Armed Conflicts and Health Impact - Is there an Overall Correlation Between Conflict Intensity and Health Outcomes in Contemporary Conflicts while Accounting for Vulnerability and Functioning of Healthcare Services?

Introduction: Armed conflict can be described as human development in reverse. Outside of the direct consequences of violence, there are numerous ways that an armed conflict may have indirect effects on people’s health and well being. Studies give varying results, and the health impact seems to differ from context to context. We aimed to determine how conflict intensity is associated with health outcomes, accounting for existing vulnerabilities and functioning of healthcare services in countries going through armed conflict. Methods: The study is based on panel data on conflict intensity, vulnerability, functioning of healthcare services, and health outcomes in 42 conflict-affected countries between 2000 and 2019, using fixed-effects panel regression analysis to determine the association between conflict intensity and health outcomes. Results: Conflict intensity was positively associated with the health outcomes included in this study. As the conflict intensity increased, the mortality and prevalence due to these outcomes also increased, albeit this was not statistically significant for half the outcomes (8/16). After adjusting for vulnerabilities and functioning of healthcare services, this positive association became significant for all the health outcomes. Vulnerabilities and functioning of healthcare services were stronger predictors of the outcomes. Sub-group analysis showed that conflict intensity was more significantly associated with outcomes in countries with high- and medium vulnerability scores. Conclusion: Existing vulnerabilities and the condition of healthcare systems are known to impact health outcomes. The association between conflict intensity and health outcomes strengthens when existing vulnerabilities and the state of healthcare services are considered. This underscores the importance of incorporating strategies to address socioeconomic inequities and strengthen healthcare system capacity in interventions for conflict-affected regions. It also raises additional concerns for the long-term negative health effects related to the increasing trend of attacks on health care in contemporary conflicts.