Article Text

Conflict-related excess mortality and disability in Northwest Syria
  1. Omar Alrashid Alhiraki1,2,
  2. Ola Fahham2,3,
  3. Hussam Alden Dubies4,
  4. Jawad Abou Hatab5,
  5. Muhammad Eyad Ba'Ath1
  1. 1Department of Surgery, Bab Al-Hawa Hospital, Idlib, Northwest Syria, Syrian Arab Republic
  2. 2Syria Research Group (SyRG), co-hosted by the London School of Hygiene and Tropical Medicine and Saw Swee Hock School of Public Health, London, UK
  3. 3Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
  4. 4Department of Surgery, Idlib University, Faculty of Medicine, Idlib, Northwest Syria, Syrian Arab Republic
  5. 5Faculty of Medicine, Free Aleppo University, Aleppo, Northwest Syria, Syrian Arab Republic
  1. Correspondence to Dr Omar Alrashid Alhiraki; dr.omar.alhiraki{at}


Introduction The Syrian conflict that started in 2011 has been ongoing for over a decade without an end in sight. Estimates regarding excess mortality and conflict-related disability vary widely, and little field research has been done to address this topic.

Methods A population-based field survey was conducted from 10 to 18 November 2020 in Northwest Syria. Forty-nine clusters were selected using staged sampling based on predefined population distribution maps. Data were collected for the period from 2000 to 2020 and were divided into pre-conflict (2000–2010) and conflict (2011–2020) periods. Mortality rates were compared using the Mann-Whitney U test, and p<0.05 was considered statistically significant.

Results A total of 1483 households were surveyed, for a population of 12 268 people. The crude mortality rate increased 3.55 times between the two periods (p>0.001). In total, 54.3% of war-related deaths were caused by aerial attacks. Despite the continued increase in mortality rates during the conflict period, most deaths from 2017 onwards were related to non-violent causes. Overall, directly and indirectly, the conflict seems to have caused approximately 874 000 excess deaths. A total of 14.9% of households reported having at least one substantial violence-related disability since 2011.

Conclusion The conflict caused the tripling of mortality rates in Syria. The estimated excess mortality in our study is higher than previous estimates. From 2017 onwards, most conflict-related deaths were due to non-violent causes. There is a high prevalence of violence-related disabilities in the studied communities. Our data could prove useful for health policymakers.

  • community-based survey
  • public health
  • traumatology
  • injury

Data availability statement

Data are available upon reasonable request. The raw data for this article will be made available by the authors without reservation.

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Data availability statement

Data are available upon reasonable request. The raw data for this article will be made available by the authors without reservation.

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  • Handling editor Seye Abimbola

  • Twitter @OAlhiraki

  • Contributors OAA and MEB conceived the study. OAA, OF, HAD and JAH trained and supervised the data collectors. MEB and OAA analysed data. OAA, OF and MEB drafted the manuscript with help from HAD and JAH. OAA and MEB accepted full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish. OAA and MEB independently reviewed and confirmed the results. All authors contributed to the interpretation and approved the version for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

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  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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