The war exposome: Environmental, chemical, and psychosocial determinants of health

Abstract Armed conflict profoundly reshapes human exposure environments by generating intense and heterogeneous combinations of chemical, physical, biological, and psychosocial stressors. These exposures do not occur in isolation but interact dynamically across the life course, potentially influencing biological systems, disease risk, and population health in complex and insufficiently understood ways. While growing evidence documents war-related environmental contamination and mental health impacts, their cumulative and integrative biological consequences remain inadequately conceptualized within existing environmental health frameworks. This perspective introduces the concept of the war exposome as a unifying framework to capture the totality of exposures generated or intensified by armed conflict. War-related exposures are characterized by high intensity, temporal compression, spatial heterogeneity, and frequent coincidence with sensitive developmental and biological windows. Environmental degradation, uncontrolled combustion, infrastructure damage, and disrupted water and sanitation systems generate complex mixtures of chemical and physical hazards, including heavy metals, disinfection by-products, persistent pollutants, and microplastics. These hazards interact with chronic psychosocial stress, trauma, displacement, and behavioral disruption, shaping biological vulnerability through shared pathways such as immune dysregulation, oxidative stress, endocrine perturbation, and epigenetic modification. We outline a war-adapted exposome research framework integrating environmental mapping, human biomonitoring, psychosocial assessment, and data integration using exposome-oriented analytical approaches, while addressing ethical, logistical, and data-governance challenges specific to conflict settings. Conceptualizing armed conflict through an exposome lens may advance interdisciplinary research, inform humanitarian health surveillance, and support evidence-based post-conflict recovery and reconstruction strategies.