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.


Almada AA, Golden CD, Osofsky SA, Myers SS. A case for Planetary Health/Geohealth. GeoHealth [Internet]. 2017;1 (2) :75-78. Publisher's VersionAbstract

Concern has been spreading across scientific disciplines that the pervasive human transformation of Earth's natural systems is an urgent threat to human health. The simultaneous emergence of “GeoHealth” and “Planetary Health” signals recognition that developing a new relationship between humanity and our natural systems is becoming an urgent global health priority—if we are to prevent a backsliding from the past century's great public health gains. Achieving meaningful progress will require collaboration across a broad swath of scientific disciplines as well as with policy makers, natural resource managers, members of faith communities, and movement builders around the world in order to build a rigorous evidence base of scientific understanding as the foundation for more robust policy and resource management decisions that incorporate both environmental and human health outcomes.

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.

Toole MJ, Waldman RJ. Refugees and displaced persons. War, hunger, and public health. JAMA [Internet]. 1993;270 :600-605. Publisher's VersionAbstract

The number of refugees and internally displaced persons in need of protection and assistance has increased from 30 million in 1990 to more than 43 million today. War and civil strife have been largely responsible for this epidemic of mass migration that has affected almost every region of the world, including Europe. Since 1990, crude death rates (CDRs) during the early influx of refugees who crossed international borders have been somewhat lower than CDRs reported earlier among Cambodian and Ethiopian refugees. Nevertheless, CDRs among refugees arriving in Ethiopia, Kenya, Nepal, Malawi, and Zimbabwe since 1990 ranged from five to 12 times the baseline CDRs in the countries of origin. Among internally displaced populations in northern Iraq, Somalia, and Sudan, CDRs were extremely high, ranging from 12 to 25 times the baseline CDRs for the nondisplaced. Among both refugees and internally displaced persons, death rates among children less than 5 years of age were far higher than among older children and adults. In Bangladesh, the death rate in female Rohingya refugees was several times higher than in males. Preventable conditions such as diarrheal disease, measles, and acute respiratory infections, exacerbated often by malnutrition, caused most deaths. Although relief programs for refugees have improved since 1990, the situation among the internally displaced may have worsened. The international community should intervene earlier in the evolution of complex disasters involving civil war, human rights abuses, food shortages, and mass displacement. Relief programs need to be based on sound health and nutrition information and should focus on the provision of adequate shelter, food, water, sanitation, and public health programs that prevent mortality from diarrhea, measles, and other communicable diseases, especially among young children and women.

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