Good Health May Make Modern Wars Less Deadly

A new study from the Human Security Report Project, The Shrinking Costs of War , finds that post-Cold War conflicts claim significantly fewer civilian and combatant lives. The principle reason for the decline in the number of deaths during war is good health practices and the immunization of children during peacetime.

"We believe that the costs of war, the deadliness of war, the number of people getting killed per conflict per year has gone down pretty dramatically," says Professor Andrew Mack, the director of the Project at the Simon Fraser University, which tracks trends in political violence.

In 1950, the estimated number of people killed, mostly in the Korean War, was 700,000. In 2007, the number of people killed around the world was less than 40,000.

In the fifties, the average war claimed 10,000 lives over the decade, but from 2000 to 2007 that number is 1000. "What we did here was we took the average number of battle deaths by decade," says Mack. "You can see there has been an extraordinary change."

One reason for the decline advanced by the report is the shift from large scale wars to small-scale insurgencies with better humanitarian assistance. Also in developing countries like Sudan, Uganda, Sri Lanka, India, Indonesia, and the Democratic Republic of Congo, warfare directly impacts relatively small areas of the national territory.

For instance, a review of 11 conflicts in sub-Saharan Africa found that, on average, serious violence affected only 12 percent of the territory of the country.

The critical finding of the study, however, is that mortality rates are under such a rapid decline that number of deaths in war cannot reverse the downward trend of the mortality rate.

The mortality rate of under-five children has been on a continuous decline in several countries that have seen prolonged wars including Ethiopia, Angola, Mozambique, Liberia and Sierra Leone, according to the study.

"The profound decline due to improved health conditions is in fact so powerful that the impact of these relatively small wars today is just not enough to reverse them," says Mack. "Immunization in peace times saves lives in war times."

The professor explains it is not uncommon for warring parties to allow "tranquility ceasefires" during active combat operations when health workers are allowed into rebel held areas to immunize children.

So, indirect deaths caused due to disease and malnutrition during war has gone down at a greater rate than the direct violent deaths. Breastfeeding, which has doubled in Sub-Saharan Africa protects children from diarrheal and respiratory infections, is another big safeguard against war.

The genocide in Rwanda remains an exception in the study. "Rwanda is sui generis. Rwanda is outside every single box. There is probably nothing like Rwanda in this century," Mack says, referring to the death of somewhere between 600,000 to 800,000 people in a couple of weeks with crude weapons and machetes.

The civil war between North Sudan and South Sudan that lasted 22 years, claimed 2 million lives and displaced 4 million people, is not explained in the report.

The Project points out that while the high death toll estimates in Iraq and Darfur have invited intense controversy, the DRC figures that 5.4 million people have died in since 1998 estimated by the International Rescue Committee, have slipped by without challenge.

The research center proposes that IRC was was way off, in calculating that 2.83 million lives were lost in DRC between 2000 and 2007, and puts the figure at 900,000 dead.

The study concludes that IRC's failure to take into account DRC's pre-war mortality rates and picking areas that are are representative of the entire country, punches holes in its survey. "The IRC was obviously not delighted with our study," Mack says.

The utility of a report that finds that modern wars cause fewer deaths is not quite clear. It has been funded by the British, Norwegian, Swedish and Swiss governments.

The professor argues that the main goal is to form an accurate evidence base for analysis and policy-making in war-impacted countries. "What the IRC's work and what some of the other work done in Iraq indicate is that we have a terrible evidence base," says Mack.

The report also highlights the success of the humanitarian groups and the global health business in achieving death prevention, according to its authors.

The full report can be read here.

addition after interview with Professor Les Roberts of Columbia University....

The IRC has rejected the findings of the Project on several grounds and stick to their original calculations and methodology.

"The IRC dismisses assertions in a research paper by the Human Security Report Project, that attempt to discredit large-scale mortality surveys in general and our Congo mortality studies in particular. We find the Human Security Report Project's study to be deeply flawed and its arguments undermined by internal inconsistencies and poor scholarship," the organization said.

The scientific editor of the first Human Security Report, Les Roberts who also helped author the initial IRC surveys noted that main finding of the report was flawed because the researchers had considered wars that were not major conflicts and a higher threshold would reverse the conclusion.

Roberts called the present report, "profoundly destructive on the way of defining crisis and monitoring crisis."

The professor defended the current method of gathering data called cluster surveys, which the new report seems to challenge. He described it as the "one of the most useful tools in monitoring health."

ADDED LATER an interview with Dr. Richard Brennan - who led and co-authored the last three reports of the IRC on DRC

Q) Do you have an objection with the claim that better health practices and immunization can lead to fewer deaths during war time?

I do not have an objection to the claim that improved humanitarian assistance CAN lead to fewer deaths during conflict. Improved medical care and public health services have been shown to reduce mortality in some conflict zones, provided that adequate security exists and there is access to humanitarian services. The science and practice of humanitarian assistance has definitely progressed in recent years. But it would be problematic to infer that this happens in all conflicts - as has been demonstrated in Rwanda, Iraq, etc.

Q) The report argues since the mortality rates are declining, the loss of lives during war time cannot reverse this trend- is this accurate?

"It is conceivable that this observation occurs in some conflicts - but erroneous to claim that it is a general rule."

Q) The report argues that unless you make an assessment of the mortality rate before the war -you cannot gauge the damage during the war accurately- is this correct?

It is important to have some measurements of mortality or other health indicators prior to the conflict ("baseline") to better evaluate the public health and human impact of conflict. This data is often difficult to obtain - hence, the need to sometimes make assumptions. IRC was always conservative in making such assumptions.

Q) Does it matter if 900,000 or 3 million have been killed? Why do the numbers matter- both are big numbers?

Obtaining the best estimate scientifically possible is important - to convey the scale of the disaster, to help guide policy and resource allocation, to inform humanitarian response, and to counter non-credible sources who may be propagating inaccurate numbers. The exact number is not the most important issue - but a scientifically valid estimate that describes the scale of the disaster is important. For example, prior to the IRC's first survey in 2000 (which estimated a death toll of 1.7 million), the New York Times reported that 100,000 people had died in DR Congo - but never gave the source of the estimate. It was very important for IRC to report that the true figure was closer to 1.7 million than to 100,000.

There will always be some imprecision with mortality estimates in conflict areas - that is why it is important to report the margin of error. Our best estimate for the period 1998 - 2007 was 5.4 million deaths - but our margin of error indicated that the number could have been as low as 3.0 million or as high as 7.6 million. The HSR reported a best estimate of closer to 2.8 million for the whole period - but did not present a margin of error. If they had, our estimates would have overlapped.

Q) Damage by the HSR report?

The HSR tries to give credence to a methodology that is widely criticized by field researchers. Those promoting this methodology are generally academics who have spent precious little time collecting data in conflict zones, unlike the IRC researchers and the experts who have advised us over the years.

The HSR has cast doubt on the value and credibility of mortality surveys generally. This is problematic, as such studies have provided invaluable information for guiding humanitarian response, resource allocation, and policy.

The HSR has contributed to doubt concerning the motives of humanitarian agencies trying to collect mortality data - thereby contributing to unhealthy skepticism and cynicism among some observers.

Q) The report argues that the IRC exaggerated the number of deaths in order to get attention to the issue. This is also a charge that has been made several times by developing countries against international organizations to get funds.....

Like all researchers, we always welcome constructive criticism of our studies. And we are not concerned when people question our methods, which we are always happy to debate in a collegial fashion. We do take issue, however, when people question our motives or ethics. Our motives were always humanitarian and never self serving.