War and Peace: The Health and Health System Consequences of Conflict in Colombia

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Internal armed conflicts have become more common and more physically destructive since the mid-20th century. Although these conflicts constitute a global problem, poorer countries have been disproportionately affected, with devastating consequences for health and development. Beyond the direct health effects of people being killed or maimed, population health is affected indirectly through destruction of economic assets, damage or lack of access to public health infrastructure and large population displacements.The overarching goal of our project is to investigate the consequences of long-term internal conflict for population health, the health system and post-conflict health policymaking through an in-depth study of the past and current experience of conflict and peace agreement in Colombia. Since 1958 an estimated 220,000 people have died in Colombia due to the civil conflict and more than six million (13% of the population) have been forcibly displaced. A peace accord between rebel forces and the Colombian government was agreed in December 2016 and has ended hostilities, creating a unique window of opportunity to conduct research of immediate policy relevance. Our project will provide much needed evidence on under-researched issues such as the consequences of conflict for health service organisation and delivery, and the impact on often overlooked populations including internally displaced families and the poorest groups.These questions will be answered through a mixed-methods research programme involving two linked work packages. The quantitative package will rely on survey data collected by the team and data already available, analysed using state-of-the-art techniques. The qualitative and historic analyses will employ focus groups with residents of selected municipalities, interviews with national and local government officials and civil society representatives, and examination of publicly available official documents and historic administrative datasets, generating a uniquely rich portrait of the consequences of civil conflicts for the health system. The conclusions drawn from all these analyses will provide the basis for specific, evidence-based health policy recommendations by the research team.The principal elements that will ensure this project has practical impact are its distinctive timeliness for health policymaking, constant stakeholder engagement and methodological rigour. Close engagement with Colombian and international policymakers, aligned with the breadth and depth of our analyses, will inform the extent of generalisation of health system policy implications to other developing countries, particularly where sustained conflicts with resulting population displacements are currently ongoing or have recently concluded. Potential beneficiaries of our research include populations affected by conflict violence, health policymakers and the broad academic community.