Generations of War: Conflict as a Social Determinant of Health in the Sudans Open Access

Martin, Lara Suzanne (2015)

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Once the largest country on the continent of Africa, Sudan now exists in two new forms. Sudan and South Sudan, two countries linked geographically, culturally, politically, and historically, have an adversarial, yet familial relationship. The effects of tribal violence in South Sudan beginning in 2013, the continuous insecurity along the border between the two countries, and failure of the 2005 Comprehensive Peace Agreement (CPA) permeate all aspects of Sudanese daily life. However, the British/Anglo-Egyptian control following the Mahdi defeat is one of the most important periods in Sudanese history as it laid the foundation in terms of power systems, infrastructure development, and resource allocation that is still present in modern day Sudan. The modern history of Sudan is built upon the framework established under the British colonial regime, but exacerbated by varying emerging political leaders in post-Independence Sudan and use of religious/cultural narratives for political gain. Through generations of replication of these systems now administered/managed by the NCP in the North and SPLA in the South, social structures and identities (ethnic, tribal, and religious) also propagate cyclical and protracted conflict. Just as poverty, the place of your birth, access to education, and politics can be determinants of both community and individual health; this paper thesis is that conflict is also a social determinant of health to consider. By framing the public health outcomes affected by war within the theoretical foundation of the social determinants of health, we are able to simultaneously explore drivers of conflict and their immediate and long-term impact on a few specific health indicators (seeing trends over time in some cases). This paper explores an expansion of the traditional understanding of the social determinants of health from only considering SES towards utilizing conflict as a social determinant of health. These two new countries are at a critical time in their new infancy and it is now that new theories such as conflict as a social determinant of health must be utilized. More than 4 million people are displaced in Sudan and South Sudan, and if the context doesn't improve, generations of children will only know war.

Table of Contents

Acknowledgements. 12

Generations of War. 16

A Colonial Framework for Conflict. 17

Colonial Rule. 17

Divide and Conquer. 19

Modern Sudan and South Sudan, Post Independence. 23

Social Determinants of Health. 30

Conflict as a Social Determinant of Health. 32

Conflict as a Driver of Health Status. 34

Direct and Indirect Indices. 35

Health in the Sudans: A Consequence of War. 38

Health Data, Sudan and South Sudan. 38

Table 1.1 Health Household Surveys. 40

Table 1.2 Malnutrition in Sudan: Conflict Versus Non-Conflict Areas. 42

Table 1.3 Malnutrition (Severe) in South Sudan: Conflict Versus Non-Conflict Areas (SSHHS, 2010). 43

UNICEF Sudan S3M Data (UNICEF, 2014). 44

Economics, Debt, and the Health Sector. 47

Table 1.4 Increasing Food Prices, Sudan (WFP, 2014). 49

Discussion and Limitations. 50

Conclusion. 54

Resources. 61

Annex I. 65

Annex II. 67

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