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

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

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

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

5. 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

6. 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

7. 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

8. 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

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

10. 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

11. 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

12. 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

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

14. 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

15. Mortality
Direct deaths vs Indirect deaths
Violence, Warfare
Diseases

16. 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:

17. Mortality
Darfur
CMR
U5MR
vMR
dMR

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

19. Concluding
Disaggregate
Understand
Target

20. Thank you