Effects of wars on the death toll in Africa

Universal Health Monitor, Year 1, Number 2, July 18th, 2024.

Andre Medici

The world is following closely with sadness the disasters associated to at least two recent wars: the cruel invasion of Ukraine by Russia and the Israel war against the Hamas terrorist group. But globally, most of the current wars are happening in Africa – the forgotten continent – where millions of deaths and massive health failures have been tragic for some of the world's poorest populations and Western society takes no notice.

The main consequences of recent wars in African Countries could be summarized as:

• High rates of death from violence, malnutrition, and disease outbreaks are common in conflict zones.
• Exposure to prolonged violence and instability has led to widespread psychological trauma and mental health disorders.
• Destruction and looting of health facilities have left large populations without access to essential healthcare services.
• Millions of people have been displaced, often living in overcrowded and unsanitary conditions that facilitate the spread of infectious diseases.
• Ongoing conflict exacerbates malnutrition and interrupts the management of chronic diseases, leading to long-term health issues.

Estimating the number of recent deaths due to wars and internal conflicts in African countries is challenging due to the lack of precise data and the ongoing nature of many conflicts. However, various reports and sources provide estimates that can help paint a picture of the human and health toll. Below are some estimates for several key conflict zones.

South Sudan

The civil war that began in 2013 is estimated to have caused approximately 400,000 deaths. This figure includes both direct violence and deaths from related causes such as malnutrition and disease. The conflict has severely disrupted healthcare services, leading to outbreaks of cholera, measles, and malaria.

Numerous hospitals and clinics have been destroyed or rendered non-operational due to direct attacks and looting. For instance, Médecins Sans Frontières (MSF) reported the destruction of their hospitals, significantly reducing the availability of essential medical services. The destruction of healthcare infrastructure has led to a lack of access to basic and emergency medical care. Malnutrition is rampant, especially among children, exacerbated by food insecurity and displacement.

Democratic Republic of the Congo (DRC)

Conflicts in the eastern DRC have resulted in millions of deaths over the past two decades. Estimates suggest that around 5.4 million people died between 1998 and 2007, primarily due to disease and malnutrition exacerbated by the conflict. Recent years continue to see significant casualties, although precise figures are hard to determine.

Outbreaks of diseases such as Ebola, measles, and cholera have been exacerbated by the instability and poor healthcare conditions.

Health facilities have frequently been targets of attacks and looting, further crippling the already weak healthcare system. The displacement of healthcare workers due to violence has led to a severe shortage of medical professionals. The health system's inability to respond effectively to disease outbreaks has led to high mortality rates from preventable diseases. Chronic malnutrition and psychological trauma are widespread, affecting long-term health outcomes.

Central African Republic (CAR)

The ongoing conflict in the CAR has resulted in thousands of deaths. Estimates suggest that between 2012 and 2017, around 5,000 to 6,000 people were killed. The situation remains unstable, with continued violence contributing to ongoing mortality.

Malaria, respiratory infections, and diarrheal diseases are prevalent due to poor living conditions and lack of medical care. Healthcare facilities have been destroyed or occupied by armed groups, severely limiting access to medical services. The country has one of the lowest ratios of healthcare workers to population, further strained by the conflict.

Displacement has forced people into overcrowded and unsanitary camps, increasing the spread of infectious diseases. The psychological impact of the conflict has led to high levels of trauma and mental health issues.

Nigeria (Northeast Region)

The Boko Haram insurgency and related conflicts in Northeast Nigeria have caused tens of thousands of deaths. Reports estimate that over 35,000 people have been killed since the insurgency began in 2009. Frequent outbreaks of diseases such as measles and cholera occur in displaced populations living in camps.

Health facilities have been destroyed, looted, or abandoned due to insecurity. The insurgency has led to the flight of healthcare workers, exacerbating the lack of medical care.  High rates of malnutrition and food insecurity persist among displaced populations. Limited access to maternal and child health services has increased mortality rates among women and children

Somalia

The conflict involving Al-Shabaab and other factions in Somalia has resulted in significant casualties. Estimates indicate that tens of thousands of people have died since the resurgence of violence in the mid-2000s. The exact number is difficult to pinpoint due to the fragmented nature of the conflict.

Libya

The civil war in Libya, which escalated following the 2011 NATO intervention and the fall of Muammar Gaddafi, has resulted in thousands of deaths. The ongoing conflict since 2014 has seen periodic escalations, with estimates suggesting several thousand deaths.

Ethiopia (Tigray Conflict)

The conflict in the Tigray region of Ethiopia, which began in November 2020, has led to a high number of casualties. Estimates vary widely, but some reports suggest tens of thousands of deaths. The conflict has also caused a humanitarian crisis, with widespread displacement and famine.

Sudan

Conflicts in Sudan, particularly in Darfur and South Kordofan, have resulted in significant casualties. The Darfur conflict alone is estimated to have caused around 300,000 deaths since it began in 2003.

Mozambique

The insurgency in the Cabo Delgado province of Mozambique, which began in 2017, has resulted in thousands of deaths. Estimates suggest that over 3,000 people have been killed in the conflict.

Summary of Estimates:

South Sudan: ~400,000 deaths, DRC: 5.4 million from 1998-2007 ongoing significant casualties, CAR: ~5,000-6,000 deaths (2012-2017), Nigeria (Northeast): >35,000 deaths, Somalia: Tens of thousands, Libya: Several thousand, Ethiopia (Tigray): Tens of thousands, Sudan (Darfur): ~300,000 deaths, Mozambique (Cabo Delgado): >3,000 deaths.