Civil conflicts in four african countries: a five-year review of trends in nutrition and mortality.

Armed conflicts are defined as political conflicts in which armed combat involves the armed forces of at least one state or one or more armed factions seeking to gain control of all or part of the state, and in which at least 1,000 people have been killed by the fighting during the course of the conflict. Globally, the number of armed conflicts has been decreasing since 1995, when it peaked at 44 recorded civil wars (1). By 2003, seven of these conflicts had ended, and in 2003 there were 37 active conflicts in the world. More than 80 percent of these conflicts were in Asia and Africa. The latter continent harbored 42 percent of all conflicts in 2003, involving 28 states and their neighboring countries (2). Many governmental and nongovernmental organizations, as well as research scholars, evaluate the human impact of civil conflict for operational and policy purposes (3). These evaluations typically measure not only direct casualties due to violence but often indirect casualties among persons affected by the breakdown of the health and social-service infrastructure and its consequences (4, 5). A World Health Organization report (6) underlined the use of mortality and nutrition as indicators for assessing the severity of a complex emergency; for identifying needs, prioritizing interventions, and monitoring impacts; and for advocacy purposes. While these factors serve as broad indications of the severity and nature of a conflict, an understanding of the process and therefore planning of the response depends on many external variables and constraints that are unique to each emergency situation (6, 7). Objectives