multimorbidity is the co - occurrence of multiple chronic medical conditions in one person , and is a major issue in modern medicine . it correlates with age , and , according to one interesting hypothesis , there is probably a common pathomechanism responsible for multimorbidity , namely low - grade systemic inflammation . cellular and cytokine mechanisms triggered by this inflammatory pattern seem to resemble the mechanisms that lead to wasting diseases.1 cachexia , expressed as body weight loss , apathy , and depression among prisoners , could be a significant mechanism of multimorbidity in camps where different life - threatening conditions were very common . the british set up concentration camps in modern - day south africa during the boer wars , after they defeated the african troops and had taken most of the territory of the transvaal republic and orange free state . the british empire decided to exterminate the boer people and started setting up concentration camps which lead to 27,927 boers being killed.2 the germans used a similar policy against the people who lived in their colonies and set up concentration camps in the german east africa ( tanganyika ) and south  west africa ( today the republic of namibia).3,4 poor con ditions caused permanent health deterioration , and extreme physical effort and starvation led to weight loss , cachexia , apathy , and depression . multiple negative factors underlying various dysfunctions plus malnutrition could cause one prisoner to suffer from multiple diseases at a time . the aim of this study was to show the extent to which the health of former prisoners was affected by incarceration in extermination camps after 5 and 30 years of leaving a camp compared with a population who had never been incarcerated , and to determine the etiological factors underlying particular dysfunctions . the study group was evaluated on the basis of questionnaires administered to 250 former prisoners , including 200 men and 50 women who were medically examined in 1950 , ie , 5 years after leaving a concentration camp , and 120 of the same former prisoners , including 100 men and 20 women who were medically examined in 1975 , ie , 30 years after leaving a concentration camp . the group of 250 survivors included 155 professionals and 95 manual workers , who were aged 19 to 60 years . the group of 120 survivors interviewed in 1975 included 50 professionals and 70 manual workers , aged 39 to 85 years . each subject was interviewed and underwent a medical examination , and some additional tests were carried out : urinalysis , morphology , erythrocyte sedimentation rate , chest x - ray , and electrocardiography . specialist tests were also conducted , if necessary , by ophthalmologists , otolaryngologists , psychiatrists , neurologists , urologists , and gynecologists . the control group in 1950 included 250 subjects , 200 men and 50 women , and in 1975 it included 120 subjects , 100 men and 20 women , who were randomized from the 1950 control group according to their age , sex , occupation , and environment to match the study group . none of the subjects in the control group had been a prisoner either at a concentration camp or any other prison or detention facility . the control group was also interviewed and medically examined . this project was approved by the ethics committee of wroclaw medical university , wroclaw , poland ( decision number kb-31/2011 ) . the patients consent was not obtained ; because the researchers analyzed the medical records of patients several decades after they had been produced , physicians had taken care of those patients at that time ( retrospective work ) . the researchers did not have the chance to meet these patients to ask for their permission , so patient records were anonymous and de - identified prior to analysis . the medical examination of 250 former prisoners of concentration camps 5 years after leaving the camp found the coexistence of multiple diseases , whereas no dysfunction was found in 74% of subjects in the control group , showing that the coexistence of multiple diseases ( multimorbidity rate ) in former prisoners immediately after leaving the camp was much higher than in subjects who had never been incarcerated , and affected almost all systems : the central nervous system ( cns ) ( 66% versus 6% in the control group ) , the skeletal system ( 42.4% versus 4.8% in the control group ) , cardiovascular system ( 34.4% versus 10% in the control group ) , and alimentary system ( 26% versus 3.2% in the control group ) . figure 1 shows the exact percentage of lesions within particular systems in former prisoners of concentration camps compared with the control group . on the basis of questionnaires and comparative analysis of the study group and control group , the condition of 120 former prisoners deteriorated substantially within 30 years after leaving the camp . this was due to the extreme conditions at the camps , famine , contagious diseases ( mainly typhus and typhoid fever ) , injuries ( mainly head injury ) , beating and torture , and pseudo - medical experiments , whose effects often became visible many years later . however , the most common were dysfunctions within the cns , which manifested in 80% of survivors , including anxiety neurosis , depressive and vegetative neurosis , anxiety - depressive disorder , and depression . furthermore , single cases of psychosis , posttraumatic epilepsy , parkinson s disease , and dementia were reported . in the control group , only 24% of subjects manifested some lesions . cardiovascular and skeletal system dysfunctions were the second and third most frequent dysfunctions manifested by former prisoners ( respectively , 58.3% versus 35% in the control group , and 55% versus 26.6% in the control group ) . less predominant than the three systems mentioned above were lesions of the respiratory system ( 25% versus 15.8% in the control group ) , alimentary system ( 20% versus 14.1% in the control group ) , urinary system ( 13.3% versus 8.3% in the control group ) , and vision and hearing ( 17.5% versus 8.3% in the control group ) . posttraumatic lesions were also very common and affected 48.4% of former prisoners but only 4.1% in the control group . more details about the percentage of lesions within the particular systems ( multimorbidity ) in former prisoners of concentration camps compared with the control group are shown in figure 2 . multimorbidity in former prisoners is characterized by the coexistence of multiple organ or system lesions . the examination in 1950 found lesions of two or more organs in 64.8% of former prisoners and only in 8% in the control group , where 74% of subjects manifested no dysfunction . more details about the percentage of multimorbidity in the study group versus control group are shown in figure 3 . the examination in 1975 found that 89.17% of former prisoners were affected by multiple organ or system lesions and only 10.8% by a single organ lesion , as shown in figure 4 . in the control group , multiple lesions were noted in 44.16% of subjects , with a single organ lesion in 55.8% , as shown in figure 4 . the follow - up data from 1975 show that multimorbidity was predominant among subjects aged 61 to 70 years , ie , in 64 former prisoners ( 53.3% ) , as shown in figure 5 . in addition to this , 83% of former prisoners who had been incarcerated for a period of 25 months to 36 months had multisystemic lesions . generally , prisoners who stayed at a camp longer than 24 months more frequently manifested multisystemic lesions compared with prisoners incarcerated for up to 24 months , as shown in figure 6 . all of the former prisoners demonstrated psychiatric symptoms of kz - syndrome / posttraumatic stress disorder , mainly depression , anxiety , sleep disorders , hyperactivity , emotional disturbances , and personality disorders , which were not observed in the control group . our findings have clinical and ethical aspects , observed in the contemporary world in the regions of ethnic and religious conflicts . clinically , results of these studies show that the organism exposed to extreme stimuli and threats is susceptible to the occurrence of many diseases , especially disorders of the cns . present times abound with such threats in the area of ethnic and religious conflicts , where extermination methods are similar to those experienced by prisoners of concentration camps and are still practiced . the study showed that the conditions at concentration camps had a negative impact on the health of former prisoners 5 and 30 years after leaving a camp . one of the consequences was premature aging as a result of multimorbidity , affecting almost all the body s organs and systems . the symptoms of premature aging manifested themselves mainly within 5 years of leaving a camp . compared with the control group , the rate of urinary system dysfunctions was 15 times higher , the rate of psychological and skeletal dysfunctions was ten times higher , the rate of alimentary dysfunctions was eight times higher , and the rate of cardiovascular diseases was four times higher in the study group . the follow - up data gathered 30 years after leaving a camp show that , in both former prisoners and the population who had never been incarcerated , the differences between the control and the study group became less evident but remained statistically significant . the rate of cns diseases was four times higher in the study group than in the control group 30 years after leaving a camp , and the rate of cardiovascular diseases or skeletal system dysfunctions in this group was double that of the control group . for instance , according to panasewicz , 1 year of incarceration corresponds to 4 years of normal life , ie , imprisonment speeds up the process of aging by 3 years on average.5 this is how panasewicz simply explains the process of premature aging : excessive emotional stress leads to depression and sleep dysfunction , causing psychophysical disability and growing fatigue , which leads to chronically progressing asthenia and premature aging . the scientific research on multimorbidity mainly focuses on three systems : the cns , cardiovascular system , and skeletal system , as was shown in polish publications by szwarc6 and witusik,7 and foreign ones by hermann and thygesen8 or eitinger and strm,9 who also mention alimentary system dysfunctions being statistically significant . the follow - up data collected 5 and 30 years after leaving a camp suggest that the rate of dysfunctions within the cns was the highest and was rising with time . other authors , eg , zielina10 and szymusik,11 also placed the cns dysfunctions at the top of their list of dysfunctions after 20 and 30 years of leaving a camp , while szwarc6 ranks them as second highest , and witusik7 as the third highest . szymusik12 also found that the rate of psychological diseases increased with time and affected almost all former prisoners of concentration camps , a finding that was supported by gtarski et al.13 the follow - up data collected from former prisoners indicate that multimorbidity is usually characterized by the coexistence of multiple somatic diseases that can frequently be linked with psychological dysfunctions . it was not uncommon for a survivor of a concentration camp to visit a doctor because of one somatic or psychological condition and to be diagnosed with several coexisting ones after a thorough interview , medical examination , and additional testing . this is one of the characteristics of multimorbidity that begins to manifest usually a few years after leaving , as indicated by the follow - up data gathered from former prisoners 5 years after leaving . the rate of multiple organ lesions was ten times higher in the study group than in the control group 5 years after leaving a camp , and two times higher 30 years after leaving a camp . the coexistence of several serious diseases in one survivor can be explained by the fact that one chronic disease had a negative impact on the whole body and caused multiorgan lesions . this hypothesis is supported by a study by kodziski , who noticed that multiorgan diseases were more frequent among former prisoners than in the general population.14 in summary , the significant outcomes of this study are as follows : 
 multimorbidity , premature aging , and increased mortality represent the principal consequences of incarceration in concentration camps.multimorbidity affects mostly the cns of former prisoners.older age and longer duration of a camp stay are the main determinants of multimorbidity . multimorbidity , premature aging , and increased mortality represent the principal consequences of incarceration in concentration camps . . the limitations of this study are the retrospective character of the analysis and recall bias . in summary , the significant outcomes of this study are as follows : 
 multimorbidity , premature aging , and increased mortality represent the principal consequences of incarceration in concentration camps.multimorbidity affects mostly the cns of former prisoners.older age and longer duration of a camp stay are the main determinants of multimorbidity . multimorbidity , premature aging , and increased mortality represent the principal consequences of incarceration in concentration camps . older age and longer duration of a camp stay are the main determinants of multimorbidity . the limitations of this study are the retrospective character of the analysis and recall bias . the consequences of incarceration in concentration camps presenting as multimorbidity affect the majority of survivors . the coexistence of several chronic diseases is manifested mainly in older prisoners , who stayed at a camp longer . their condition is most often characterized by premature aging with systemic inflammation and degenerative diseases , causing a dramatic increase in the mortality rate among that population . present times abound with areas of ethnic and religious conflict , where extermination methods are similar to those experienced by prisoners of concentration camps and are still practiced .