Intended for healthcare professionals

Education And Debate

Armed conflict as a public health problem

BMJ 2002; 324 doi: (Published 09 February 2002) Cite this as: BMJ 2002;324:346
  1. C J L Murray, executive directora (,
  2. G King, professor of governmentb,
  3. A D Lopez, coordinator, epidemiology and burden of diseasea,
  4. N Tomijima, technical officer, epidemiology and burden of diseasea,
  5. E G Krug, director, injuries and violence preventionc
  1. a Evidence and Information for Policy, World Health Organization, 1211 Geneva 27, Switzerland
  2. b Center for Basic Research in the Social Sciences, Harvard University, Cambridge, MA, USA
  3. c Noncommunicable Diseases and Mental Health, World Health Organization, Geneva
  1. Correspondence to: C J L Murray

    Armed conflict is a major cause of injury and death worldwide, but we need much better methods of quantification before we can accurately assess its effect

    Armed conflict between warring states and groups within states have been major causes of ill health and mortality for most of human history. Conflict obviously causes deaths and injuries on the battlefield, but also health consequences from the displacement of populations, the breakdown of health and social services, and the heightened risk of disease transmission. Despite the size of the health consequences, military conflict has not received the same attention from public health research and policy as many other causes of illness and death. In contrast, political scientists have long studied the causes of war but have primarily been interested in the decision of elite groups to go to war, not in human death and misery.

    We review the limited knowledge on the health consequences of conflict, suggest ways to improve measurement, and discuss the potential for risk assessment and for preventing and ameliorating the consequences of conflict.

    Summary points

    Conflict related death and injury are major contributors to the global burden of disease

    Information systems break down during conflict, leading to great uncertainty in the magnitude of mortality and disability

    The World Health Survey may provide a reliable and valid basis for assessing conflict related mortality and disability

    Forecasting models may provide a plausible basis for assessing risk of conflict and thus prevention

    Improved collaboration between political scientists and experts in public health would benefit measurement, prediction, and prevention of conflict related death

    Assessing the public health impact of conflict

    The impact of war on populations arises both from the direct effects of combat—namely, battle deaths—and from the indirect consequences of war, which may occur for several years after a conflict ends.1 Indirect effects of conflict on mortality can be formally …

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