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

自20世纪中期以来，国内武装冲突变得更加普遍，对身体的破坏性也更大。虽然这些冲突构成了一个全球性问题，但较贫穷的国家受到的影响更大，对健康和发展造成了毁灭性的后果。除了人们被杀害或致残造成的直接健康影响外，经济资产遭到破坏、公共卫生基础设施遭到破坏或无法使用以及大量人口流离失所，也间接影响到人口健康。我们项目的总体目标是通过深入研究哥伦比亚过去和现在的冲突与和平协议的经验，调查长期内部冲突对人口健康、卫生系统和冲突后卫生政策制定的影响。自1958年以来，哥伦比亚估计有22万人死于内战，600多万人（占人口的13%）被迫流离失所。叛军与哥伦比亚政府于2016年12月达成和平协议，结束了敌对行动，为开展与当前政策相关的研究创造了独特的机会。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口的影响，包括国内流离失所家庭和最贫困群体。这些问题将通过一个涉及两个相互联系的工作包的混合方法研究方案来回答。定量方案将依赖于该小组收集的调查数据和现有数据，并使用最先进的技术进行分析。定性和历史分析将采用与选定城市的居民进行焦点小组讨论，与国家和地方政府官员及民间社会代表进行访谈，并审查可公开获得的官方文件和历史行政数据集，从而对国内冲突对卫生系统造成的后果形成独特而丰富的描述。从所有这些分析中得出的结论将为研究小组提出具体的、基于证据的卫生政策建议提供基础。确保该项目产生实际影响的主要因素是其独特的卫生决策及时性、利益攸关方的持续参与和方法的严谨性。根据我们分析的广度和深度，与哥伦比亚和国际政策制定者密切接触，将为卫生系统政策对其他发展中国家的影响的推广程度提供信息，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国家。我们研究的潜在受益者包括受冲突暴力影响的人群、卫生政策制定者和广泛的学术界。

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.