Five million children aged 5 and under were killed in the last two decades due to the indirect consequences of warfare in Africa. That number is three times greater than the number of combatants who died in armed conflict across the continent.
In the first comprehensive analysis of the large and lingering effects of armed conflict on the health of children, Stanford Medicine’s Eran Bendavid, MD, said he and his fellow researchers turned to data to try to get an accurate number of child casualties.
“We wanted to understand the effects of war and conflict, and discovered that this was surprisingly poorly understood,” Bendavid, an associate professor of medicine and core faculty member at Stanford Health Policy, told me in an interview. “The most authoritative source, the Global Burden of Disease, only counts the direct deaths from conflict, and those estimates suggest that conflicts are a minuscule cause of death.”
The numbers are anything but miniscule: 3.1 to 3.5 million infants born within 30 miles of armed conflict died from indirect consequences of battle zones between 1995 and 2005. That number jumps to 5 million deaths of children under 5 in those same conflicts.
On the entire continent, the authors wrote, the number of infant deaths related to conflict from 1995 to 2015 were more than three times the number of direct deaths from armed conflict. Further, they demonstrated that babies born within 30 miles of an armed conflict face an increase of 7.7 percent in the risk of dying before age 1.
Their research appears in The Lancet.
The authors matched data on 15,441 armed-conflict events with data on 1.99 million births and subsequent child survival across 35 African countries. Their primary conflict data came from the Uppsala Conflict Data Program Georeferenced Events Dataset, which includes detailed information about the time, location, type and intensity of conflict events from 1946 to 2016.
The researchers also used all available data from the Demographic and Health Surveys conducted in 35 African countries from 1995 to 2015 as the primary data sources on child mortality in their analysis.
“Lack of access to key health services or to adequate nutrition are the standard explanations for stubbornly high infant mortality rates in parts of Africa,” said co-author Marshall Burke, PhD, an assistant professor of earth systems science and fellow at the Center for Food Security and the Environment. “But our data suggest that conflict can itself be a key driver of these outcomes, affecting health services and nutritional outcomes hundreds of kilometers away and for nearly a decade after the conflict event."
The results suggest efforts to reduce conflict could lead to large health benefits for children.
Zachary Wagner, PhD, a health economist at RAND Corporation who until recently was a postdoctoral research fellow at Stanford Medicine, and lead author of the study, said he knows few are surprised that conflict is bad for child health.
“However, this work shows that the relationship between conflict and child mortality is stronger than previously thought and children in conflict zones remain at risk for many years after the conflict ends.”
He notes that nearly 7 percent of child deaths in Africa are related to conflict and reiterated the grim fact that child deaths greatly outnumber direct combatant deaths.
“We hope our findings lead to enhanced efforts to reach children in conflict zones with humanitarian interventions,” Wagner said. “But we need more research that studies the reasons for why children in conflict zones have worse outcomes in order to effectively intervene.”
A version of this story originally appeared on Stanford Health Policy.
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