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In Focus: Conflict-related Mortality |
2 November 2006 |
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The recent Lancet article attempting to quantify the death toll since the 2003 invasion of Iraq has been the subject of much controversy. What is clear is that there is a dearth of accurate data and huge practical and methodological challenges inherent in calculating conflict death tolls. This special issue of Human Security Research features a series of recently-published reports and articles on conflict-related mortality and is designed to shed some light on what we know, what we don't know and the challenges facing those who try to measure the human costs of conflict. |
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What's New in Human Security Research : |
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IRAQ: Mortality After the 2003 Invasion of Iraq
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ARMED CONFLICT: The Declining Risk of Death in Battle
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MYANMAR: Mortality Rates in Conflict Zones in Karen, Karenni, and Mon States
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ANGOLA: A Data Review of Field Surveys in Angola Between 1999-2005
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SUDAN: Counting The Deaths In Darfur: Estimating Mortality From Multiple Survey Data
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DR CONGO: Mortality in the Democratic Republic of Congo
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EAST TIMOR: The Profile of Human Rights Violations in Timor-Leste, 1974-1999
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GUINEA-BISSAU: Mortality Patterns During a War in Guinea-Bissau 1998-99
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EPIDEMIOLOGY: Interpreting and Using Mortality Data in Humanitarian Emergencies
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UGANDA: Health and Mortality Survey Among Internally Displaced Persons
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DATA ANALYSIS: Conflict-related Mortality: An Analysis of 37 Datasets
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BATTLE DEATHS: Monitoring Trends in Global Combat: A New Dataset of Battle Deaths
IRAQ
Mortality After the 2003 Invasion of Iraq: A Cross-Sectional Cluster Sample Survey
The Lancet (Oct. 2006)
There has been widespread concern over the scale of Iraqi deaths after the invasion by the US-led coalition in March, 2003. Various methods have been used to count violent deaths, including hospital death data from the Ministry of Health, mortuary tallies, and media reports. The best known is the Iraq Body Count, which estimated that, up to September 26, 2006, between 43 491 and 48 283 Iraqis have been killed since the invasion. Estimates from the Iraqi Ministry of the Interior were 75% higher than those based on the Iraq Body Count from the same period. An Iraqi non-governmental organisation, Iraqiyun, estimated 128 000 deaths from the time of the invasion until July, 2005, by use of various sources, including household interviews. The authors estimate that, as a consequence of the coalition invasion of March 18, 2003, about 655 000 Iraqis have died above the number that would be expected in a non-conflict situation, which is equivalent to about 2·5% of the population in the study area.
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ARMED CONFLICT*
The Declining Risk of Death in Battle
International Studies Quarterly (Sept. 2006)
A recent article by Sarkees, Wayman, and Singer using the new Correlates of War (COW) data on the distribution of interstate, intrastate, and extrastate wars from 1816 to 1997 claims there was a relatively constant risk of death in battle during that time. Lacina, Gleditsch, and Russett show in this article, that the authors' information is skewed by irregularities in the COW deaths data, and contest their pessimistic interpretation. Using revised information on battle deaths from 1900 to 2002 they demonstrate that the risk of death in battle by no means followed a flat line, but rather declined significantly after World War II and again after the end of the Cold War. Future users should note that the deaths data collected for the three conflict types by COW are not comparable, and using them as such tends to underestimate the share of fatalities due to major interstate conflicts.
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MYANMAR*
Mortality Rates in Conflict Zones in Karen, Karenni, and Mon States in Eastern Burma
Tropical Medicine & International Health (July 2006)
The Karen, Karenni and Mon ethnic peoples living in conflict areas along the Thai-Burma border survive in what the Burmese military has declared 'free-fire' or 'black zones' in eastern Burma. War in these zones often force villagers into hiding in the jungles as internally displaced persons (IDPs). Entire villages are also systematically displaced as a part of a military strategy for control of conflict-affected areas. IPSs and war-affected residents living in these zones rely upon a network of mobile indigenous health workers for basic healthcare known collectively as the 'Backpack Health Worker Team' (BPHWT), which also regularly collects health information. This paper presents population-based mortality estimates for conflict zones within Burma, and describes the methods used by mobile health workers to collect this data for otherwise unreachable populations.
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ANGOLA
A Data Review of Field Surveys in Angola Between 1999-2005
Centre for Research on the Epidemiology of Disasters (June 2006)
The effects of armed conflicts on mortality fall into one of two categories: direct and indirect. By direct mortality we mean those violent deaths caused by military operations among both soldiers and civilians, often called battle deaths. The loss of life caused by armed conflicts does not stop there. In fact, much more death and misery is inflicted on civil populations by indirect means. Those collateral effects of conflict are commonly known as “indirect” or “excess” mortality. They account for those non-violent deaths among civil populations that would not have occurred without the conflict. Over the last decades, indirect deaths have greatly outnumbered direct battle-deaths in most conflicts. The main causes of those indirect deaths include economic collapse, food shortages and malnutrition, the disruption of health systems, mass population movements to overcrowded settlements, and the stretching of public safety systems due to long conflicts.
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SUDAN
Counting The Deaths In Darfur: Estimating Mortality From Multiple Survey Data
Households In Conflict Network (Apr. 2006)
The exact number of deaths in the Darfur region due to the conflict will probably never be known. However, most certainly, it is far too many. Estimating mortality in conflicts is a notoriously difficult exercise, even more so in Darfur where the conditions causing death are extremely variable. Malnutrition, epidemics and violence occur sporadically, claiming many lives in some areas and none in others. Recognising the importance of tracking mortality and estimating deaths, humanitarian aid agencies working in the region have undertaken mortality surveys among their beneficiaries at different times to assess the condition of their status and the severity of the crises. These are based on sound statistical and epidemiological techniques and provide insights into the varying levels of mortality over the entire region.
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DEMOCRATIC REPUBLIC OF CONGO
Mortality in the Democratic Republic of Congo: A Nationwide Survey
International Rescue Committee (Mar. 2006)
Commencing in 1998, the war in the Democratic Republic of Congo has been a humanitarian disaster, but has drawn little response from the international community. To document rates and trends in mortality and provide recommendations for political and humanitarian interventions, the authors did a nationwide mortality survey during April-July, 2004. They used a stratified three-stage, household-based cluster sampling technique. Of 511 health zones, 49 were excluded because of insecurity, and four were purposely selected to allow historical comparisons. From the remainder, probability of selection was proportional to population size. Geographical distribution and size of cluster determined how households were selected: systematic random or classic proximity sampling. Heads of households were asked about all deaths of household members during January, 2003, to April, 2004. The conflict in the Democratic Republic of Congo remains the world's deadliest humanitarian crisis.
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EAST TIMOR
The Profile of Human Rights Violations in Timor-Leste, 1974-1999
Human Rights Data Analysis Group (Feb. 2006)
This report details widespread and systematic violations in Timor-Leste during the period 1974-1999. Benetech's statistical analysis establishes that at least 102,800 (+/- 11,000) Timorese died as a result of the conflict. Approximately 18,600 (+/- 1000) Timorese were killed or disappeared, while the remainder died due to hunger and illness in excess of what would be expected due to peacetime mortality. The magnitude of deaths in Timor-Leste has long been a subject of contentious debate, and Benetech's results help to place the debate on a factual basis. These estimates are the most accurate and scientifically rigorous ever made for conflict-related mortality in Timor-Leste. They are based on a database of three independent sources: narrative statements, a retrospective mortality survey, and a census of public graveyards -- all of which were developed jointly by Benetech's Human Rights Data Analysis Group (HRDAG) and the Commission for Reception, Truth, and Reconciliation (CAVR in Portuguese), the truth commission for Timor-Leste.
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GUINEA-BISSAU*
Mortality Patterns During a War in Guinea-Bissau 1998-99: Changes in Risk Factors?
International Journal of Epidemiology (Dec. 2005)
This paper on mortality patterns in Guinea-Bissau contributes to the current extensive discussions on monitoring mortality rates during humanitarian crises. Mortality is the most sincere expression of vulnerability and, when well monitored, should direct efforts for relief, protection, and humanitarian intervention. Unfortunately, areas with humanitarian crises in the world today seldom enjoy an active case finding system like that set up by the authors prior to conflict in Guinea-Bissau. One lesson from this research is the importance of maintaining, and if possible enhancing, any such system in areas of crisis. Failing this, at best we get occasional special mortality studies that are easily biased by rapid population movements and difficult to interpret owing to their cross-sectional nature. This is just the situation in most of the major humanitarian crises in the last decade, including the Democratic Republic of Congo, Afghanistan, and Iraq. Without a system of on-going monitoring, even if special studies are accurate, the information is frequently not available to act on in a timely basis. In Guinea-Bissau, monitoring helped minimize all these problems.
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EPIDEMIOLOGY
Interpreting and Using Mortality Data in Humanitarian Emergencies: A Primer for Non-Epidemiologists
Humanitarian Policy Group (Sept. 2005)
Mortality data, properly collected, interpreted and used, have much to contribute to the appropriateness and effectiveness of humanitarian action in emergencies, and to advocacy on behalf of populations in crises. Most actors involved in relief will one day be confronted by such data, but the different ways in which this information can be collected, and their potential pitfalls, are not yet common knowledge among non-epidemiologists. This Network Paper describes the practice and purpose of that branch of epidemiology concerned with population mortality. It sets out the key indicators used to express mortality data, different options for how to measure mortality rates and suggestions for how to assess, interpret and use mortality reports. The paper also discusses the politics of mortality figures. The paper’s aim is to enable readers to critically interpret mortality study reports, and to understand how these are used (or misused) to formulate policy.
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UGANDA
Health and Mortality Survey Among Internally Displaced Persons in Gulu, Kitgum and Pader Districts, Northern Uganda
Ministry of Health, Republic of Uganda // World Health Organization // United Nations Children's Fund // United Nations Food Programme // United Nations Population Fund // International Rescue Committee (Jul. 2005)
In northern Uganda, nearly two decades of conflict have resulted in the internal displacement of up to two million persons. In Gulu, Kitgum and Pader Districts, the most affected by violence, nearly 90% of the population had relocated to camps as of 2005. The Government of Uganda’s national policy for internally displaced persons (IDPs) calls, among others, for provision of medical care and water and sanitation to all IDPs by both central and local government, and entitles them to security of person and property. The Office of the Prime Minister is tasked with advocating on behalf of IDPs and sharing information nationally and internationally on their plight. In 2005, the Ministry of Health of Uganda and the United Nations Childrens’ Fund (UNICEF) requested assistance from the World Health Organization (WHO) to assess the health status of IDPs in the three Districts. The study was led by the Ministry of Health and WHO in partnership with the offices of the District Director of Health Services of Gulu, Kitgum and Pader, UNICEF, the UN World Food Programme, the UN Population Fund, and the International Rescue Committee.
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DATA ANALYSIS*
Conflict-related Mortality: An Analysis of 37 Datasets
Disasters (Dec. 2004)
Mortality rates are among the main indicators of the human impact of armed conflict and many surveys have assessed this impact both for targeting and evaluating humanitarian aid programmes. Almost no epidemiological analysis such as calculating relative risk was performed nor were reference values clearly described. Here the aim is to review published mortality rates for a better understanding of age-specific mortality in armed conflict. Published mortality rates from conflict situations were collected and pre-conflict reference rates composed. The authors calculated the relative risk of dying in conflict compared to pre-conflict for children under 5 and people older than five years old. Although limited by reporting inadequacies, the results confirm the high vulnerability of children younger than 5 but identify a higher relative risk of dying among those 5 years old or older. Although not entirely new, this observation is not fully understood. Further systematic epidemiological research is needed to estimate and understand the impact of armed conflict on mortality.
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BATTLE DEATHS*
Monitoring Trends in Global Combat: A New Dataset of Battle Deaths
European Journal of Population (Feb. 2004)
Both academic publications and public media often make inappropriate use of incommensurate conflict statistics, creating misleading impressions about patterns in global warfare. This article clarifies the distinction between combatant deaths, battle deaths, and war deaths. A new dataset of battle deaths in armed conflict is presented for the period 1946-2002. Global battle deaths have been decreasing over most of this period, mainly due to a decline in interstate and internationalised civil armed conflict. It is far more difficult to accurately assess the number of war deaths in conflicts both past and present. But there are compelling reasons to believe that there is a need for increased attention to non-battle causes of mortality, especially displacement and disease in conflict studies. Therefore, it is demographers, public health specialists, and epidemiologists who can best describe the true human cost of many recent armed conflicts and assess the actions necessary to reduce that toll.
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Compiled by Robert Hartfiel and Barbora Farkasova
Human Security Research is produced by the Human Security Centre at the Liu Institute for Global Issues at UBC. The Human Security Centre produces the annual Human Security Report and is funded by the governments of Canada, Norway, Sweden, Switzerland and the United Kingdom. For more information on human security visit the Human Security Gateway, an online research and information database that contains a broad range of human security-related resources.
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