The effects of armed conflict on the health of women and children

Abstract

Women and children bear substantial morbidity and mortality as a result of armed conflicts. This Series paper focuses on the direct (due to violence) and indirect health effects of armed conflict on women and children (including adolescents) worldwide. We estimate that nearly 36 million children and 16 million women were displaced in 2017, on the basis of international databases of refugees and internally displaced populations. From geospatial analyses we estimate that the number of non-displaced women and children living dangerously close to armed conflict (within 50 km) increased from 185 million women and 250 million children in 2000, to 265 million women and 368 million children in 2017. Women's and children's mortality risk from non-violent causes increases substantially in response to nearby conflict, with more intense and more chronic conflicts leading to greater mortality increases. More than 10 million deaths in children younger than 5 years can be attributed to conflict between 1995 and 2015 globally. Women of reproductive ages living near high intensity conflicts have three times higher mortality than do women in peaceful settings. Current research provides fragmentary evidence about how armed conflict indirectly affects the survival chances of women and children through malnutrition, physical injuries, infectious diseases, poor mental health, and poor sexual and reproductive health, but major systematic evidence is sparse, hampering the design and implementation of essential interventions for mitigating the harms of armed conflicts.

Figure 1. Geographical distribution of armed conflict events, 1989-2018, shown in log10 scale

Inset shows the number of countries in conflict in each year. Data are from the Uppsala Conflict Data Program.

Figure 2. Estimated number of children and women displaced by conflict, 2009-17

Figure 3. Women and children exposed to conflict within 50 km

The number and proportion of children (<18 years; panel A) and women (aged 18-49 years; panel B) living within 50 km of conflict in Africa, Asia (including the Middle East), and the Americas (Latin America and the Caribbean). The denominator is the total age-matched population in those three world regions.

Figure 4. Increase in risk of mortality in the first year of life for infants born within 50 km of armed conflict

The figure shows the increase in risk of mortality from having any nearby conflict (red bar), and the mortality risk from conflicts of increasing intensity (blue bars). Observed rate is the population average mortality rate. Error bars are 95% CI. Data for this analysis comes from 4·72 million births between 1995 and 2015 recorded in all Demographic and Health Surveys with cluster coordinates in 64 countries in the Americas, Africa, and Asia. Syria, Yemen, or South Sudan are not included in the mortality risk increase estimations (they were not geocoded in the Uppsala Conflict Data Program or Demographic and Health Surveys were not available), which might bias the effects downward. Compared with the original analysis,27 the effect size in Africa is higher (9·4%, vs 7·7% in the original analysis). Although these differences are not statistically significant, they are notable and result from additional Demographic and Health Surveys that were not available at the time of the 2018 analysis, and combined modelling that included data from Asia and the Americas.

Figure 5. Relationship of mortality among women of childbearing age and armed conflict within 50 km in Africa

The pooled effect of exposure to any conflict (in red), and the changing effect with exposure to conflicts below or above medial intensity (in green), and increasing deciles of conflict intensity (in blue) for the sample from Africa is based on 19·3 million women-years of observation in 33 African countries.Mortality and location of women was taken from index woman information in Demographic and Health Surveys.