Forced Migration and Mortality (2001) / Chapter Skim
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Pages 38-51
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From page 38... ...
38 APPENDIX: FIVE ILLUSTRATIONS OF UNCERTAINTY: MORTALITY IN AFGHANISTAN, BOSNIA, NORTH KOREA, RWANDA, AND SIERRA LEONE Steven Hansch This appendix presents short narratives of five countries that have experienced recent conflict, in which data on mortality are difficult to ascertain. They are included as a kind of rough overview on how general estimates of mortality are generated in emergencies, rather than a scientific study of mortality estimation in these settings.
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From page 39... ...
STEVEN HANSCH 39 live in Iran or in refugee camps in Pakistan, where many of them fled during the conflict with the Soviet Union that began in 1979. Evidence of Mortality Inside Afghanistan The war in Kabul in 1993 reportedly led to 23,000 deaths, and fighting in the north during the mid- and late 1990s led to numerous massacres and disappearances.
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40 APPENDIX: FIVE ILLUSTRATIONS OF UNCERTAINTY Refugee Camps in Pakistan Media coverage during the conflict with the Soviet Union characterized the refugees as poor, desperate, hungry, and ill. Due to political stakes and the media coverage, most Westerners believed that the refugees were living in terrible conditions.
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STEVEN HANSCH 41 areas outside of immediate combat zones. Among children seen in a Kabul hospital, half of all deaths were related to diarrhea, and two-thirds of all patients seen were malnourished (Choudhry et al., 1989)
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42 APPENDIX: FIVE ILLUSTRATIONS OF UNCERTAINTY 400 mass graves were identified, each holding between 3 and 300 dead bodies. Various groups working on exhumations are collaborating with the efforts to trace missing persons, including Physicians for Human Rights, a U.S.
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44 APPENDIX: FIVE ILLUSTRATIONS OF UNCERTAINTY Evidence of Mortality Mortality estimates in North Korea are prone to many potential biases, including: • Observational bias related to lack of access to the population by independent authorities and international aid workers; • Observational bias related to the intrinsic invisibility of high-risk individuals: many manifestations of poverty, malnutrition and related mortality tend to be hidden; • Observational bias related to the areas where aid workers work: this can also lead to over-reporting because of biases on the part of aid workers; • Time-frame validity: this may be due to mis-reporting of dates by individuals or purposeful mis-reporting of dates by governments; • Construct validity: it is difficult to define deaths due only to famine because of intervening factors; • Reporting bias for political reasons: this may be mis-reporting by the government, by civilians, or by refugees; or • Sampling bias because of the use of data from refugees from North Korea: refugees who have fled North Korea are more likely to be fleeing from situations in which crisis is more intense, the risk of death is higher, and, statistically, more deaths have occurred. Estimates of Excess Mortality Estimates of mortality due to famine in North Korea come from a number of sources.
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From page 45... ...
STEVEN HANSCH 45 estimates of closer to 3 million deaths. These groups may have political motives for overestimating mortality, however.
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From page 46... ...
46 APPENDIX: FIVE ILLUSTRATIONS OF UNCERTAINTY Evidence of Mortality Throughout Rwanda The killings in Rwanda took place across the country all at once, but the lines of population displacement proceeded in a wave following the progress of the Tutsi forces, who streamed southward from Uganda. Most of the deaths from the crisis occurred in a short span of 10 weeks in 1994, and most resulted from one-on-one attacks by Hutu villagers against their neighbors, most often with machetes (Prunier, 1995)
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From page 47... ...
STEVEN HANSCH 47 Mortality Risk Factors Rwanda was a very complex emergency with many mortality risks. Most of the deaths occurred in three sub-populations: • Tutsi civilians residing in Rwanda, particularly those in the north and public officials; • Resident Hutus who were not part of the Interhamwe (the Hutu militia group who massacred Tutsis)
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From page 48... ...
48 APPENDIX: FIVE ILLUSTRATIONS OF UNCERTAINTY must be surmised. Estimates range from 20,000 to 50,000 additional deaths during the 1990s.
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STEVEN HANSCH 49 The presence or absence of aid agencies also appears to play a large role in which groups of people suffer excess mortality. Some of the largest IDP camps benefit from good public health programs by international NGOs.
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50 APPENDIX: FIVE ILLUSTRATIONS OF UNCERTAINTY Dowell, S., A
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STEVEN HANSCH 51 Pilsczek, F 1996 Visiting doctor's perspective in Afghanistan.
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