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

自世纪中期以来，国内武装冲突变得更加普遍，破坏性也更大。虽然这些冲突构成了一个全球性问题，但较贫穷国家受到的影响尤其严重，对健康和发展造成了破坏性后果。除了人们被杀害或致残的直接健康影响外，人口健康还受到经济资产破坏、公共卫生基础设施受损或无法获得以及大量人口流离失所等间接影响。通过深入研究哥伦比亚冲突与和平协定的过去和当前经验，对卫生系统和冲突后卫生政策的制定进行研究。自1958年以来，估计有22万人死于内战，超过600万人（占人口的13%）被迫流离失所。2016年12月，叛军与哥伦比亚政府达成了一项和平雅阁，结束了敌对行动，为开展与当前政策相关的研究创造了一个独特的机会。我们的项目将为研究不足的问题提供急需的证据，如冲突对卫生服务组织和提供的后果，以及对经常被忽视的人群的影响，包括国内流离失所的家庭和最贫困的群体。这些问题将通过一个混合方法的研究计划来回答，该计划涉及两个相互联系的工作包。定量数据包将依靠该小组收集的调查数据和现有数据，并使用最新技术进行分析。定性和历史分析将采用与选定城市居民的焦点小组，与国家和地方政府官员和民间社会代表的访谈，以及对公开的官方文件和历史行政数据集的审查，以生成关于卫生系统内部冲突后果的独特而丰富的描述。从所有这些分析中得出的结论将为研究小组提出具体的循证卫生政策建议提供依据，确保该项目产生实际影响的主要因素是其对卫生政策制定的独特及时性、利益攸关方的持续参与和方法的严谨性。与哥伦比亚和国际政策制定者的密切接触，与我们分析的广度和深度保持一致，将告知卫生系统政策对其他发展中国家的影响，特别是在目前正在进行或最近结束的持续冲突导致人口流离失所的情况下。我们研究的潜在受益者包括受冲突暴力影响的人口、卫生政策制定者和广大学术界。

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.