Challenges of the Epidemiological Investigation of War and Conflict

Background: War and conflict (hereafter: war) is one of themost stubborn public health challenges. There is little quantitativeevidence on the health effects of war, especially in low andmiddle-income war-affected societies, where war is mostly anendemic societal disorder. In an optimistic point of view,available evidence on the health effects of war may be a part ofthe tip of the iceberg. In addition to the scarcity, quality of themost of available evidence on the health effects of war is underquestion. It is a result of highly nuisance challenges of theepidemiological investigations during war-induced complexsituations.Methods: A comprehensive web search was done usingkeywords including war , violence , and conflict . Retrieveddocuments were reviewed and relevant documents were criticallyappraised. Author reported limitations were extracted. ListedLimitations were discussed in group-discussions to find warinducedlimitations. These limitations were considered as themost common challenges of the epidemiological investigation inwar situation.Results and conclusion: Two groups of challenges werediscovered, as the epidemiological investigation in war situationhas two main parts (i.e. the investigation of war, and theinvestigation of the results of war). Very long induction-period ofthe upstream determinants of war, invisible or less visible parts ofthe iceberg of the sufficient causes of war, and highlymultifactorial nature of war may be the most common challenges of the epidemiological investigation of war. Unknowndenominator of the epidemiological indices, political andintentional misreporting, misuse of epidemiological evidence forintensifying the damages, lower participation rate, distrustfulnessof participants, unknown pattern of population displacements,destroyed local health systems, finding native interested datacollectors,and invisible types of modern wars are of thechallenges of the investigation of the results of war.Epidemiological investigation of war and the health effects of warneed to be taught and learned as a new branch of epidemiology.

Keywords:

Epidemiology , Challenges , War , Conflict , Bias