More children die from the indirect impact of armed conflicts in Africa than by weapons used in those conflicts, according to a new study led by Stanford University researchers.

The research is the first comprehensive analysis of the large and lingering effects of armed conflicts — civil wars, rebellions and interstate conflicts — on the health of noncombatants.

The numbers are sobering: between 3.1 million and 3.5 million infants born within 30 miles of armed conflict died from indirect consequences of battles from 1995 to 2015. That number jumps to 5 million deaths of children ages 5 and younger in those same conflict zones.

“The indirect effects of conflict on children are so much greater than the direct deaths from warfare,” said Eran Bendavid, MD, senior author of the study, which was published Aug. 30 in The Lancet.

The authors also found evidence of increased mortality risk from as far away as 60 miles from armed conflicts and for eight years after them. Being born in the same year as a nearby armed conflict is riskiest for children younger than 1, the authors found, but the lingering effects remain elevated over the years and, even after a conflict has ended, raise the risk of death for infants by over 30 percent.

In the entire continent, the authors wrote, the number of infant deaths related to armed conflicts from 1995 to 2015 was more than three times the number of direct deaths from these conflicts. Further, they found that among babies born within a 30-mile range of armed conflict, the risk of dying before age 1 was on average 7.7 percent higher than it was for babies born outside that range.

The authors recognize it is not surprising that African children are vulnerable to nearby armed conflict. But they show that this burden is substantially higher than previously indicated.

‘Surprisingly poorly understood’

“We wanted to understand the effects of war and conflict, and discovered that this was surprisingly poorly understood,” said Bendavid, associate professor of medicine and core faculty member at Stanford Health Policy. “The most authoritative source, the Global Burden of Disease, only counts the direct deaths from conflict, and those estimates suggest that conflicts are a minuscule cause of death.”