Infectious diseases in the context of war, civil strife and social dislocation

In addition to causing the displacement of millions of people, conflict also takes an important toll on both agrarian and industrial economies. Some estimate that a 15-year civil war would reduce gross domestic product by as much as 30 percent. Local economies may be even more devastated, with more immediate consequences for the health of the population, particularly through food shortages resulting in a high prevalence of under-nutrition. In rural areas, where a relatively high proportion of food is derived from subsistence farming, farmers may be physically unable to plant as much as they might in the absence of conflict. Where even small-scale commercial food production is a way of life, farmers may be obstructed from bringing their produce to market. Resulting scarcities can be responsible for higher food prices, which, combined with the loss of jobs and currency inflation, leave the general population with less food with which to feed families. More direct effects of conflict, such as the destruction of irrigation systems and theft of produce by soldiers, have also been observed. Where conflict is exacerbated by drought, pest infestation, or other detrimental factors, famine can result. For those city dwellers living in conflict, the food situation can become particularly problematic. Without the ability to revert to subsistence agricultural methods, to find alternative food sources, or to adopt coping mechanisms such as consuming seed stock, those whose nutrition depends entirely on a healthy marketplace can rapidly become deprived. © 2008 Elsevier Inc. All rights reserved