People affected by conflict: humanitarian needs and numbers
Summary of report1
Location: Global
What we know: Conflict has humanitarian consequences.
What this report adds: Analyses of CRED Complex Emergency Database surveys indicate that displaced people and conflict affected residents are most adversely affected by conflict in terms of health and nutrition. Refugees have the lowest death rates and least bad nutrition/health indicators. National health data are unreliable guides to the health needs of people affected by conflict. Measles vaccination coverage is below target in most conflict affected populations, acute malnutrition is increasing and mortality is falling.
A recent report by Centre for Research on the Epidemiology of Disasters (CRED) documents the humanitarian needs and numbers of people affected by conflict (PAC). In 2012, it estimates 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.
Pakistan and Nigeria had the largest numbers of 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.
Detailed analyses of CE-DAT surveys2 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.
The report recommends that 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 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 conflict affected populations.
Looking at PAC health indicators, rather than national data, also changes the ranking of countries by need. 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, the report suggests that 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.
Causes of death in young children are overwhelmingly from preventable causes, including measles, diarrhoea, malaria, respiratory and other infectious diseases, plus malnutrition. Acute malnutrition is a growing problem in conflict-affected countries. DAT surveys show measles vaccine coverage is below the UNHCR target in every surveyed country except Kenya. To some extent, mortality is under control in most conflict-affected countries. While the report cannot give a full account why death rates are falling, it may be due to a lower intensity of conflicts that were of greatest concern a decade ago. Somalia is a notable exception.
1People affected by conflict: humanitarian needs and numbers (2013). CRED. http://www.cred.be/publications
2The Complex Emergency Database (CE-DAT) was launched within the SMART initiative and has been developed and is run by CRED at the Catholic University of Louvain. It is an international initiative to monitor and evaluate the health status of populations affected by complex emergencies. The database focuses on mortality and acute malnutrition – the most commonly used public health indicators of the severity of a humanitarian crisis. CE-DAT currently contains more than 3,300 epidemiological surveys from 51 countries.