Published online by Cambridge University Press: 08 August 2012
In recent years a gradual understanding has developed on the need to take a broader view of the concept of ‘protection’ during times of armed conflict. Whilst destruction and suffering caused directly by warring parties continues to be a matter of deep concern, focus has started to also turn to an examination of the indirect impact armed conflict has on civilian populations. In particular, the large number of deaths caused by disruption to medical and humanitarian assistance is gaining attention. The Harvard Burden of Disease Unit has recently called for more reliable data on the health effects of armed conflict. The Small Arms Survey of the Graduate Institute of International and Development Studies, Geneva, has stated that armed conflict is a major cause of ill health and mortality not just from obvious injuries and death on the battlefield but also due to factors such as loss of access to basic health care. They estimate that in contemporary conflicts there is a ratio of four indirect to one direct death due to armed conflict. The scale of the problem can be seen, for example, in the Democratic Republic of the Congo where it is estimated that 38,000 excess deaths per month are caused mostly by easily treatable diseases which go untreated due to insecurity arising from armed conflict. The conflict in Iraq has had similar effects; between 2003 and 2007, 18,000 of the country's 34,000 doctors fled and many other were killed, with a catastrophic impact on the health care system.