of war ever moving toward the battlefield exerted enormous biopower, and the laws of the state enacted to facilitate mobilization for the war reenforced this power through the draft. The biopolitics of the state legitimizing the movement of men to war fostered an environment of unhealth and created a potent vector for the spread of pandemic disease.

Despite the importance of mobility on enabling the spread of the disease, the biopolitics of wartime mobilization also undermined the resources necessary to control and combat the disease both at home and abroad. The Lever (Food and Fuel Control) Act, signed into law on August 17, 1917, constituted a large expansion of executive power in the United States into the domestic economy. WWI was believed to necessitate a societal effort, and the Lever Act established government regulatory bodies, including the US Food Administration and the US Fuel Administration, that allowed the federal government to control the production, sale, storage, and cost of nearly every product or service in the United States. The law gave President Wilson explicit power to requisition anything he considered necessary at a price he deemed appropriate. The Act itself represented the culmination of resource biopolitics and exerted biopower over every aspect of American life. The Act didn’t facilitate the spread of disease like the mobility of soldiers, but it did constrain resources. In fact, the Act’s implementation led to fuel shortages and undermined the ability of many to keep homes and businesses adequately warm. Punishments and collective sociological incentives to shape the dietary habits of Americans in the service of the national war effort were common. The Lever Control Act was not alone in influencing US consumption and production at this time. Seven additional acts—including the revenue acts of 1917 and 1918 and the five liberty bond acts—all reduced the financial resources available to Americans when the pandemic hit. Each of these laws transformed the nation through the biopolitics of war. The singular focus on the wartime efforts relegated most domestic concerns, including the eventual management of influenza, to a secondary position.

To mobilize for war, the government also rated every US medical doctor to determine their fitness for duty. The government found that at the time (a period of transformation in American medical education) 20 many doctors were simply not qualified for service. 21 Of those fit for service, the Army and Navy recruited more than thirty-eight thousand physicians. This recruitment constituted most trained medical professionals in the United States, and their absence resulted in physician shortages nationwide. 22 A similar story played out for nurses. By 1918, the United States experienced widespread shortages of domestic human capital of medical professionals. Again, the biopolitics of wartime privileged the needs to the armed forces and the waging of conflict over public health.

Resource allocations from goods and services to human capital in the biopolitics of war placed domestic populations in an increasingly precarious position. Entire cities and towns suffered devastating losses from influenza. The biopower of the state resulted in the systematic weakening of domestic medical care. Yet it was the state’s exertion of power of the information sphere that likely resulted in the most damage.

To secure the US war effort, the Wilson administration and Congress passed both the Espionage Act of 1917 and the Sedition Act of 1918. Both acts sought to control and limit the freedom of information. However, it was the Sedition Act’s chilling effect on the public discourse and the freedom of the press that was most damaging when influenza broke out. Despite clear indications of a serious, widespread, and deadly pandemic, official government propaganda downplayed the severity of the crisis and countered the advice of public health experts. 23 Large group gatherings with parades and fanfare were held to encourage Americans to buy liberty bonds to support the war. When the press reported on the pandemic, they were quickly chastised, and similar information was not published. As millions of people were sickened and thousands were dying, the press remained largely silent. The result was that the Spanish Influenza is not called the American Influenza, because during the growing crisis only neutral Spain published reports of the pandemic. 24

To further control the population, the US Department of Justice established the American Protective League (APL) in March 1917. By war’s end, the APL comprised more than 250,000 members in more than 600 cities. 25 It constituted a Stasi-like organization that fostered domestic spying and reporting on any person or organization that countered the official government narrative. Those that the APL identified could be sentenced to up to twenty years in prison under the Sedition Act of 1918. The combination of legislative initiatives and the creation of a domestic volunteer intelligence service heavily influenced the biopolitics of wartime America. By constraining the information space, the state disempowered the subject. The biopower of the state, resulting from the biopolitics of wartime mobilization meant to empower the state for national defense in a foreign war, concurrently weakened its domestic capacity to control disease.

Syria: Brief Conflict History

The Syrian conflict began between July 2011 and April 2012, following a period of protests and civil uprising that demanded increased democratic freedoms and the release of political prisoners. The Syrian protest movement followed similar events in Tunisia and Egypt. It grew following the arrest of several school children for writing anti-regime graffiti on the walls of their school in Dara. 26 The protests intensified after the release of the children, when it was discovered that one of them had been killed in captivity and the others had been severely tortured. 27 What initially began as protests quickly escalated to violence between protestors and regime forces.

Although the events in Dara were the catalyst that eventually led to the war in Syria, the conflict’s origins are complex, rooted in the social, political, economic, ethnic, and religious context of Syria itself. 28 To separate the diverse attributes leading to the present conflict limits an understanding of the state’s fragmentation and the subsequent rise of quasi-governmental bodies throughout Syria. The July 2011 defection of Syrian military members and the subsequent formation of the Free Syrian Army demarcates the transition from civil uprising to civil war.

The conflict in Syria, even prior to the outbreak of COVID-19, was extremely damaging to human rights and public health. It resulted in 5.6 million refugees, 6 million internally displaced persons, and more than 400,000 people killed. 29 Beyond the conventional horrors of war, civilian populations in Syria have been subjected to irregular weapons, such as barrel bombs and weapons of mass destructions (chemical weapons). 30 Although there were large outflows of civilian refugees to neighboring countries for a time, the COVID-19 pandemic brought these flows largely to a halt or imposed severe mobility restrictions on transborder refugees seeking shelter in third-party nations. 31

Multiple governmental or quasi-governmental bodies each exert bio-power over their subject populations in Syria. The largest territory is controlled by the Assad regime, with assistance from the Russian Federation and Iran. This area constitutes most of the southern and western territory of Syria, as defined by its pre-2011 borders. The People’s Protection Units (YPG), Kurdish Workers’ Party (PKK), Peshmerga, and other affiliated fighters control the second-largest territory, comprised of large swaths of land in the northeast of Syria. Israel controls a sizeable block of territory along its northwestern border with Syria, known as the Golan Heights. Ahrar al Sham, Jaish al Islam, and several other smaller groups control part of the southeastern deserts of Syria along the Jordanian border. The Islamic State controls a few isolated pockets of territory in the middle of Syrian government–controlled areas. And the Free Syrian Army (FSA) and Turkish groups control a portion of Syrian territory along Syria’s northern border with Turkey.

The resulting fragmentation has severely constrained population mobility over the ten years of conflict. Shifting political borders—combined with new exertions of power over diverse populations—continues to place millions of Syrians at risk of extreme poverty. Whether unable to travel between or within cities or across borders, Syrians’ physical freedom of movement has been hindered. Displacement has compounded mobility challenges for refugee populations during the COVID-19 pandemic, as transborder trade, aid, and migration have been disrupted. 32 These disruptions are often at the behest of domestic or international actors seeking to control various geographical areas or to undermine the groups operating within them. Populations of internally displaced persons (IDPs) and foreign refugees have been displaced forcibly from homes and forced to shelter in ever-crowded housing conditions. These displaced populations often include multigenerational families that are uniquely prone to the spread of COVID-19. 33 While the mobility of populations seeking healthcare has been disrupted, it is unlikely that the mobility limitations have substantially impacted internal displacement. Instead, a larger number of at-risk individuals have been placed in even closer proximity in refugee camps and in home environments. 34

There are two subject-oriented mobility issues that operate in concert with one another. First, mobility to secure medical care is restricted and second, mobility fostering the spread of pandemic disease is necessitated. Conflict borders (frequently changing in geographic location and permissive scope) impose restrictions on mobility that impact the influx of resources into and out of the country. Additional mobility restrictions arise from the sanctioning of the Syrian regime by multiple countries and the control of borders by Syrian regime allies. 35

The mobility restrictions that have arisen since the pandemic’s beginning are compounded by severe war-induced healthcare challenges. Much of Syria, outside of Damascus, has been devastated by civil war. 36 Data indicate that only approximately 52 percent of Syrian hospitals were fully functioning in March 2020. 37 Often hospitals were subject to military attack, a means of exerting biopower over a place of care and safety. 38 Moreover, the UN Human Rights Council reports that approximately 70 percent of all physicians fled Syria since the start of the war. 39 Since the war’s beginning, more than 350 healthcare facilities were attacked and 923 medical personnel were killed. 40 These facts alone placed Syria at a severe resource disadvantage when dealing with COVID-19. Adding to these factors was the lack of consistent governance over many areas in the country or inconsistent governance regimes. This situation curbed the ability to provide the basic resources necessary to prepare for an emergent public health crisis.

Initial availability of basic public health measures, such as testing capabilities in non-government-controlled areas, was extremely limited. Often tests needed to be sent out of the country. 41 Resources were constrained further through biopolitics: the Russian Federation, China, South Africa, and Viet Nam vetoed an extension of Security Council Resolution 2165 from 2014, which extended relief corridors for cross-border humanitarian aid into non-government-controlled areas of Syria. 42 With the outflow of medical professionals, the destruction of medical facilities, the lack of testing, and the prevention of transborder aid flows, millions of Syrians faced extremely constrained public health resources. These stresses, combined with poverty rates in the 80 percent range in much of the non-government-controlled areas, had many organizations fearing a humanitarian catastrophe. 43

Further constraining human capital resources in Syria is a reversion toward traditional patriarchal social structures. The dissolution of the prior social order and the ongoing conflict have resulted in women being increasingly relegated to the role of traditional housewives. 44 The challenges faced by women have reduced their numbers in healthcare environments and placed them at a severe power disadvantage relative to men. Even where there are notable exceptions, such as Pediatrician Amani Ballour, 45 the administration and management of hospitals has been severely impacted due to human and resource capital depletion and flight.

Although biopower has substantially altered mobility and hindered resources available to combat COVID-19, studies have found a broad understanding nationally of the disease itself. 46 Data indicate a “good level of awareness” of COVID-19 and “adequate level of knowledge” about the Sars-CoV-2 virus. 47 However, a broad knowledge of the disease does not mitigate its potential ramifications or sufficiently inform subjects on how to protect themselves. Many non-governmental actors have undertaken efforts to provide knowledge to the Syrian population through a variety of digital and non-digital means, including WhatsApp, Facebook, Snapchat, and other platforms. 48 Yet recent evidence suggests a restriction in COVID-19 data emanating from the Assad government in Damascus—including restrictions on the publication of actual COVID-19 infection and mortality rates, 49 as well as general information pertaining to the virus. 50

In contrast to the US experience in 1918–19, the Syrian experience with COVID-19 is influenced by the complexities of the conflict. The result is biopolitics in which inconsistent and often contrasting applications of biopower hinder public health response efforts across multiple vectors. While adapting to the biopower of a consistent constraint might be possible, the Syrian case is particularly complicated, as the conflict’s dynamics result in continuously shifting mobility, resource, and information constraints.

Ukraine: Brief Conflict History

Between April 2014 and February 2022, Ukraine was involved in a quasi-civil/quasi-international war with Russian-backed separatists and Russian regular soldiers in large portions of eastern Ukraine known as the Donbas. This case analysis covers the biopolitics of COVID-19 prior to when hostilities expanded on February 24, 2022. The geographic scale of the conflict covered a contact line of more than 500 kilometers. 51 More than ten thousand civilians and soldiers have been killed in the conflict, thousands have been injured, and more than two million persons have been displaced. 52 Among the persons who have been displaced, more than 1.5 million are now considered internally displaced persons (IDPs) who reside in different parts of Ukraine. The other half-million persons have mostly relocated to different locations in the Russian Federation. 53

The conflict in eastern Ukraine followed the overthrow of the Yanukovych government in Kyiv and the seizure by military force, and subsequent annexation, of the Crimean peninsula by the Russian Federation in February 2014. In late March and early April, Russian-backed protestors began taking over government administrative buildings in Ukraine’s eastern oblasts. These protests quickly devolved into separatist movements and resulted in police and security forces clashing with increasingly well-armed protestors. While attempts at securing territory and support in multiple oblasts failed, the protestors, with substantial support from Russian intelligence and Spetsnaz forces, succeeded in solidifying control in the Luhansk and Donetsk oblasts. When the conflict in Ukraine broke out in mid-2014, two different groups formed separate quasi-independent states: the Luhansk People’s Republic (LPR) and the Donetsk People’s Republic (DPR). The two republics formed a military force comprised of approximately 40,000 mixed forces of individuals from eastern Ukraine and across the Russian Federation. These forces were joined by approximately 4,000 Russian officers and, by early 2015, increasingly large volumes of military equipment, including tanks, artillery, and multiple-launch rocket systems.

Although the initial conflict period saw substantial shifts in the line of contact between Ukrainian and separatist forces and resulted in the destruction of massive amounts of infrastructure, by early 2015 the border between the warring sides solidified and trenches were constructed. Throughout 2020 and into 2021, regular border skirmishes occurred on a near daily basis, with the Organization for Security and Cooperation in Europe (OSCE) reporting between 50 and 100 daily ceasefire violations at various points along the contact line. The situation in eastern Ukraine is currently experiencing an uptick in incidents. Reports indicate that the number of cross-border violations of the Minsk II protocols are increasing, and the Russian Federation has prepositioned upwards of 35,000 soldiers on the Ukrainian-Russian frontier. 54 The conflict is defined by substantial disinformation and cyber operations that seek to undermine the integrity of the governments on both sides of the contact line with propaganda and mis- and-disinformation. 55 Official channels of information dissemination have also been targeted by both sides through artillery barrages aimed at infrastructure.

Approximately 1.5 million persons still reside within the LPR 56 and 2.3 million persons still live in the DPR. 57 Many of those who reside in the DPR and LPR maintain Ukrainian bank accounts, are pensioners, or have family and friends in Ukraine. Prior to the outbreak of COVID-19, there were an estimated 2.3 million monthly border crossings from the Donbas into Ukraine for basic services, including healthcare, shopping, and banking. 58 That number dropped to less than 50,000 by February 2021 and returned to 97,000 crossings as of July 2021—a 92.5 percent decline from 2019. 59 In early-April 2020, the Ukrainian government decided to implement COVID-19 travel restrictions on DPR and LPR citizens and effectively closed all border checkpoints. Individuals crossing the LPR or DNR border with Ukraine must use the VDOMA (in home) application or seek to route transit through the Russian Federation. 60 Individuals are also required to take expensive COVID-19 tests and quarantine for ten days upon entry into the country. Both the use of digital tools and the mandate for COVID-19 tests are substantial applications of biopower against populations of the occupied territories. Reporting indicates individuals traveling across the border have resorted to bribing border guards to avoid public health measures, thereby partially countering the biopower of the state. 61 The journey, which once took only a few hours, has increased substantially. On occasion, some of those who wished to cross the border were detained between LPR/DPR and Ukrainian checkpoints for various reasons, including invalid paperwork, a lack of access to mobile phones to use the VDOMA application, or other reasons. Similarly, the transit of goods and services across the Ukrainian contact line with both the DPR and LPR has slowed to a trickle since a 2017 ban on trade between Ukraine and its breakaway regions. 62

Neither DPR nor LPR are officially recognized as independent states and therefore are barred from direct commercial transactions with Russian firms. To circumvent these restrictions, both territories have engaged in trade with other breakaway territories, such as South Ossetia and Abkhazia. Yet, despite a lack of trade westward to Ukraine, both states are estimated to be recipients of more than $5 billion in annual aid from the Russian Federation. 63 Both republics have also substantially increased their transborder coal trade with the Russian Federation from 1.1 million tons in 2015 to an estimated 4.2 million tons in 2017. 64 These trade practices are more permissive than those in many parts of Syria. Yet they severely constrain the economic situation in the breakaway republics and illustrate a form of biopower to constrain resources that impact public health. The transit of goods across borders is difficult and rife with criminality. In Ukraine, as in Syria, there are mobility restrictions on both persons and goods.

Like the situation in Syria, the medical infrastructure of the breakaway territories of Ukraine was severely depleted following civil conflict. Human capital resources, physicians, and nurses are in short supply, with some estimates indicating that upward of 40 percent of all physician positions remained vacant prior to 2019. 65 Recent evidence suggests increasing incidence and prevalence of HIV and tuberculosis. While a lack of medical resources is most acute within the occupied territories, Medicos del Mundo indicates that the problem persists on the contact line. 66 Reports from inside the occupied territories paint a picture of limited resources—both human and medical—with struggles to keep oxygen tanks from freezing, beds filled, and a lack of diagnostic equipment, including COVID-19 tests. 67 In January 2021, the Russian Federation announced it was defying a Ukrainian ban on its Sputnik V COVID-19 vaccine and began distributing limited doses. Although the Sputnik vaccine was met with initial skepticism, its efficacy has been borne out, and supplies of the vaccine have been distributed in more than seventy countries—including Syria and the breakaway republics of Ukraine. 68

Health information in Ukraine has remained contentious since the outbreak of conflict in 2014. While the actual numbers of COVID-19 cases in both Ukraine and its breakaway republics have been subject to much scrutiny, the data out of the DPR and LPR were inaccurate—particularly in the early days of the pandemic. 69 Early on, the DPR and LPR sought to downplay the pandemic’s extent in their jurisdictions while drawing attention to the COVID-19 spread in other areas of Ukraine. 70 As the number of cases continued to rise, the ability to hide the situation from the public in the territories diminished. The DPR Ministry of Health now issues daily COVID counts. The DPR’s COVID-19 count as of September 14, 2021, indicated 616 new daily cases of disease and current COVID-19 hospital occupancy of 2,761 patients, of which 939 were on oxygen support. The biopolitics of competing jurisdictions between Ukrainian and separatist-held territories partially shifted the narrative away from total obfuscation to the presentation of data as a means of demonstrating governmental effectiveness.

The conflict dynamics of Ukraine isolated the populations of the DPR and LPR, restricted the movement both into and out of the conflict zone, reduced the resources available within the territories, and set the stage for disputes over information for surveillance and public health programming. Surveillance data at present on both the DPR and LPR is difficult to discern and inconsistent with the reporting standards of both Ukraine and Russia. The biopolitics of the war and the pandemic collided in Ukraine and Syria, fostering conditions that exacerbate the spread and control of disease.

Taking Stock

The case studies analyzed here demonstrate how biopolitics can help explain the complexity between politics and human life during times of conflict. Biopower normalizes the intrusion of the state into subjects’ lives. Under conflict conditions, the normalization of biopower privileges the needs of combatants at the expense of noncombatants. This reality makes the population the target of state power under the rationale of improving security, narrowly defined, at the expense of security defined as health and welfare of the populace. The result is a degradation of both the former and the latter, particularly under pandemic conditions. Figure 2 below illustrates our model of the relationship between public health and resources, information, mobility, and political commitment.

Fig. 2.

The Impact of the Meta-Variables of Biopower on Public Health

When faced with a pandemic, nations are concerned about their residents’ health and safety, economic stability, the integrity of borders, and other related issues. Conflict zones tend to be deprived of resources such as the technologies, supplies, and human capital necessary to effectively contain a pandemic. In all three of our case studies, a shortage of medical supplies, physicians, and nurses undermined public health efforts. These shortages were a direct result of political decisions enacted in laws, violence against healthcare institutions, limits on mobility, and more. Moreover, each of the conflicts detailed here had a constrained information environment. Constraints, ostensibly serving the strategic and tactical purposes of the conflicting parties, are damaging to the populations under their care. Undermining or restricting information exacerbates the spread of disease, prevents the undertaking of basic precautions, and slows public health responses. While restricted mobility can constrain the spread of a pathogen, it can often force populations into non-traditional mobility dynamics that make the spread of disease more likely. Moreover, while constraining the mobility of civilian populations, the movement of soldiers and materials for war can further increase the spread of a given pathogen, as illustrated in all three cases. Mobility is a double-edged sword, as it is necessary for seeking and providing medical care, yet it also moves potential carriers of a pathogen between population groups, thereby further increasing spread.

The biopolitics of pandemics that occur during a conflict can be simplified to decisions pertaining to mobility, resources, and information. Where decisions put the needs of citizens first, public health campaigns are more likely to succeed. Where conflict intervenes and alters the biopolitics of the state, or substate entities party to a conflict, public health outcomes are imperiled. The outcome of biopolitics in conflicts is the application of biopower resulting in negative outcomes that exacerbate and undermine nearly every attribute of a public health. Without a consistent political commitment centered on the health and safety of a population, the result is fragmentation and disorder across all three variables.

Whether the country is a rising power (the United States in 1918), a middle-income country in the grips of a civil war (Syria), or a developing country fighting a hybrid civil-international conflict (Ukraine), the impact of biopolitics on the control of a pandemic must include an analysis of how conflict alters decisions pertaining to mobility, resources, and information. While the unique conditions in different wars alter the prescriptive responses for each variable, the consideration of each is critical for controlling the impact of biopolitics in such a way as to minimize the harm of a pandemic—even under conditions of conflict.

Aaron Brantly is an associate professor of political science and the director of the Tech4Humanity lab at Virginia Tech. He has worked on issues related to cybersecurity from multiple angles, including human rights and development, intelligence and national security, and military cybersecurity. 

Nataliya Brantly, MPH is a PhD Candidate in the Science Technology and Society Department at Virginia Tech.