In 2012, we estimate that more than 172 million people were affected by conflict worldwide. Of this total, 149 million or 87% were conflict-affected residents (CARs). Internally displaced persons (IDPs) accounted for another 18 million and refugees for five million. The global total is higher because our figures only include 24 countries for which comparable and validated data are available.
Pakistan and Nigeria had the largest numbers of people affected by conflict (PAC) - at 28 million and nearly 19 million respectively - but Libya and Somalia had the largest proportion of their populations affected by violence and insecurity, at around 90% each.
These numbers represent the first systematic attempt to produce objective and comparable figures for all PAC. Our methods are transparent and reproducible over time and across countries, and our results are designed to be sufficiently detailed to be useful to decision-makers, policy advisors and members of the public alike.
Detailed analyses of CE-DAT surveys demonstrate that an individual’s health is directly related to their status as a CAR, IDP or refugee:
IDPs suffer the worst health impacts of conflict. They and their children are almost twice as likely as refugees to die from conflicted-related causes, particularly disease and starvation. IDPs also suffer the highest rates of acute malnutrition and are half as likely as refugees to be immunised against measles.
CAR adults and children suffer significantly higher death rates than refugees, and significantly higher acute malnutrition too. They have equally poor immunization rates to IDPs.
Refugees have the lowest death rates of all three PAC groups. They also have the lowest rates of acute malnutrition and the highest level of immunisation against measles.
We find this an unacceptable level of inequality among victims of conflict. In order to rectify it, we think IDPs should be a higher priority for the humanitarian community and that the specific health needs of CARs should not be overlooked.
CE-DAT surveys also demonstrate that national health data are unreliable guides to the health needs of PAC. The three basic indicators of health (mortality, malnutrition and measles vaccination) are rarely the same for national and conflictaffected populations. Nor is it safe to assume that PAC health is always worse. Indeed, in some countries it is better. In South Sudan, for example, national data fails to reflect reality on the ground and small-scale CE-DAT surveys are a far better guide to health needs.
Looking at PAC health indicators, rather than national data, also changes the ranking of countries by need. These changes are sometimes dramatic. Yemen, for example, jumped from 10th place to the top of our list when the focus was PAC child mortality, rather than national death rates. For childhood malnutrition, Djibouti rose to second place from 11th, while Kenya climbed ten places.
For all these reasons, needs-based decision-making about humanitarian aid should not be based on national estimates of mortality or malnutrition. Small-scale surveys are a better source of timely and accurate information. Better use of this data resource should be made for needs assessment and funding appeals.
With regard to measles - a highly contagious viral disease - it remains one of the leading causes of death among children affected by conflict, even though a safe and cost-effective vaccine is available. CE-DAT surveys show measles vaccine coverage is below the UNHCR target in every surveyed country except Kenya. By involving local communities, it is possible to design locally-managed and remotely-supervised programmes to improve coverage even in places too dangerous for health workers to visit.
CE-DAT data show that, to some extent, mortality is under control in most conflict-affected countries. While we cannot give a full account why death rates are falling, we believe it is largely due to a lower intensity of conflicts that were of greatest concern a decade ago. Somalia is a notable exception.
It is important to note, however, that the causes of death in young children are overwhelmingly from preventable causes, including measles, diarrhea, malaria, respiratory and other infectious diseases, plus malnutrition. Thus, despite recent progress, all populations in surveyed countries remain a concern.
With regard to nutrition, CE-DAT surveys send a clear warning that acute malnutrition is a growing problem in conflict-affected countries. Unless action is taken, this is likely to result in increased deaths within two to three years. In the Horn of Africa, we think emergency responses need to be quicker and more effective. Famine alert systems exist and work well, but the warnings they sound must get better responses.