The burden of armed conflict: a public health approach

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

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

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

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

10. Malnutrition 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 2 billion people suffer from it

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 2 Bundervoet, Verwimp, Akresh, 2008, “Health and civil war in rural Burundi”, Microcon RWP 5 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

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

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

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

16. Mortality 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 Direct deaths vs Indirect deaths 20% 80%

17. Mortality Darfur CMR U5MR vMR dMR

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

19. Concluding Disaggregate Understand Target

20. Thank you