Understanding effects of armed conflict on health outcomes: the case of Nepal

A secondary analysis has been conducted of two demographic health surveys-Nepal Family Health Survey (NFHS) 1996 and Nepal Demographic and Health Survey (NDHS) 2006; the latter was supplemented by a study carried out by the Nepal Health Research Council in 2006.The data show Nepal has made progress in 16 out of 19 health indicators which are part of the Millennium Development Goals whilst three indicators have remained static. Our analysis suggests a number of conflict and non-conflict factors which may have led to this success.The lessons learnt from Nepal could be replicable elsewhere in conflict and post-conflict environments. A nationwide large-scale empirical study is needed to further assess the determinants of Nepal's success in the health sector at a time the country experienced a decade of armed conflict.Violent conflicts pose a challenge to human civilisations, human health and health systems [1-3]. Epidemiological studies indicate that war ranks among the top-ten causes of death worldwide [4-6]. Populations affected by armed conflict experience severe public health consequences mediated by population displacement, food scarcity, and the collapse of basic health services, which together often give rise to complex humanitarian emergencies [7,8]. Conflict has both direct and indirect effects on people's health and on the overall health system [8]. Armed conflicts can also cause the displacement of people and an increase in infectious diseases [2,9].Nepal recently emerged from a decade-long violent conflict (1996 to 2006). This violent conflict had an effect on both the population's health and the health care system[10-12].It led to over 13,000 fatalities[13], the disappearance of at least 1,200 people [10,14], the disablement of thousands of people, and the internal displacement of many more [14,15]. Over 1,000 health posts in rural areas were destroyed [16], more than a dozen health workers had been killed and many others were harassed, kidnapped, threatene