Health burden and attributable economic damage of conflict and terrorism in the Eastern Mediterranean Region

ABSTRACT

This study aimed to vividly describe the direct and severe health impacts of conflict in the Eastern Mediterranean Region (EMR) using data from the Global Burden of Disease (GBD). It also sought to quantify the staggering portion of economic damage attributable to the health burden of conflict and terrorism. From 1990 to 2019, the region endured the devastating effects of conflict and terrorism. These circumstances led to 64%, 50%, and 35% of all causes of Disability-Adjusted Life Years (DALYs) in Libya, Syria, and Palestine, respectively, in 2011, 2016, and 2008. These figures represent not just statistics but the profound human cost of these conflicts. The health-related economic burden (HEB) due to conflict was estimated at $4.6 billion in Iraq, $3.7 billion in Afghanistan, and $1.7 billion in Libya in current international dollars. However, due to missing data, the HEB could not be calculated for Yemen and Syria despite significant conflict-related DALYs. In 2019, the HEB to Current Health Expenditure (CHE) ratio, which indicates the proportion of the health-related economic burden compared to health expenditure, was 30% in Afghanistan and 25% in Iraq. This high ratio underscores the significant strain that conflict places on the health systems.

KEYWORDS:

• Geopolitical determinants of health
• conflict and terrorism
• Middle East
• North Africa
• economic burden

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets used and analysed during the current study are available in the ‘IHME, GBD’ and ‘World Bank Data’ websites, http://ghdx.healthdata.org/gbd-results-tool,https://data.worldbank.org/indicato.

Authors’ contributions

RM provided the conception and proposed the design of the work, SHS contributed to data acquisition and interpretation, and drafted the manuscript, MM substantively revised the draft.

Additional information

Funding

The authors received no specific funding for this work.

Notes on contributors

Sedighe Hosseini Shabanan

Sedighe Hosseini Shabanan, an MD-MPH graduate from Tehran University of Medical Sciences, has dedicated her recent endeavors to radiological studies of liver diseases, a field that aligns with her career trajectory as a diagnostic radiologist in training. Her commitment extends beyond her primary research focus, as she actively investigates non-communicable causes of death, including those stemming from conflicts and acts of terrorism. Her work in public health, particularly in this area, serves as an inspiration for all.

Maziar Moradi-Lakeh

Maziar Moradi-Lakeh, a Medical Doctor with post-graduate education in Public Health, Community Medicine, and Global Health, brings a wealth of experience to his work. With around 19 years in academic and leadership positions, as well as research and consultancy for international organizations, national health systems, and private life industries, his expertise is unparalleled. His main areas of interest, including Health Metrics and Evaluation, Disease Epidemiology and Burden of Disease, and Health Economics and Outcome Research, are backed by a substantial body of work, with over 250 peer-reviewed papers and other types of publications to his name.

Sadaf Seif Hosseini

Sadaf Seif Hosseini is a medical doctor from Tehran University of Medical Sciences and is currently a fourth-year cardiology resident physician in Tehran, Iran. She has a master’s degree in public health. She is keenly interested in epidemiology, disease assessment burden, preventive medicine, population-based studies, and health economics and policy. She is an experienced data analyst and has conducted research projects on public health issues and cardiology. Over the last 4 years, she has worked on preventive cardiology as primordial, primary, and secondary prevention in cardiology clinics. She has conducted research on HIV patients suffering from endocarditis, focusing on its public health impacts, especially from a financial perspective. During the COVID-19 pandemic, she worked on the COVID-19 Epidemiology Committee of the National Health Organization. After the pandemic, she has been working on conditions such as post-COVID heart failure and transplants, which are considered one of the highest causes of disease burden during the COVID-19 pandemic and significantly affect health expenditure. Dr. Seif aims further to incorporate public health perspectives into her future cardiovascular studies.

Reza Majdzadeh

Reza Majdzadeh is a distinguished figure in health systems and inequality. He currently holds the position of professor in the Global Public Health Program at the University of Essex (UoE), following his previous leadership as the head of the Iran National Institute of Health Research (NIHR). He oversaw reforms within Iran’s health sector during his tenure, aligning them with the Universal Health Coverage agenda. With extensive consultancy experience exceeding two years at the World Health Organization’s Eastern Mediterranean Regional Office, Dr Majdzadeh has been actively involved in various nations across the region. His academic pursuits primarily revolve around analyzing the geopolitical determinants of health and the resilience of health systems in the face of diverse challenges, notably exploring the impact of economic sanctions on population health. Dr. Majdzadeh’s scholarly contributions are noteworthy, as evidenced by his research portfolio comprising over 370 papers indexed in PubMed. In addition to his academic endeavours, Professor Majdzadeh has played a pivotal role in establishing two research centres specializing in Knowledge Utilization and Community-Based Participatory Research.