This article investigates the effects that attacks during armed conflict which damage water and wastewater services have on the outbreak and transmission of infectious disease. It employs a lens of uncertainty to assess the level of knowledge about the reverberations along this consequential chain and to discuss the relevance to military planning and targeting processes, and to the laws of armed conflict. It draws on data in policy reports and research from a wide variety of contexts, and evidence from protracted armed conflicts in Iraq, Yemen and Gaza. The review finds a strong base of evidence of the impact of attacks on water and wastewater services, and a high level of confidence in information about the transmission of infectious disease. One clear risk identified is when people are exposed to water supplies which are contaminated by untreated wastewater. Obtaining a similar level of confidence about the cause and effect along the full consequential chain is challenged by numerous compounding variables, though there are a number of patterns related to the duration of the armed conflict within which the attacks occur. As the conflict protracts, both the risk of the spread of infectious disease and the evidence base for gauging the reverberating effects becomes stronger, for example. The article concludes that the reverberating effects of damage from an attack can be foreseen in some contexts and can be expected to become more foreseeable over time. The analysis suggests that the most pragmatic path for military institutions and those involved in targeting operations to take this knowledge into account is through a “precautionary approach” which assumes the existence of the reverberating effects, and works them in to the standard information-gathering and planning processes.

中文翻译：

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攻击对城市服务的影响 II：对水和废水系统的破坏对传染病的影响

本文调查了武装冲突期间破坏供水和污水处理服务的袭击对传染病爆发和传播的影响。它采用不确定性的视角来评估对这一后果链上的影响的知识水平，并讨论与军事规划和目标进程以及武装冲突法的相关性。它利用了来自各种背景的政策报告和研究中的数据，以及伊拉克、也门和加沙旷日持久的武装冲突的证据。审查发现了攻击对水和废水服务的影响的有力证据基础，以及对传染病传播信息的高度信心。一个明确的风险是当人们接触到被未经处理的废水污染的水源时。尽管存在许多与发生攻击的武装冲突持续时间相关的模式，但要在整个后果链上获得对因果关系的相似程度的信心受到许多复合变量的挑战。例如，随着冲突的持续，传染病传播的风险和衡量影响的证据基础都变得更强。文章得出的结论是，在某些情况下可以预见攻击造成的损害的回响效应，并且随着时间的推移预计会变得更加可预见。