The Health Costs of Civil Conflict

Crippa, Andrea and d'Agostino, Giorgio and Dunne, J. Paul and Pieroni, Luca and Tian, Nan (2026): The Health Costs of Civil Conflict.

Abstract

This paper considers the health consequences of civil conflict . It undertakes a cross-national analysis of the World Health Organisation's (WHO)'s disability-adjusted life years (DALY) dataset for 2020. The log of the DALYs is regressed on measures of conflict experience over the ten previous years, allowing for political and economic factors and spillovers from neighbour’s conflicts. This is done by using a non linear model and principal components estimation procedures. Substantial and significant effects are found. This supports earlier notions that civil war disproportionally affects children and young people. Robustness checks are made for different measurements of conflict experience, reflecting conflict intensity and persistence and these strengthen the conclusion that the legacy costs of a civil conflict are substantial and longlasting.

• Item Type: MPRA Paper
• Language: English
• Keywords: Civil war; public health; disability-adjusted life year
• Subjects: D - Microeconomics > D7 - Analysis of Collective Decision-Making > D74 - Conflict ; Conflict Resolution ; Alliances ; Revolutions; I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy ; Regulation ; Public Health

References

Anderton, C. H. and Carter, J. R. (2009). Principles of conflict economics: A primer for social scientists.

Blattman, C. and Miguel, E. (2010). Civil war. Journal of Economic Literature, 48(1):3–57.

Buhaug, H., Cederman, L., and Gleditsch, K. S. (2014). Square pegs in round holes: inequalities, grievances and civil war. International Studies Quarterly, 58:418–431.

Carballo, M. and Solby, S. (2001). Hiv/aids, conflict and reconstruction in sub-saharan africa. Paper presented at the conference on Preventing and Coping with HIV/AIDS in Post-Conflict Societies: Gender Based Lessons from Sub-Saharan Africa.

Charalampous, Periklis, et all. (2022). Burden of non-communicable disease studies in europe: a systematic review of data sources and methodological choices. European Journal of Public Health, 32(2):289–296.

Cramer, C. (2006). Civil war is not a stupid thing: Accounting for violence in developing countries. Hurst and Company.

Crippa, A., d’Agostino, G., Dunne, J., and Pieroni, L. (2025). The price of war: A cross-country analysis on the conflict-growth nexus. World Development, 195:107087.

de Groot, O. J. (2010). The spillover effects of conflict on economic growth in neighbouring countries in africa. Defence and Peace Economics, 21(2):149–164.

De Mesquita, B. B., Smith, A., Siverson, R. M., and Morrow, J. D. (2005). The logic of political survival. MIT press.

Devleesschauwer, B., Charalampous, P., Gorasso, V., Assuno, R., Hilderink, H., Idavain, J., Lesnik, T., Santric-Milicevic, M., Pallari, E., Pires, S. M., Plass, D., Wyper, G. M. A., Von der Lippe, E., and Haagsma, J. A. (2024). Standardised reporting of burden of disease studies: the strobod statement. Population Health Metrics, 22(1).

Dunne, J. P. (2013). Armed Conflicts. Global Problems, Smart Solutions Costs and Benefits. Cambridge University Press, Cambridge.

Dunne, J. P. and Tian, N. (2016). Determinants of civil war and excess zeroes. Working Paper 191, University of Cape Town.

Dunne, J. P. and Tian, N. (2019). Costs of civil war and fragile states in africa. Review of Development Economics, (23).

Elbe, S. (2002). Hiv/aids and the changing landscape of war in africa. International Security, 27(2):159–177.

Emadi, M., Delavari, S., and Bayati, M. (2021). Global socioeconomic inequality in the burden of communicable and non-communicable diseases and injuries: an analysis on global burden of disease study 2019. BMC Public Health, 21(1).

Foege, W. H. (2000). Arms and public health: a global perspective. pages 1–18.

Garrett, L. (2001). The collapse of global public health and why it matters for new york. Journal of urban health, 78(2):403–409.

Ghobarah, H. A., Huth, P., and Russet, B. (2003). Civil wars kill and maim people long after the shooting stops. American Policial Science Review, 97(2):189–202.

Guha-Sapir, D. and Van Panhuis, W. (2002). Mortality risks in recent civil conflicts: a comparative analysis. Center for Research on the Epidemiology of Disaster, Brussels.

Hoeffler, A. and Reynal-Querol, M. (2003). Measuring the costs of conflict. Washington, DC: World Bank.

Ikegami, M. and Wang, Z. (2023). Does military expenditure crowd out health-care spending? cross-country empirics. Quality & quantity, 57(2):1657–1672.

Lake, D. A. and Baum, M. A. (2001). The invisible hand of democracy: political control and the provision of public services. Comparative political studies, 34(6):587–621.

Murray, C. J. and Acharya, A. K. (1997). Understanding dalys. Journal of health economics, 16(6):703–730.

Olson, M. (1993). Dictatorship, democracy, and development. American political science review, 87(3):567–576.

Petersson, T. and Wallensteen, P. (2015). Armed conflicts, 1946-2014. Journal of Peace Research, 52(4):536–550.

Przeworski, A. (2000). Democracy and development: Political institutions and well-being in the world, 1950-1990. Number 3. Cambridge University Press.

Roberts, L., Charles, H., Belyakdoumi, F., Cobey, L., Ondeko, R., Despines, M., and Keys, J. (2001). Mortality in Eastern Democractic Republic of Congo. International Rescue Committe. Oxford University Press, Atlanta, GA.

Rustad, S. (2025). Conflict trends: A global overview, 1946–2024. PRIO Paper 2025.

Salehyan, I. and Gleditsch, K. S. (2006). Refugees and the spread of civil war. International organisation, 60(2):335–366.

Spangaro, J., Toole-Anstey, C., MacPhail, C. L., Rambaldini-Gooding, D. C., Keevers, L., and Garcia-Moreno, C. (2021). The impact of interventions to reduce risk and incidence of intimate partner violence and sexual violence in conflict and post-conflict states and other humanitarian crises in low and middle income countries: a systematic review. Conflict and health, 15(1):86.

Toole, M. J. (1997). Complex emergencies: Refugees and other populations. The Public Health Consequences of Disasters. Oxford University Press, New York.

UNDP (2025). The impact of the conflict on syria. Technical report, United Nations Development Programme.

Vesco, P., Baliki, G., Brück, T., Döring, S., Eriksson, A., Fjelde, H., Guha-Sapir, D., Hall, J., Knutsen, C. H., Leis, M. R., et al. (2025). The impacts of armed conflict on human development: A review of the literature. World Development, 187:106806.

WHO, G. (2020). Who methods and data sources for global burden of disease estimates.