CHAPTER 2 The consequences of conflict

1 Countries suffer from many differentconsequences of violent conflict. Violentconflict kills people in different ways although it is often difficult to estimate howmany. Civilians and soldiers are killed incombat; people die because of a higherprevalence of diseases; and people arekilled because of an increase in violentcrime. Wars force mass migration. Countriesthat have experienced violent conflict alsoface a high risk of renewed conflict. Conflictalso has economic consequences . It leads tounemployment and loss of income owing to disruption of economic activity, destruc-tion of infrastructure, uncertainty, increasedcost of doing business, and capital , social spending is often cut toaccommodate increased military spending,and the economy undergoes structuralchanges.

2 Dealing with the consequences ofviolent conflict is a humanitarian imperative;but it is also important because it decreasesthe risk of the conflict CHAPTER examines the social andeconomic consequences of conflict. Social consequences Mortality levels The literature distinguishes between battledeaths combatants and civilians killedduring military operations and total wardeaths which include battle deaths anddeaths from disease, starvation, malnutri-tion, and deathsBetween 1960 and 2005, about millionbattle deaths were recorded in state-basedarmed conflicts worldwide. Figure this total down by region. About battle deaths about 24 percent ofthe global total were recorded in Africa;and about million 54 percent of thetotal in these aggregate numbers, thequestion is: who is killed in militaryoperations?

3 Murray et al(2002) examine theage and sex distribution of battle to their data, men aged 15 29 aremost likely to be killed, but women make upnearly a quarter of all battle deaths. Theirestimates also suggest that battle deaths arealmost equally split between military andcivilian war deathsTable presents data on battle deaths andtotal war deaths for some African wars. Thepercentage of battle deaths in total deaths isgenerally low, ranging from about 3 percentto 30 percent. Although this is a large range,these numbers indicate that deaths frommilitary operations usually constitute only asmall proportion of total war of total war deaths have largemargins of error and no comprehensivedataset exists to total war deaths is a difficultexercise. A number of epidemiologicalstudies have attempted to do so usingCHAPTER 2 The consequences of conflict(C) AfricanBank 2008 Ch2 8/4/09 12:52 Page 11household surveys which are difficult orimpossible to carry out in war zones.

4 Thesemicro surveys, usually carried out towardsthe end of a war or once the war is over, relyon recalled data. One example is the workby Coghlan et al(2006), in which theresearchers try to estimate the number ofdeaths from the war in the DemocraticRepublic of Congo during 1998-2004. Theestimated total death toll was about , making the war the deadliest warsince the end of World War II (Coghlan et al2006). The latest estimates (as of mid-2008)put the estimated war death toll (excludingbattle deaths) at million. Legacy effectsWars affect people s lives long after thefighting has stopped. Wars do not only kill,they also cause disability due to injury orincreased disease burden. One of the diseasesthat affects Africa disproportionately isHIV/AIDS. The disease is contracted throughsexual transmission or contamination of a person s blood with the virus (throughneedle transmission, for example).

5 Buv ,Bishikwabo-Nsarhaza, and Mutangadura(2002) provide an overview of the spread andeffect of HIV-1 infection in sub-SaharanAfrica. By the end of 2001, the HIV-1 adult12 African Development Report 2008/2009 Figure : Battle deaths, 1960 2005 Source: UCDP/PRIO armed conflict (C) AfricanBank 2008 Ch2 8/4/09 12:52 Page 12prevalence rate in the region was estimated percent. Estimated prevalence rates forother regions were much lower: theCaribbean region had the second highestprevalence rate of percent, while all otherregions had prevalence rates of less than 1percent. The discussion on why Africa ismore severely affected than any other regionfocuses on two explanations: war andpoverty. Wars are conducive to the rapidspread of HIV. Soldiers facing the risk oflosing their lives weigh the risks ofcontracting HIV against stressful situationsand dangers related to war.

6 Civilians are oftensubjected to human rights abuses, includingsexual violence. Some women find them-selves in abject poverty, which may lead themto use commercial sex to survive. In general,displacement during war weakens socialcohesion and relationships which maylead to promiscuity. As stated above, povertyis another reason for the high prevalencerates. Poverty seems to increase the genderimbalance. Although women are more at risk of contracting HIV, it seems that theycannot demand condom use from theirpartners. Buv , Bishikwabo-Nsarhaza andMutangadura (2002) conclude that popula-tions in many parts of Africa are becomingtrapped in a vicious HIV-poverty cycle. War also leaves people of the victims of civil war are civilians,who are subjected to, or witness, war-related traumatic events such as shootings,The consequences of conflict 13 Table.

7 Battle and total war deaths in selected African countriesCountry Period Battle DeathsTotal Deaths Algeria1991 200290,200 Angola 1975 2002 160, million Burundi1990 20026750200,000 Congo, Brazzaville1993 20029791 DRC 1998 2008 million*Egypt1992 981347 Guinea-Bissau1998 99 1,850 Liberia1989 9623500150000 200000 Morocco 1975 8913,000 Mozambique1967 92145, 1 million Nigeria1967 7075,000500,000 2 million Sierra Leone1991 200012,997 Uganda1981 91107700 * This figure excludes battle deaths. Sources: Lacina and Gleditsch (2005); Coghlan et al (2006); UCDP/PRIO armed conflict dataset; and Human SecurityBrief (2007).

8 (C) AfricanBank 2008 Ch2 8/4/09 12:52 Page 13killings, rape, torture and murder of familymembers. A random household survey ofresidents and internally displaced persons inFreetown, the capital of Sierra Leone, in1999, showed that almost every respondenthad been exposed to conflict. Fifty percentof the respondents had lost someone closeto them, and 41 percent had actuallywitnessed the death of this person. Torturehad been witnessed by 54 percent,executions by 41 percent, amputations by 32percent, and public rape by 14 percent. Thewitnessing of such events can lead to seriouspsychological stress. War ruins a country s economy,including the health sector. Post-conflictgovernments have insufficient revenues tospend on the health sector, which facesenormous demand. Yet, donors are oftenreluctant to fund improvements in the healthsector until they are certain that peace canbe sustained.

9 Regional spillover effects due todiseaseMost of the total war deaths are attributableto communicable diseases and not toviolence. Nationwide public health pro-grammes for disease control and preventioncannot be carried out during civil war. Thishas implications for the health of the citizensin the country at war; however, the negativehealth effects of civil war go beyondborders. For example, Uganda has notreported any wild cases of polio since 1996,but it has to continue mass immunizations inborder regions for fear that the disease willspill over from sudan and the DemocraticRepublic of Congo (Wendo, 2002).A further well documented example ofcivil war being a major impediment to theeradication of endemic diseases is the caseof Dracunculiasis, or Guinea worm worldwide campaign to eradicatedracunculiasis began at the Centers forDisease Control and Prevention in 1980.

10 Atthat time, there were an estimated cases in more than 20 Africancountries. Thanks to the regional eradicationprogram the incidence of the disease wasreduced by 98 percent. Most of theremaining patients were in Southern Sudanbecause the campaign could not becompleted during the civil war in the the temporary Guinea Worm Cease-Fire in 1995, health workers were able todistribute cloth water filters to villagers aspart of the regional eradication distribution of more than 200,000 filterswas considered a tremendous of filters continued after thetemporary cease-fire. It was estimated at thetime that it would take three to five years tocompletely eradicate dracunculiasis after the end of the war. Until then, the cost of the disease to sudan and her neighbourswould be substantial: About $2 million peryear to maintain the eradication programmein sudan , and the cost of maintainingsurveillance to detect cases exported fromsouthern sudan to other regions of thecountry and to neighbouring countries.