Global Burden of Armed Violence - The Geneva Declaration on ...

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32 This chapter discusses what we know about GLOBAL BURDEN <strong>of</strong> ARMED VIOLENCE Photo ! A mother holds up her severely malnourished baby in the refugee camp <strong>of</strong> Xjosa Sabz Poosh, Afghanistan. © Tim Dirven/Panos Pictures Most conflicts are either low-intensity civil wars that involve poorly trained armies who target civilians, or asymmetric wars that pit a well- equipped army against a militarily weaker opponent (Harbom, 2007). Both scenarios inflict violent (‘direct’) and non-violent (‘indirect’) deaths on civilians. Contemporary armed conflicts involve organized and disorganized armed forces inflicting violence on both soldiers and civilians, with wide- spread consequences for the health and economic infrastructures <strong>of</strong> whole countries. While violent death is an indicator <strong>of</strong> armed conflict, disease and malnutrition have been the main causes <strong>of</strong> death among civilians in most major conflicts since the late 1980s (Guha-Sapir and Degomme, 2005a). ‘excess mortality’ and ‘indirect deaths’ in armed conflict. It first overviews the epidemiological and demographic methods for estimating excess mortality, current knowledge gaps, and the scien- tific challenges. <strong>The</strong> second section summarizes data from a variety <strong>of</strong> cases to arrive at some benchmarks to evaluate the level <strong>of</strong> indirect victimi- zation in contemporary conflicts. <strong>The</strong> chapter closes with three brief case studies estimating indirect deaths in South Sudan, Sierra Leone, and Iraq. <strong>The</strong> main findings <strong>of</strong> the chapter are the following: In the majority <strong>of</strong> conflicts since the early 1990s for which good data is available, the burden <strong>of</strong> indirect deaths was between three and 15 times the number <strong>of</strong> direct deaths. Variation in the ratio <strong>of</strong> direct to indirect deaths depends on the pre-conflict level <strong>of</strong> development <strong>of</strong> the country, the duration <strong>of</strong> the fighting, the intensity <strong>of</strong> combat, access to basic care and services, and humanitarian relief efforts. <strong>The</strong> lethal burden <strong>of</strong> armed conflict in 2004– 07 was many times greater than the number <strong>of</strong> direct conflict deaths. A reasonable aver- age estimate would be a ratio <strong>of</strong> four indirect deaths to one direct death in contemporary conflicts, which would represent at least 200,000 indirect conflict deaths per year, and possibly many more. 3 <strong>The</strong>re may have been up to 400,000 indirect conflict deaths per year in the DRC alone since 2002. Appropriate methods exist to arrive at a more accurate account <strong>of</strong> the number <strong>of</strong> indirect deaths in conflict zones; these should be applied systematically wherever possible to individual conflicts.
Sexual violence in armed conflict accounts for a sizable, albeit hidden, proportion <strong>of</strong> indirect conflict deaths with the majority <strong>of</strong> victims being women and girls. What is excess mortality? Epidemiologists use mortality rates to assess the severity <strong>of</strong> the impact <strong>of</strong> conflict on civilian populations affected by complex humanitarian emergencies (Toole and Waldman, 1997; Guha- Sapir et al., 2005; Checchi and Roberts, 2005). Standardized mortality calculations make possible comparisons between populations and judgements on the severity <strong>of</strong> a crisis. Excess mortality captures the difference between the death rates (‘crude mortality’) in a non-conflict situation and in a conflict or crisis situation. It includes those dying both from the direct and the indirect consequences <strong>of</strong> armed conflict. However, its accuracy depends on the reliability <strong>of</strong> baseline mortality data. In many protracted conflict areas the establishment <strong>of</strong> this baseline is complicated by the absence <strong>of</strong> reliable data. <strong>The</strong> crude mortality rate (CMR) is informative only when compared with a national or regional Figure 2.1 Typology <strong>of</strong> conflict mortality Crude mortality baseline CMR (the ‘expected’ mortality in a country in a normal situation) or with alert level thresholds which signify a crisis situation 4 . <strong>The</strong> numerical difference between the ‘crisis CMR’ and the ‘baseline CMR’ is termed the ‘excess mortality’. This value represents the mortality that can be attrib- uted to the crisis and is used to estimate the magnitude <strong>of</strong> the emergency and to monitor the humanitarian response. Excess mortality is traditionally broken down into two types <strong>of</strong> death—direct and indirect—according to whether or not the cause <strong>of</strong> death was violence (see Figure 2.1). Excess mortality Baseline mortality Direct deaths are caused by war-related injuries and attacks (such as those inflicted by a bullet, bomb, mine, machete, or assault) (SMART, 2005, p. 81). 5 Indirect deaths are caused by the worsen- ing <strong>of</strong> social, economic, and health conditions in the conflict-affected area. <strong>The</strong>y can result from a variety <strong>of</strong> different factors including (but not lim- ited to) inability to access health care, damage to health systems and public health infrastructure, changes in behaviour that increase the incidence <strong>of</strong> diseases, malnutrition, unsanitary living conditions, food insecurity, and loss <strong>of</strong> livelihood and agricultural land (Guha-Sapir and van Panhuis, 2002; Gayer et al., 2007). Indirect deaths Direct deaths Source: Ratnayake et al. (2008) 33 I N D I R EC T CO N F L I C T DE AT H S 1 2 3 4 5 6 7
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Page 5 and 6: Foreword Armed vio
Page 7 and 8: Contents Executive Summary ........
Page 9 and 10: About the Geneva <
Page 11 and 12: of direct conflict
Page 13 and 14: Executive Summary Armed</st
Page 15 and 16: Figure 1 captures graphically the d
Page 17 and 18: This report also finds that the aft
Page 19 and 20: ��
Page 21 and 22: Chapter One Direct Conflict Death <
Page 23 and 24: approaches that featured cross-nati
Page 25 and 26: us, non-state and intercommunal arm
Page 27 and 28: niques and inclusion requirements (
Page 29 and 30: Figure 1.2 Estimates of</st
Page 31 and 32: North Africa Sudan 7,284 1,098 2,60
Page 33 and 34: Map 1.1 The GBAV c
Page 35 and 36: �� Increasing di
Page 37 and 38: Table 1.4 Estimated direct conflict
Page 39 and 40: Table 1.7 Direct conflict death rat
Page 41 and 42: accounts overwhelmingly for the glo
Page 43: Chapter Two The Ma
Page 47 and 48: continued for six months due to the
Page 49 and 50: Table 2.1 Comparison of</st
Page 51 and 52: of sexual violence
Page 53 and 54: can be explained by the relatively
Page 55 and 56: Box 2.3 A very dark number: direct
Page 57 and 58: Photo Victims of v
Page 59 and 60: Table 2.5 Violent death estimates f
Page 61 and 62: Chapter Three Armed</strong
Page 63 and 64: ized by a clear victory of<
Page 65 and 66: On the basis of Ch
Page 67 and 68: illegal war economies, including th
Page 69 and 70: standards issued by UNHCR emphasize
Page 71 and 72: Table 3.4 Risk factors for youth vi
Page 73 and 74: Map 3.2 The youth
Page 75 and 76: Given the potential importance <str
Page 77 and 78: interventions based on identified n
Page 79 and 80: Chapter Four Lethal Encounters: Non
Page 81 and 82: violence in Mexico in 2007-08 (BBC,
Page 83 and 84: comparisons between regions <strong
Page 85 and 86: tively. The Caribb
Page 87 and 88: the homicide count is derived. None
Page 89 and 90: Table 4.1 National-level homicide t
Page 91 and 92: sistent increases during the time p
Page 93 and 94: Box 4.3 Sex, age, and armed violenc
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The police are sat
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American countries have similar tre
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evidence on the patterns and distri
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Chapter Five What’s in a Number?
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observe that war has negative effec
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Box 5.1 Accounting for the costs <s
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of conflict and co
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Table 5.2 The soci
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In Uganda, a protracted armed confl
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�� Lost product
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Figure 5.3 Potential gains in life
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playing a role in promoting an end
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16 Specifically, the health and yea
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Chapter Six Armed
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(Myrttinen, 2003, p. 38). T
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NATO Forces and The</strong
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go missing, or are killed. In such
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disaggregated data is still not ava
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Acts of sexual vio
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Dowry-related violence A dowry is t
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sex ratios reported at birth is pre
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Chapter Seven Other Forms o
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will likely emerge. Armed</
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Gangs in Central America Central Am
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��
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The absence <stron
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Table 7.1 Recorded cases of
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Figure 7.2 Kidnap for ransom cases
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armed violence, since, beyond the d
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Bibliography Executive Summary CNP
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Burr, M. 1993. A Working Document:
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Thieren, Michael. 2005. ‘Health I
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——. 2008. Small Arms Survey 200
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Nations-Survey-on-Crime-Trends-and-
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ground Paper. Geneva</stron
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--. 2003. ‘Masculinities and Masc
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ights-and-wrongs-of</strong
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Boxes List of Illu
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Map 4.1 Homicide rates per 100,000
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Figure 2.1 Typology of</str
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