Introduction
Empirical evidence isolating the independent effect of armed conflict on health is scant, has methodological limitations, and neglects a growing burden of non-communicable diseases (NCDs). This thesis aims to evaluate the impact of armed conflict on civilian morbidity and mortality globally.
Methods
Two systematic reviews assessed the existing evidence on conflict and NCDs (Chapters 4 & 5). Longitudinal, fixed effects panel regression models used data from the Uppsala Conflict Data Program and Global Burden of Disease to assess relationships between four armed conflict specifications and health outcomes. Outcomes included all-cause and cause-specific civilian mortality (Chapter 6), and maternal and child mortality and health service coverage (Chapter 7). Models were adjusted for ten confounders, lagged by between one and ten years, and were age- and -sex stratified. Multiple sensitivity analyses assessed model robustness.
Results
Systematic review findings found positive but inconsistent associations between conflict and NCDs, although two thirds of studies had low methodological quality. Empirical research chapters included 193 countries between 1990 and 2017 and found that more intense conflicts (wars) drove associations. Wars were associated with an increase in civilian mortality by 81.5 per 100,000 population (95% CI 14.3-148.8), predicting 29.4 million (95% CI 22.1-36.6) deaths globally over the study period, two thirds of which were from communicable, maternal, neonatal, and nutritional diseases and 20% of which were from NCDs. Males appeared more affected than females, particularly for deaths from injuries, and point estimates were largest for children under 5 years and adults over 69 years. Wars were positively associated with all maternal and child health indicators, predicting 14.1 million (95% CI 11.5-16.7) infant deaths. Sensitivity analyses demonstrated robustness of findings.
Discussion
This thesis comprehensively and robustly contributes to understanding the detrimental impact of conflict on civilian morbidity and mortality globally, including on NCDs and across the life course.