Social determinants of health in countries in conflict - What is GIS ...

Chapter 4
The impact of conflict on health
4.1 Mortality and morbidity directly due to conflict
In a conflict setting, the direct impact on health is due to death, injuries or disabilities
caused by violence. The indirect impact is associated with conflict as a result of the
complete disruption of daily social life and infrastructure. While such data are difficult
to collect, those on mortality, and to a lesser extent morbidity, due to conflict are likely
to be more accurate than those which are indirectly associated with conflict.
In Iraq, estimates of deaths during and after the 2003 invasion vary widely according
to the source. The first epidemiological survey of excess mortality, conducted 17–18
months after the invasion, showed over half of the deaths recorded resulted from violent
causes and more than 50% of deaths occurred in Falluja [40]. A follow-up cluster sample
survey conducted between May and July 2006, identified an escalation in the mortality
rate that surprised the researchers, an estimate of 654 965 excess deaths since the
invasion, of which 600 000 were due to violence (the most common cause was identified
as gunfire). The Iraq family health survey conducted by the Iraq Family Health Survey
Group between January 2002 and June 2006 estimated the number of violent deaths as
151 000 (95% uncertainty range, 104 000 to 223 0000) from March 2003 to June 2006
[41].
In West and South Darfur, cluster sample surveys conducted by the staff of Epicenter,
the Paris-based research division of Médecins Sans Frontières (MSF), identified high
mortality rates. In West Darfur, in 2003: “in four sites surveyed high mortality and family
separation amounted to a demographic catastrophe.” The death rates (calculated, in the
short term, as numbers per 10 000 per day) were highest among adult and adolescent
males, especially during the destruction of settlements and during flight, but women and
children were also targeted. During the period in “camps” the overall mortality rate fell
but remained greater than the emergency benchmark (that is, double the normal mortality
numbers for the Region, 1 per 10 000 per day) [42]. In South Darfur, in September 2004,
in the three survey areas the overall death rate per 10 000 population per day was 3.2,
2.0 and 2.3, for each respective area, and mortality for children under 5 years of age was
5.9, 3.5 and 1, respectively [43].
Overall, civilian mortality in 2006 was the highest in Afghanistan since 2001, with at
least 669 civilians killed in more than 350 armed attacks [44]. In the occupied Palestinian
territory, 31 426 people were injured between 29 September 2000 (the beginning of
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