The phenomenon that more people die from the indirect effects of warfare than are killed directly is widely recognised. Wagner and colleagues studied the effect of armed conflict on child mortality in Africa. They used a geospatial approach, linking georeferenced data on armed conflict to georeferenced data from the Demographic and Health Surveys. Their study covered two decades (1995-2015) and 35 African countries. The outcome variable was child survival to the age of one year. Overall, there was nearly an eight-percent increased risk of child death during a year of conflict. However, many of the conflicts were small, and the increased risk of death before the age of one year was over 25% for armed conflicts with more than 1,000 direct fatalities. The cumulative effect over eight years was up to four times higher than the contemporaneous increase, and the effect is greatly increased for long-lasting conflicts. There were significantly stronger effects in rural than in urban areas. The authors also examined child growth and found an increased risk of stunting in relation to conflict.
Sadly, there was no shortage of armed conflicts in the 35 African countries studied – 15,441 armed conflicts were recorded in the Uppsala Conflict Data Program over the two decades. The results reported here represent a massive burden of disease on a scale with malnutrition.
Avoiding conflict is a tricky subject, which lies outside the health domain, and which is discussed in Paul Collier’s book ‘The Bottom Billion’. Conflict is also very strongly associated with national poverty, and generally the avoidance of conflict is, arguably, the biggest threat confronting humankind, as we will discuss in the future.
— Richard Lilford, CLAHRC WM Director
- Wagner Z, Heft-Neal S, Bhutta ZA, Black RE, Burke M, Bendavid E. Armed conflict and child mortality in Africa: a geospatial analysis. Lancet. 2018; 392: 857-65.
- Collier P. The Bottom Billion: Why the Poorest Countries are Failing and What Can Be Done About It. Oxford: Oxford University Press; 2007.