BACKGROUND: Ever since World War I, when the U.S. government defined the tobacco industry as “essential” and included tobacco in soldiers’ rations, the industry has taken advantage of the stress, disruption and instability caused by conflict in order to maintain and even increase its profits. The tobacco industry is currently operating in zones of active or recent conflict including Sudan, Israel-Palestine, and Russia-Ukraine. In 2018, the Convention Secretariat produced a report on WHO FCTC implementation in complex emergency situations. A COP decision later that year called upon Parties in these situations to continue to fulfil their WHO FCTC obligations as much as possible. This research builds on the report, asking to what extent tobacco control is viable during conflict. The aim is to show how tobacco control researchers may support governments to counter industry interference even in contexts of limited policymaking and enforcement capacity.
METHODS: A review of grey literature and internal tobacco industry documents, alongside online media monitoring of industry activity in conflict zones.
RESULTS: Tobacco control infrastructure may be destroyed in conflict zones; specialists may be killed or displaced. Pharmaceutical supply chains, including for products used to treat tobacco dependence, are often disrupted. War has a detrimental effect on mental health, which may lead to higher tobacco use prevalence. The tobacco industry continues to access policymakers, whilst adapting its supply chains to ensure flow of its products. There is also evidence that the tobacco industry has been complicit in the illicit trade in conflict zones.
CONCLUSIONS: The global tobacco epidemic remains a major public health threat even in times of war. Local public health communities and policymakers must be supported by their global counterparts, in order to resist tobacco industry interference, fulfil their WHO FCTC obligations, and make tobacco control a cornerstone of post-conflict reconstruction.