Recent research on the Darfur conflict identifies diseases as being the main cause of death since 2005 with displaced populations being the most susceptible. It further provides scientific basis for the number of excess deaths caused by the Darfur conflict between 2003 and 2008. The research also shows that any reduction in humanitarian assistance can cause mortality rates to increase, giving rise to serious concerns about the consequences that could arise from the last year's expulsion of humanitarian workers from Sudan by the country's president. The findings are reported in an Article in this week's Conflict Special Issue of The Lancet—written by Dr Olivier Degomme and Professor Debarati Guha-Sapir, Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium, and colleagues.
The authors say*:"In this study, we examine key conflict dynamics such as changes over time of crude and cause-specific mortality rates and we assess the effect of shifting levels of displacement on those rates. This is where this analysis differs from previous reports which mainly focussed on calculating excess deaths."
The authors gathered retrospective mortality surveys from an online database. They then used statistical models to assess mortality rates for five periods which were then applied to UN population data. Of the 107 mortality surveys analysed, 63 met all criteria for analysis. The results showed significant reductions in mortality rates from early 2004, the peak of the conflict when rates were eight to ten times higher than expected, to the end of 2008. The rates were however higher during a period of reduced deployment of humanitarian aid workers between July, 2006, and September, 2007. The authors say: "Our findings also suggest that more than 80% of excess deaths were not a result of the violence. These results are in agreement with studies of other conflicts in which initial mortality peaks were often related to a period of intense violence and subsequently high number of violence-related deaths, but the main causes of mortality during the stabilisation period were diseases such as diarrhoea." A further finding was that population displacement was associated with increased rates of deaths associated with diarrhoea, but also with reduction in violent deaths.
The exact number of estimated excess deaths depends on the baseline used. Using a baseline for Sudan of 0.3 deaths per 10,000 per day, the number of excess deaths is around 300,000; using the baseline for Sub-Saharan Africa, this decreases to 210,000.
The authors conclude: "The Darfur conflict shows a typical pattern of mortality rates with time, characterised by a peak in the number of violent deaths that is followed by a protracted phase of increased disease-related mortality rate. The phase particularly affects displaced individuals living in conditions of poor sanitary infrastructure, making them susceptible to diseases associated with diarrhoea. Adequate humanitarian assistance to prevent and treat these potentially fatal diseases is essential. The full effect of the expulsion of non-governmental organisations from Darfur is still not known, but the increased mortality rate during a period of reduced humanitarian deployment in 2006 suggests that we should fear the worst."
In an accompanying Comment, Dr Francesco Checchi, London School of Hygiene and Tropical Medicine, UK, says: "A reasonable aim for the next decade would be not only to greatly increase the coverage of essential health data in war-affected populations, but also to increase measurement of indicators such as mortality rate and nutritional status through prospective community surveillance. This approach provides real-time information for action, and should be encouraged. However, surveillance is prone to under-reporting; therefore, development of improved methods is a public health imperative."
Dr Olivier Degomme, Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium. T) +32 2 764 3327 E) olivier.degomme@uclouvain.be
Dr Francesco Checchi, London School of Hygiene and Tropical Medicine, UK. Contact by e-mail. E) Francesco.checchi@lshtm.ac.uk For full Article and Comment see: http://press.thelancet.com/darfur.pdf
Note to editors: *A quote direct from Dr Degomme and cannot be found in the text of the Article
Journal
The Lancet