The burden of armed conflict: a public health approach Chiara Altare CRED Microcon Conference Brighton, June 30th 2011

Understanding heterogeneity Channels Population groups Patterns Understanding heterogeneity through analysis Effective targeted interventions

Health as peace building tool Commonly recognised public good & a shared goal for most cultures Tangible actions can redress felt deprivation among communities

Impact of conflict on health Diseases Malnutrition & Food security Mortality Injuries, Disabilities Sexual violence

Impact of conflict on health Diseases Malnutrition & Food security Mortality Primary public health indicators used to evaluate the health status of a population in emergency

Morbidity Main killers in conflict Standard killers in developing countries Measles, diarrhoea, respiratory infections, malaria Conflict exacerbates disease spreading Displacement new pathogens Overcrowding quicker transmission Break down of health system limited care

Morbidity Uganda1 No impact of displacement on health outcome? Same morbidity prevalence No impact of displacement on health outcome? IDP in camps Returnees 1 Bozzoli, Brück, 2010, “Child morbidity and camp decongestion in post-war Uganda”, Microcon RWP 24

Morbidity Uganda Only targeted interventions can be effective Same morbidity prevalence, different causes Only targeted interventions can be effective IDP in camps Returnees Overcrowding Access to safe water

Malnutrition 2 billion people suffer from it Malnutrition Food Health Care and Hygiene

Malnutrition 2 billion people suffer from it Malnutrition Food Health Care and Hygiene Reduced local production Collapse of trade Breakdown of the health system Limited income available Displacement Overcrowding Limited access to safe water

Malnutrition Acute Malnutrition Chronic Malnutrition 20% of under 5 deaths 35% of under 5 morbidity Impairs mental and physical development Limits potential of nations to recover

Malnutrition Burundi2 Exposure to conflict increases probability of being stunted The longer the exposure the more important the growth retardation Short-run health impact of war have long run welfare impact 2 Bundervoet, Verwimp, Akresh, 2008, “Health and civil war in rural Burundi”, Microcon RWP 5

Mortality Expected mortality vs Excess mortality Deaths occurring during peacetime Deaths that would have not occured without the conflict

Mortality Expected mortality vs Excess mortality - Severity of the crisis - Deaths ascribable to pre-existing conditions or to violence Appropriate response Deaths occurring during peacetime Deaths that would have not occured without the conflict

Mortality Direct deaths vs Indirect deaths Violence, Warfare Diseases

Mortality Direct deaths vs Indirect deaths 20% 80% Violence, Warfare Diseases - Follow different patterns3 - Affect different population groups Main cause of death 3 Degomme, Guha-Sapir, 2010 “Patterns of mortality in Darfur conflict”, Lancet 375:294-300

Mortality Darfur CMR U5MR vMR dMR

Cause of death & population group Mortality Cause of death & population group IDP in camps Residents Diseases Violence

Concluding Disaggregate Understand Target

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