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Civil Wars Kill and Maim People—Long After the Shooting Stops

Published online by Cambridge University Press:  22 August 2003

Post Doctoral Fellow, Center for Basic Research in theSocial Sciences, 34 Krikland St., Harvard University, Cambridge, MA 02138 (
Professor of Political Science, Center for Political Studies, 426 Thompson Street, P.O. Box 1248, University of Michigan, Ann Arbor, MI 48106-1248 (
Dean Acheson Professor of International Relations, Department of Political Science, Yale University, New Haven, CT 06520 (


Political scientists have conducted only limited systematic research on the consequences of war for civilian populations. Here we argue that the civilian suffering caused by civil war extends well beyond the period of active warfare. We examine these longer-term effects in a cross-national (1999) analysis of World Health Organization new fine-grained data on death and disability broken down by age, gender, and type of disease or condition. We test hypotheses about the impact of civil wars and find substantial long-term effects, even after controlling for several other factors. We estimate that the additional burden of death and disability incurred in 1999, from the indirect and lingering effects of civil wars in the years 1991–97, was approximately equal to that incurred directly and immediately from all wars in 1999. This impact works its way through specific diseases and conditions and disproportionately affects women and children.We thank the Weatherhead Initiative on Military Conflict as a Public Health Problem, the Ford Foundation, and the World Health Organization, NIA (P01 17625-01), for financial support and Gary King, Thomas Gariepy, Melvin Hinich, Kosuke Imai, Roy Licklider, Jennifer Leaning, Greg Huber, Lisa Martin, Christopher Murray, Joshua Salomon, and Nicholas Sambanis for comments. Our data are available at and at the Virtual Data Center web site,, when it becomes operative.

© 2003 by the American Political Science Association

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Adeola Francis 1996 Military Expenditures, Health, and Education Armed Forces and Society 22 3 441-55Google Scholar
Ahlstram C. 1991 Casualties of Conflict: Report for the Protection of Victims of War Uppsala Department of Peace and Conflict, Uppsala University
Archer Dane Rosemary Gartner 1976 Violent Acts and Violent Times: A Comparative Approach to Postwar Homicide Rates American Sociological Review 41 4 937-63Google Scholar
Ball Nicole 1988 Security and Economy in the Third World Princeton, NJ Princeton University Press
Bates Robert H. 1999 Ethnicity, Capital Formation, and Conflict Working Paper No. 27. Cambridge, MA Harvard Center for International Development
Bracken Patrick Celia Petty 1998 Rethinking the Trauma of War London Save the Children
Braveman Paula Alan Meyers Thomas Schlenker Curt Wands 2000 Public Health and War in Central America War and Public Health Bary S. Levy Victor W. Sidel Washington, DC American Public Health Association 238-53
Bueno de Mesquita Bruce James Morrow Randolph Siverson Alastair Smith 1999 An Institutional Explanation of the Democratic Peace American Political Science Review 93 4 791 807Google Scholar
Prevention 1992 Famine-Affected, Refugee, and Displaced Populations: Recommendations for Public Health Issues Morbidity and Mortality Weekly Report 41 RR-13 1 76Google Scholar
Collier Paul 1999 On the Economic Consequences of Civil War Oxford Economic Papers 51 168-83Google Scholar
Collier Paul Anke Hoeffler 2000 Greed and Grievance in Civil War Policy Research Paper 2355. Washington, DC World Bank
Collier Paul Anke Hoeffler 2001 Regional Military Spillovers Paper for the Annual Bank Conference on Development Economics Washington, DC World Bank
Collier Paul Anke Hoeffler 2002 On the Incidence of Civil War in Africa Journal of Conflict Resolution 46 1 13 28Google Scholar
Dasgupta Partha 1993 An Inquiry into Well-Being and Destitution New York Oxford University Press
Davis David Joel Kuritsky 2002 Violent Conflict and Its Impact on Health Indicators in Sub-Saharan Africa, 1980 to 1997. Paper presented at the annual meeting of the International Studies Association New Orleans, LA
DeRouen Karl 2000 The Guns-Growth Relationship in Israel Journal of Peace Research 37 1 69 84Google Scholar
Dixon William Bruce Moon 1989 Domestic Political Conflict and Basic Needs Outcomes: An Empirical Assessment Comparative Political Studies 22 2 178-98Google Scholar
Doyle Michael Nicholas Sambanis 2000 International Peacebuilding: A Theoretical and Quantitative Analysis American Political Science Review 94 4 779 803Google Scholar
Elbadawi Ibrahim Nicholas Sambanis 2002 How Much War Will We See? Explaining the Prevalence of Civil War Journal of Conflict Resolution 46 3 307-34Google Scholar
Epstein Helen 2001 AIDS: The Lesson of Uganda New York Review of Books 48 11 18 23Google Scholar
Evans David B. Tandon Ajay Murray Christopher J. L. Lauder Jeremy A. 2000a The Comparative Efficiency of National Health Systems in Producing Health: An Analysis of 191 Countries GPE Discussion Paper No. 29. Geneva World Health Organization
David B. Evans L. Bendib A. Tandon J. Lauer S. Ebenezer W. R. C. Hutubessy Y. Asada L. C. J. Murray 2000 Estimates of Income Per Capita, Literacy, Educational Attainment, Absolute Poverty, and Income Gini Coefficients for the World Health Report 2000 Global Programme on Evidence for Health Policy Discussion Paper No. 7 Geneva World Health Organization
Richard Feachem Dean Jamison Eduard Bos 1991 Changing Patterns of Disease and Mortality in Sub-Saharan Africa Disease and Mortality in Sub-Saharan Africa Richard Feachem Dean Jamison New York Oxford University Press
Deon Filmer Lant Pritchett 1999 The Impact of Public Spending on Health: Does Money Matter? Social Science & Medicine 49 4 1309-23Google Scholar
Foege William 2000 Arms and Public Health: A Global Perspective War and Public Health Levy Barry S. Sidel Victor Washington, DC American Public Health Association
Garrett Laurie 2001 The Return of Infectious Disease Plague and Politics Price-Smith Andrew T. New York Palgrave
Frederico Gerosi Gary King 2002 Short Term Effects of War Deaths on Public Health in the U.S. Working paper Cambridge, MA Harvard Center for Basic Research in the Social Sciences
Hazem Ghobarah Paul Huth Bruce Russett Gary King 2001 The Comparative Political Economy of Human Misery and Well-Being Paper presented at the annual meeting of the American Political Science Association San Franciso, CA
Goldstein Joshua 2001 War and Gender: How Gender Shapes the War System and Vice Versa New York Cambridge University Press
L. M. Grobar S. Gnanaselvam 1993 The Economic Effects of the Sri Lankan Civil War Economic Development and Cultural Change 41 2 395 405Google Scholar
Ted Robert Gurr 1993 Minorities at Risk: A Global View of Ethnopolitical Conflict Washington, DC United States Institute of Peace
Ted Robert Gurr 2000 Peoples Versus States: Minorities at Risk in the New Century Washington, DC United States Institute of Peace
Per Gustafson Victor Gomes Cesaltina Veiira Henrik Jaensen Seng Remonie Renee Norberg Badara Samb Anders Naucler Peter Aaby 2001 Tuberculosis Mortality during a Civil War in Guinea-Bissau Journal of the American Medical Association 286 5 599 603Google Scholar
Caroline Hartzell Matthew Hoddie Donald Rothchild 2001 Stabilizing the Peace After Civil Wars International Organization 55 1 183 208Google Scholar
Havard Hegre Tanja Ellingsen Scott Gates Nils PetterGleditsch 2001 Toward a Democratic Civil Peace? Democracy, Political Change, and Civil War, 1816–1992 American Political Science Review 95 1 33 48Google Scholar
Donald Horowitz 1985 Ethnic Groups in Conflict Berkeley University of California Press
David Lake Matthew Baum 2001 The Invisible Hand of Democracy: Political Control and the Provision of Public Services Comparative Political Studies 34 6 587 621Google Scholar
Roy Licklider 1995 The Consequences of Negotiated Settlements in Civil Wars, 1945–1993 American Political Science Review 89 3 681 90Google Scholar
Zeev Maoz Bruce Russett 1993 Normative and Structural Causes of Democratic Peace, 1946–1986. American Political Science Review 87 3 624-38Google Scholar
Colin Mathers Ritu Sadana Joshua Salomon Christopher Murray Alan Lopez 2000 Estimates of DALE for 191 Countries: Methods and Results Global Programme on Evidence for Health Policy Working Paper No. 16. Geneva World Health Organization
Alex Mintz 1989 Guns versus Butter American Political Science Review 83 4 1285-93Google Scholar
Nancy Mock Ellen Mathys 2002 Conflict and HIV: A Framework for Risk Assessment to Prevent HIV in Conflict Settings Paper presented at the annual meeting of the International Studies Association New Orleans, LA
Bruce Moon 1991 The Political Economy of Basic Human Needs Ithaca, NY Cornell University Press
Bruce Moon William Dixon 1992 Basic Needs and Growth-Welfare Tradeoffs International Studies Quarterly 36 2 191 212Google Scholar
Anna-Barbara Moscicki Nancy Hill Steve Shiboski Kim Powell Naomi Jay Evelyn Hanson Susana Miller Lisa Clayton Sepideh Farhat Jeanette Broening Teresa Darragh Joel Palefsky 2001 Risks for Incident Human Papillomavirus and Low-Grade Squamous Intrepithelial Lesion Development in Young Females Journal of the American Medical Association 285 23 2995 3002Google Scholar
James Murdoch Todd Sandler 2002 Economic Growth, Civil Wars, and Spatial Spillovers Journal of Conflict Resolution 46 1 91 110Google Scholar
Christopher Murray Alan Lopez 1996 The Global Burden of Disease Cambridge, MA Harvard School of Public Health on behalf of the World Health Organization and World Bank
Christopher Murray Alan Lopez 2000 Progress and Directions in Refining the Global Burden of Disease Approach: A Response to Williams Health Economics 9 1 69 82Google Scholar
Mancur Olson 1993 Dictatorship, Democracy, and Development American Political Science Review 87 3 567-76Google Scholar
Duncan Pederson 2002 Political Violence, Ethnic Conflict and Contemporary Wars: Broad Implications for Health and Well-Being Social Science and Medicine 55 2 175 90Google Scholar
J. P. Pouillier P. Hernandez 2000 Estimates of National Health Accounts: Aggregates for 191 Countries in 1997 GPE Discussion Paper No. 26. Geneva World Health Organization
Andrew T. Price-Smith 2002 The Health of Nations: Infectious Disease, Environmental Change, and Their Effects on National Security and Development Cambridge, MA MIT Press
Lant Pritchett Lawrence Summers 1996 Wealthier Is Healthier Journal of Human Resources 31 4 841-68Google Scholar
Adam Przeworski Michael Alvarez Cheibub Jose Antonio Fernando Limongi 2000 Democracy and Development: Political Institutions and Well-Being in the World, 1950–1990 Cambridge Cambridge University Press
Patrick Regan 2000 Civil Wars and Foreign Powers Ann Arbor University of Michigan Press
Elizabeth Reid 1998 A Future, If One Is Still Alive: The Challenge of the HIV Epidemic Hard Choices: Moral Dilemmas in Humanitarian Intervention Jonathan Moore Lanham, MD Rowman & Littlefield 269-86
Marta Reynal-Querol 2002 Ethnicity, Political Systems, and Civil Wars Journal of Conflict Resolution 46 1 29 54Google Scholar
Les Roberts Charles Hale Fethi Belyakdoumi Laiura Cobey Roselida Ondeko Michael Despines John Keys 2001 Mortality in Eastern Democratic Republic of Congo Atlanta, GA International Rescue Committee
Nicholas Sambanis 2001 Do Ethnic and Nonethnic Civil Wars Have the Same Causes? A Theoretical and Empirical Inquiry (Part I) Journal of Conflict Resolution 45 3 259-82Google Scholar
Nicholas Sambanis 2002 A Review of Recent Advances and Future Directions in the Literature on Civil War Defence and Peace Economics 14 3 215 43Google Scholar
Amartya Sen 1981 Poverty and Famine New York Oxford University Press
Ghanshyam Shah 1997 Public Health and Urban Development: The Plague in Surat London Sage
J. David Singer Melvin Small 1994 Correlates of War Project: Data on Civil Wars, 1816–1992 Ann Arbor Inter-university Consortium for Political and Social Research, University of Michigan, No. 9905
Harvey Starr Thomas G. Dale 2002 The ‘Nature’ of Contiguous Borders: Ease of Interaction, Salience, and the Analysis of Crisis International Interactions 28 3 213-35Google Scholar
Arthur A. Stein 1980 The Nation at War Baltimore, MD Johns Hopkins University Press
Arthur A. Stein 1980 Evaluating War: Outcomes and Consequences Handbook of Political Conflict Ted Robert Gurr New York Free Press
F. Stewart 1993 War and Underdevelopment: Can Economic Analysis Help Reduce the Costs? Journal of International Development 5 4 357-80Google Scholar
Simon Szreter 2001 Economic Growth, Disruption, Deprivation, Disease, and Death Plague and Politics Andrew T. Price-Smith New York Palgrave
Charles L. Taylor Hudson Michael C. 1972 World Handbook of Political and Social Indicators 2nd ed. New Haven, CT Yale University Press
Michael J. Toole 1997 Complex Emergencies: Refugee and Other Populations The Public Health Consequences of Disasters Eric Noji New York Oxford University Press
Michael J. Toole 2000 Displaced Persons and War War and Public Health Levy Barry S. Sidel Victor W. Washington, DC American Public Health Association
United Nations 1998 World Urbanization Prospects: The 1996 Revision New York United Nations
Tatu Vanhanen 1999 Domestic Ethnic Conflict and Ethnic Nepotism: A Comparative Analysis Journal of Peace Research 36 1 55 73Google Scholar
Tatu Vanhanen 2000 A New Data Set for Measuring Democracy, 1810–1998 Journal of Peace Research 37 2 251-65Google Scholar
Peter Wallensteen Margareta Sollenberg 2000 Armed Conflict, 1989–99 Journal of Peace Research 37 5 635-50Google Scholar
Walter Barbara 2002 Committing to Peace Princeton, NJ Princeton University Press
Michael D. Ward Gleditsch Kristian S. 2002 Location, Location, Location: An MCMC Approach to Modeling the Spatial Context of War and Peace Political Analysis 10 244-60Google Scholar
Richard Wilkinson 1996 Unhealthy Societies: The Afflictions of Inequality New York Routledge
Alan Williams 1999 Calculating the Global Burden of Disease: Time for a Strategic Reappraisal? Health Economics 8 1 1 8Google Scholar
World Health Organization (WHO) 2000 The World Health Report 2000: Health Systems: Improving Performance Geneva World Health Organization
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