Mortality Data in Service of Conflict-Affected Populations

  • Romesh Silva
  • Nobuko Mizoguchi


Silva and Mizoguchi tackle the serious challenge of obtaining data to describe mortality during and after armed conflict. The chapter starts by reviewing the changing nature of armed conflict and the implication of this for collecting data to guide public health interventions and humanitarian response. Distinguishing between the direct and indirect mortality effects of conflict, the authors showcase approaches to measuring mortality in war-affected societies, with examples, and review the strengths and limitations of these methods. They conclude by highlighting challenges for the global health community in producing high quality, timely and actionable mortality data.


  1. 1.
    Toole MJ, Waldman RJ. The public health aspects of complex emergencies and refugee situations. Annual Review of Public Health. 1997 May;18(1):283–312. Available from:
  2. 2.
    Murray CJL, Lopez AD. Armed conflict as a public health problem. British Medical Journal. 2002 Feb 9;324(7333):346–9. Available from:
  3. 3.
    International Institute for Strategic Studies. Armed conflict survey, 2017: the worldwide review of political, military and humanitarian trends in current conflicts. London, UK: International Institute for Strategic Studies. 2017 [cited 2018 5th November]. Available from:
  4. 4.
    Mokdad AH, Forouzanfar MH, Daoud F, Mokdad AA, Bcheraoui CE, Moradi-Lakeh, M et al. Global burden of diseases, injuries, and risk factors for young people’s health during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2016;387(10036):2383–401. Available from:
  5. 5.
    United Nations. Transforming our world: the 2030 agenda for sustainable development. New York, USA: United Nations. 2015 [cited 2018 5th November]. Available from:
  6. 6.
    Every Casualty Campaign. Charter for the recognition of every casualty of armed violence. London: Every Casualty Campaign. 2012 [cited 2017 19th June 19]. Available from: Accessed.
  7. 7.
    Torche F, Shwed U. The hidden costs of war: exposure to armed conflict and birth outcomes. Sociological Science. 2015;2:558–81. Available from:
  8. 8.
    Pinker, S. The better angels of our nature: The decline of violence in history and its causes. London, UK: Penguin Books Ltd; 2011.Google Scholar
  9. 9.
    Chaudoin S, Peskowitz Z, Stanton C. Beyond zeroes and ones: the severity and evolution of civil conflict. Rochester, NY: Social Sciences Research Network. 2013 [cited 2017 19th June]. Available from:
  10. 10.
    Spiegel PB, Checchi F, Colombo S, Paik E. Health-care needs of people affected by conflict: future trends and changing frameworks. Lancet. 2010; 375(9711):341–345. Available from:
  11. 11.
    United Nations High Commissioner for Refugees. UNHCR statistics: the world in numbers. [cited 2017 24th April]. Available from:
  12. 12.
    Guha-Sapir D, D’Aoust O. Demographic and health consequences of civil conflict. World Development Report 2011 background report. Washington D.C., USA: World Bank Group. 2010 [cited 2018 5th November]. Available from:
  13. 13.
    3RP regional refugee and resilience plan 2016–2017: 2016 annual report. 3RP; 2017. [cited 2018 5th November]. Available from:
  14. 14.
    Hanafi S, Hilal L, Takkenberg L. UNRWA and Palestinian refugees: from relief and works to human development. New York, USA: Routledge; 2014.Google Scholar
  15. 15.
    Rubenstein L, Brittle M. Responsibility for protection of medical workers and facilities in armed conflict. Lancet. 2010 Jan;375(9711):329–40. Available from:
  16. 16.
    Geneva Declaration Secretariat. Global burden of armed violence. Geneva: Geneva Declaration Secretariat. 2008 [cited 2017 19th June]. Available from:
  17. 17.
    Mikkelsen L, Phillips DE, AbouZahr C, Setel PW, de Savigny D, Lozano R, et al. A global assessment of civil registration and vital statistics systems: monitoring data quality and progress. 2015 Oct;386(10001):1395–406. Available from:
  18. 18.
    Checchi F, Roberts L. Documenting mortality in crises: what keeps us from doing better? PLoS Med. 2008 Jul 1;5(7):e146. Available from:
  19. 19.
    Tabeau E, Bijak J. War-related deaths in the 1992–1995 armed conflicts in Bosnia and Herzegovina: a critique of previous estimates and recent results. European Journal of Populations. 2005 Jun;21(2-3):187–215. Available from:
  20. 20.
    Nielsen J, Jensen H, Andersen PK, Aaby P. Mortality patterns during a war in Guinea-Bissau 1998–99: changes in risk factors? International Journal of Epidemiology. 2005 Dec 2;35(2):438–46. Available from:
  21. 21.
    Feikin DR, Adazu K, Obor D, Ogwang S, Vulule J, Hamel MJ, et al. Mortality and health among internally displaced persons in western Kenya following post-election violence, 2008: novel use of demographic surveillance. Bulletin of the World Health Organization. 2010 May 10;88(8):601–8. Available from:
  22. 22.
    The Sphere Project. Sphere handbook: humanitarian charter and minimum standards in disaster response. Bourton on Dunsmore, United Kingdom: Practical Action Publishing. 2011 [cited 2017 19th January]. Available from:
  23. 23.
    Bowden S, Braker K, Checchi F, Wong S. Implementation and utilisation of community-based mortality surveillance: a case study from Chad. Conflicts and Health. 2012;6(1):11. Available from:
  24. 24.
    United Nations High Commissioner for Refugees. Health information system (HIS) toolkit. Geneva: United Nations High Commissioner for Refugees. 2010 [cited 2017 13th January]. Available from:
  25. 25.
    United Nations High Commissioner for Refugees. Twine. Geneva: United Nations High Commissioner for Refugees. 2014 [cited 2017 13th January]. Available from:
  26. 26.
    World Health Organization. Outbreak surveillance and response in humanitarian emergencies: WHO guidelines for EWARN implementation. Geneva, Switzerland: World Health Organization. 2012 [cited 2017 13th January]. Available from:
  27. 27.
    Masquelier B, Silva R. Assessing UNHCR registration data as a source of mortality statistics for conflict-affected populations: A Yemeni case study. Working Paper Series, No. 1. Geneva, Switzerland: United Nations High Commissioner for Refugees; 2017. Google Scholar
  28. 28.
    Iraq Body Count. London: Iraq body count. 2017 [cited 2017 24th April]. Available from:
  29. 29.
    Davenport C, Ball P. Views to a kill: exploring the implications of source selection in the case of Guatemalan state terror, 1977–1995. Journal of Conflict Resolution. 2002;46(3):427–450. Available from: Scholar
  30. 30.
    Checchi F, Roberts L. Interpreting and using mortality data in humanitarian emergencies: a primer for non-epidemiologists. Network Paper Number 52. London, UK: Humanitarian Practice Network at ODI. 2005 [cited 2018 5th November]. Available from
  31. 31.
    The SMART Project. Measuring mortality, nutritional status, and food security in crisis situations: SMART methodology version 1. Toronto: The SMART Project. 2006 [cited 2017 23rd April]. Available from:
  32. 32.
    United Nations, Department of Economic and Social Affairs, Statistical Division. Handbook on the collection of fertility and mortality data. New York, USA: United Nations. 2004 [cited 2018 5th November]. Available from:
  33. 33.
    Working Group for Mortality Estimation in Emergencies. Wanted: studies on mortality estimation methods for humanitarian emergencies, suggestions for future research. Emerging Themes in Epidemiology. 2007;4(1):9. Available from: http://dx.doi.orf/10.1186/1742-7622-4-9
  34. 34.
    Coghlan B, Ngoy P, Mulumba F, Hardy C, Bemo VN, Stewart T, et al. Update on mortality in the Democratic Republic of Congo: Results From a third nationwide survey. Disaster Medicine and Public Health Preparedness. 2009 Jun;3(02):88–96. Available from:
  35. 35.
    Roberts B, Morgan OW, Sultani MG, Nyasulu P, Rwebangila S, Myatt M, et al. A new method to estimate mortality in crisis-affected and resource-poor settings: validation study. International Journal of Epidemiology. 2010 Nov 1;39(6):1584–96. Available from:
  36. 36.
    Jahn A, Mwinuka V, McGrath N, Fine PE, Branson K, Mwafilaso J, et al. Evaluation of a village-informant driven demographic surveillance system in Karonga, Northern Malawi. Demographic Research. 2007 Mar 23;16:219–48. Available from:
  37. 37.
    Stark L, Roberts L, Wheaton W, Acham A, Boothby N, Ager A. Measuring violence against women amidst war and displacement in northern Uganda using the “neighbourhood method.” Journal of Epidemiology & Community Health. 2009 Nov 24;64(12):1056–61. Available from:
  38. 38.
    Silva R, Price M. Trade-offs in using indirect sampling to measure conflict violence. Journal of the American Medical Association. 2011 Aug 3;306(5). Available from:
  39. 39.
    Heuveline P. Between one and three million: towards the demographic reconstruction of a decade of Cambodian history (1970–79). Population Studies. 1998;52(1):49–65. Available from:
  40. 40.
    Iraq Family Health Survey Study Group. Violence-related mortality in Iraq from 2002 to 2006. New England Journal of Medicine. 2008 Jul 24;359(4):431–4. Available from:
  41. 41.
    Burnham G, Lafta R, Doocy S, Roberts L. Mortality after the 2003 invasion of Iraq: a cross-sectional cluster sample survey. Lancet. 2006 Oct;368(9545):1421–8. Available from:
  42. 42.
    Silva R, Ball P. The demography of conflict-related mortality in Timor-Leste (1974–1999): reflections on empirical quantitative measurement of civilian killings, disappearances, and famine-related deaths. In: Asher J, Banks D, Scheuren FJ, eds. Statistical methods for human rights. New York, USA: Springer; 2008:117–139.Google Scholar
  43. 43.
    Brunborg H, Lyngstad TH, Urdal H. Accounting for genocide: how many were killed in Srebrenica? European Journal of Population. 2003;19(3):229–48. Available from:
  44. 44.
    Lacina B, Gleditsch NP. Monitoring trends in global combat: a new dataset of battle deaths. European Journal of Population. 2005 Jun;21(2-3):145–66. Available from:
  45. 45.
    Altare C, Guha-Sapir D. The complex emergency database: a global repository of small-scale surveys on nutrition, health and mortality. PLoS One. 2014 Oct 21;9(10):e109022. Available from:
  46. 46.
    Pedersen J, Liu J. Child mortality estimation: appropriate time periods for child mortality estimates from full birth histories. PLoS Medicine. 2012 Aug 28;9(8):e1001289. Available from:
  47. 47.
    Elamein M, Bower H, Valderrama C, Zedan D, Rihawi H, Almilaji K, et al. Attacks against health care in Syria, 2015–16: results from a real-time reporting tool. Lancet. 2017 Nov;390(10109):2278–86. Available from:
  48. 48.
    Pezzulo C, Bird T, Utazi EC, Sorichetta A, Tatem AJ, Yourkavitch J, et. al. Geospatial modelling of child mortality across 27 countries in sub-Saharan Africa. Rockville, US: ICF International; 2016. DHS Spatial Analysis Reports No. 13. [cited 2017 24th April]. Available from:
  49. 49.
    Galway L, Bell N, SAE A, Hagopian A, Burnham G, Flaxman A, et al. A two-stage cluster sampling method using gridded population data, a GIS, and Google EarthTM imagery in a population-based mortality survey in Iraq. International Journal of Health Geographics. 2012;11(1):12. Available from:
  50. 50.
    Hay SI, Noor AM, Nelson A, Tatem AJ. The accuracy of human population maps for public health application. Tropical Medicine and International Health. 2005 Oct;10(10):1073–86. Available from:

Copyright information

© The Author(s) 2019

Authors and Affiliations

  • Romesh Silva
    • 1
  • Nobuko Mizoguchi
    • 2
  1. 1.UNFPANew YorkUSA
  2. 2.Independent ResearcherWashington, DCUSA

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