In recent decades, there has been a significant increase in both the prevalence and outbreaks of infectious diseases. Technological improvements have enhanced our ability to collect data on these diseases. Experts can now examine variables that can influence complex infectious disease data, such as socioeconomic factors, demographics, culture, and environmental factors. One variable that needs further examination is the impact of armed conflict on disease outbreaks and outcomes.
CEID’s Patrick Stephens collaborated with a research team to examine how mechanisms of armed conflict (fatal organized violence) impact disease outbreaks. In recent decades, the number of armed conflicts has increased, as well as conflict-related fatalities. Previous research has touched upon armed conflicts having significant influence on infectious disease outbreaks in both the short and long term, but have yet to be further explored and quantified. These conflicts can have short term impacts due to increased risk of disease spread from overcrowding and poor sanitation. Medical interventions and responses to address infectious diseases, such as vaccination or surveillance, are also often disrupted during times of armed conflict. War can result in long term public health effects with the destruction of public health infrastructure and limited access to care. Increased disease burden during outbreaks reduces wealth due to decreased worker capacity and economic development, which leads to more conflict.
There are two ways to quantify the impact of armed conflict on disease: direct mortality and indirect mortality or morbidity. Direct mortality occurs when a violence-related event causes injury or death. Indirect mortality or morbidity is when the effects of war, such as unsanitary living conditions, overcrowding in confined spaces, and increased population movement, increase disease transmission and outbreaks. Widespread diseases such as cholera, malaria, pneumonia, tuberculosis, and respiratory diseases are more likely to spread in these conditions.
The team worked to incorporate armed conflict data into a framework and analyzed two opposing influences on outbreaks: reduced reporting and increased transmission. As public communication and health infrastructure breaks down during armed conflict, disease outbreaks are less likely to be reported. This lack of reporting can make outbreaks appear less severe or frequent. These opposing factors are important to consider when creating a framework examining the relationship between armed conflict and disease outbreaks.
The team compared data on outbreak frequency from Democratic Republic of Congo, Nigeria, Tanzania, and Zambia as these sub-Saharan countries have similar environments and economic conditions. Compared to the more peaceful countries of Tanzania and Zambia, the Democratic Republic of Congo and Nigeria have greater rates of armed conflict. The war-torn countries of Nigeria and the Democratic Republic of Congo had double the number of outbreaks, compared to Tanzania and Zambia. This study found that the frequency of disease outbreaks were significantly impacted by armed conflicts. This data highlights the importance of considering armed conflict as a driver of disease. This research can be utilized by other researchers to incorporate the influence of war in further disease ecology framework.
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By: Brenna Daly