centre for research on the epidemiology of disasters - cred the burden of armed conflict: a public...
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Centre for Research on the Epidemiology of Disasters - CRED
The burden of armed conflict: a public health approach
Chiara AltareCRED
Microcon ConferenceBrighton, June 30th 2011
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Centre for Research on the Epidemiology of Disasters - CRED
Understanding heterogeneity
ChannelsChannels PatternsPatternsPopulation groups
Population groups
Understanding heterogeneity through analysis
Effective targeted interventions
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Centre for Research on the Epidemiology of Disasters - CRED
Health as peace building tool
• Commonly recognised public good & a shared goal for most cultures
• Tangible actions can redress felt deprivation among communities
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Centre for Research on the Epidemiology of Disasters - CRED
Impact of conflict on health
• Diseases• Malnutrition & Food security• Mortality • Injuries, Disabilities• Sexual violence
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Centre for Research on the Epidemiology of Disasters - CRED
• Diseases• Malnutrition & Food security• Mortality
Impact of conflict on health
Primary public health indicators used to evaluate the health status of a population in emergency
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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
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Morbidity
Uganda1
Same morbidity prevalence
No impact of displacement on health outcome?
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IDP in campsIDP in camps ReturneesReturnees
1 Bozzoli, Brück, 2010, “Child morbidity and camp decongestion in post-war Uganda”, Microcon RWP 24
Centre for Research on the Epidemiology of Disasters - CRED
Morbidity
UgandaSame morbidity prevalence, different causes
Only targeted interventions can be effective
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IDP in campsIDP in camps
OvercrowdingOvercrowding Access to safe water
Access to safe water
ReturneesReturnees
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Malnutrition
2 billion people suffer from it
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Food Food Health Health Care and HygieneCare and Hygiene
MalnutritionMalnutrition
Centre for Research on the Epidemiology of Disasters - CRED
Malnutrition
2 billion people suffer from it
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Food Food Health Health Care and HygieneCare and Hygiene
MalnutritionMalnutrition
Reduced local production
Collapse of trade
Reduced local production
Collapse of trade
Breakdown of the health
systemLimited income
available
Breakdown of the health
systemLimited income
available
DisplacementOvercrowding
Limited access to safe water
DisplacementOvercrowding
Limited access to safe water
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Malnutrition
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Acute MalnutritionAcute Malnutrition Chronic MalnutritionChronic Malnutrition
20% of under 5 deaths
35% of under 5 morbidity
20% of under 5 deaths
35% of under 5 morbidity
Impairs mental and physical development
Limits potential of nations to recover
Impairs mental and physical development
Limits potential of nations to recover
Centre for Research on the Epidemiology of Disasters - CRED
Malnutrition
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
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2 Bundervoet, Verwimp, Akresh, 2008, “Health and civil war in rural Burundi”, Microcon RWP 5
Centre for Research on the Epidemiology of Disasters - CRED
Mortality
Expected mortality vs Excess mortality
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Deaths occurring during peacetime
Deaths occurring during peacetime
Deaths that would have not occured without the conflictDeaths that would have not occured without the conflict
Centre for Research on the Epidemiology of Disasters - CRED
Mortality
Expected mortality vs Excess mortality
- Severity of the crisis- Deaths ascribable to pre-existing conditions
or to violence
Appropriate response
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Deaths occurring during peacetime
Deaths occurring during peacetime
Deaths that would have not occured without the conflictDeaths that would have not occured without the conflict
Centre for Research on the Epidemiology of Disasters - CRED
Mortality
Direct deaths vs Indirect deaths
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Violence, WarfareViolence, Warfare DiseasesDiseases
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Mortality
Direct deaths vs Indirect deaths
20% 80%
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Violence, WarfareViolence, Warfare DiseasesDiseases
3 Degomme, Guha-Sapir, 2010 “Patterns of mortality in Darfur conflict”, Lancet 375:294-300
Main cause of deathMain cause of death- Follow different patterns3
- Affect different population groups
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Mortality
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CMR U5MR
vMR dMR
Darfur
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Mortality
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Cause of death & population group
IDP in campsIDP in camps
DiseasesDiseases ViolenceViolence
ResidentsResidents
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Concluding
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DisaggregateDisaggregate
UnderstandUnderstand
Target Target
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Thank you
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