The Epidemiology of Civil War

Abstract

This dissertation explores the causal connection between violence occurring in armed conflicts and the emergence of infectious disease within or in close proximity to active conflict zones. While we have known for quite some time that war leads to disease, our understanding of what types of violence contribute to higher (or lower) incidence of specific types of infectious disease remains limited. Establishing the connection between disease and patterns of violence in armed conflict is important since that knowledge can help to inform where humanitarian aid should go and, crucially, what form that aid should take to best support the health needs of civilians suffering the effects of violence. I propose a new theory explaining the disease-conflict connection through a mechanism of civilian population movements in response to changing patterns of observable violence occurring across varying conflict contexts. Variation in conflict intensity as well as the spatial location of that violence – conflict geography – helps to explain downstream variation in the spread of infectious disease. This theory relies upon a mechanism of rational civilians making decisions to maximize their safety in response to violence. As security conditions deteriorate, civilians attempt to improve their situation by pursuing a strategy to remove themselves from areas which present the greatest risk to their personal integrity. In order to decide how to respond to the violence they observe, civilians jointly examine the intensity and geographic location of violence and decide whether to shelter in place, shuffle into nearby areas to find safety, or flee longer distances into neighboring regions or countries. My dissertation demonstrates that conflict context shapes how civilians respond to changing levels of violence. The varied strategies civilians pursue in response to this violence influences the spread of infectious disease by shaping which disease-causing pathogens civilians are more or less likely to encounter. Some patterns of violence facilitate contagious disease transmission while others create ideal conditions for noncontagious disease infections. By explaining the connection between conflict and war through civilian displacement mechanisms, the theory presented and tested in this dissertation allows us to better understand why disease emerges in some conflicts but not others, but also where and what types of disease will emerge across different conflict contexts.