Conflict and Cholera: Yemen's Man-Made Public Health Crisis and the Global Implications of Weaponizing Health.

The cholera epidemic in Yemen, which began in October 2016 and reached its peak in 2017, was the largest disease outbreak in modern history. Suspected cases topped 1 million, and there were more than 2,000 confirmed deaths in the first 8 months of the outbreak. Although cholera is an ancient disease, and there were other countries around the globe experiencing outbreaks at the same time as the outbreak in Yemen, Yemen's outbreak had a number of unique features. The outbreak spread at an unprecedented pace and has been directly linked to the country's ongoing armed conflict. In this article we ask: What does the recent cholera outbreak in Yemen teach us about the relationship between conflict and infectious disease? Is the intentional targeting of infrastructure, as is occurring in Yemen, the new face of modern warfare? And what implications does a strategy of infrastructure destruction have for global health security? To answer these questions, we examined the history of the conflict in Yemen, the relationship between conflict and infectious disease, the intentional destruction of infrastructure throughout Yemen, and the resulting cholera outbreak. We discuss health as a weapon of war and seek to understand whether this indirect form of biological warfare is a new standard war tactic. Lastly, we address what the weaponization of health means for both global health security and US national security.