Civil Strife and Displacement

Displacement Camp in EritreaWe poorly understand the ways in which multiple complex, coincident, and interacting environmental changes will alter habitability and drive population displacement, but these changes are likely to be associated with large burdens of disease and disability. Little is currently understood about how the combination of climatic disruption, natural hazards (e.g., droughts, heat waves, floods, fires, tropical storms), water scarcity, land degradation, and resulting crop and livestock failures may interact to make parts of the world that currently support large numbers of people uninhabitable. How many people are likely to be displaced? What populations are most vulnerable? And when people are displaced (many of them with very few resources) into areas where they may not be welcome, will civil strife ensue? We know that such displacement is associated with sharp increases in infectious disease outbreaks, malnutrition, and physical and mental trauma. What are the best approaches to managing increasing requirements for population movement with the least conflict and health burden?  These types of questions require urgent focus.

Learning Objectives

  • L1: List the direct and indirect drivers of civil strife and displacement.
  • L2: Analyze the impact of transnational movements on population health.
  • L3: Consider how projected ecosystem changes over the next 50-100 years may impact issues of civil strife and displacement.


Burkle, Frederick M. J. Fortnightly review: Lessons learnt and future expectations of complex emergencies. BMJ [Internet]. 1999;319 :422-426. Publisher's VersionAbstract

Complex emergencies today represent the ultimate pathway of state disruption. Zwi says that recent conflicts such as those in northern Iraq, Somalia, Rwanda, Angola, the former Yugoslavia, and the province of Kosovo should be interpreted as complex political disasters where “the capacity to sustain livelihood and life is threatened primarily by political factors, and in particular, by high levels of violence.”1 Although each of the over 38 major conflicts that have occurred in this decade since the end of the cold war is unique, all share similar characteristics (box). Most blatant is that they represent catastrophic public health emergencies in which over 70% of the victims are civilians, primarily children and adolescents.

These mainly internal crises are popularly referred to as complex emergencies. The complexity refers to the multifacted responses initiated by the international community and further complicated by the lack of protection normally afforded by international treaties, covenants, and the United Nations Charter during conventional wars.

McMichael AJ, Patz J, Kovats RS. Impacts of global environmental change on future health and health care in tropical countries. Br Med Bull [Internet]. 1998;54 :475-88. Publisher's VersionAbstract

The aggregate human impact on the environment now exceeds the limits of absorption or regeneration of various major biophysical systems, at global and regional levels. The resultant global environmental changes include altered atmospheric composition, widespread land degradation, depletion of fisheries, freshwater shortages, and biodiversity losses. The drive for further social and economic development, plus an unavoidable substantial increase in population size by 2050--especially in less developed countries--will tend to augment these large-scale environmental problems. Disturbances of the Earth's life-support systems (the source of climatic stability, food, freshwater, and robust ecosystems) will affect disproportionately the resource-poor and geographically vulnerable populations in many tropical countries. Ecological disturbances will alter the pattern of various pests and pathogens in plants, livestock and humans. Overall, these large-scale environmental changes are likely to increase the range and seasonality of various (especially vector-borne) infectious diseases, food insecurity, of water stress, and of population displacement with its various adverse health consequences.

McMichael AJ. Insights from past millennia into climatic impacts on human health and survival. Proceedings of the National Academy of Sciences [Internet]. 2012. Publisher's VersionAbstract

Climate change poses threats to human health, safety, and survival via weather extremes and climatic impacts on food yields, fresh water, infectious diseases, conflict, and displacement. Paradoxically, these risks to health are neither widely nor fully recognized. Historical experiences of diverse societies experiencing climatic changes, spanning multicentury to single-year duration, provide insights into population health vulnerability—even though most climatic changes were considerably less than those anticipated this century and beyond. Historical experience indicates the following. (i) Long-term climate changes have often destabilized civilizations, typically via food shortages, consequent hunger, disease, and unrest. (ii) Medium-term climatic adversity has frequently caused similar health, social, and sometimes political consequences. (iii) Infectious disease epidemics have often occurred in association with briefer episodes of temperature shifts, food shortages, impoverishment, and social disruption. (iv) Societies have often learnt to cope (despite hardship for some groups) with recurring shorterterm (decadal to multiyear) regional climatic cycles (e.g., El Niño Southern Oscillation)—except when extreme phases occur. (v) The drought–famine–starvation nexus has been the main, recurring, serious threat to health. Warming this century is not only likely to greatly exceed the Holocene’s natural multidecadal temperature fluctuations but to occur faster. Along with greater climatic variability, models project an increased geographic range and severity of droughts. Modern societies, although larger, better resourced, and more interconnected than past societies, are less flexible, more infrastructure-dependent, densely populated, and hence are vulnerable. Adverse historical climate-related health experiences underscore the case for abating human-induced climate change.

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