Legacies of civil war violence on health fragility: evidence from south sudan
1
Sanford School of Public Policy, Duke University, Durham, United States
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Armed conflict generates long-term disruption of health systems, yet the geographic legacy of war violence on present-day fragility remains underexplored. South Sudan’s 2013-2018 civil war displaced millions and devastated infrastructure, but its enduring effects on regional health access are poorly understood. This study investigates whether counties most obstructed by battles during the war now exhibit higher fragility levels, particularly in health and human security.
METHODS:
We combined county-level fragility data from the International Organization for Migration from a 2023 report and ongoing 2024 multidimensional fragility index report, with battle event data from the Armed Conflict Location & Event Data from 2013 - 2018. Counties were categorized by battle exposure intensity (high, moderate, low). Fragility dimensions analyzed include health and human information, including maternal and child health, Water, Sanitation, and Hygiene, access to medical care, among others. Correlational analysis assessed whether historical conflict exposure predicts current fragility, either negatively or positively- improving or deteriorating a county’s condition.
RESULTS:
Preliminary analysis would predict that counties that were espoused to high levels of battle exposure during the 2013-2018 civil war displayed elevated fragility scores in both the 2023 and 2024 report. These findings suggest a geographical correlation to conflict exposure and durability of health systems and resilience, as the closer to a county that faced higher levels of violence, the worse that county is.
CONCLUSIONS:
South Sudan’s civil war has left a lasting health footprint that continues to shape county-level fragility today. Conflict-exposed counties remain disproportionately vulnerable, underscoring the importance of incorporating historical conflict patterns into humanitarian planning and public health system strengthening. Recognizing the long-term legacy of war violence is essential for building resilient health systems in post-conflict settings.
Armed conflict generates long-term disruption of health systems, yet the geographic legacy of war violence on present-day fragility remains underexplored. South Sudan’s 2013-2018 civil war displaced millions and devastated infrastructure, but its enduring effects on regional health access are poorly understood. This study investigates whether counties most obstructed by battles during the war now exhibit higher fragility levels, particularly in health and human security.
METHODS:
We combined county-level fragility data from the International Organization for Migration from a 2023 report and ongoing 2024 multidimensional fragility index report, with battle event data from the Armed Conflict Location & Event Data from 2013 - 2018. Counties were categorized by battle exposure intensity (high, moderate, low). Fragility dimensions analyzed include health and human information, including maternal and child health, Water, Sanitation, and Hygiene, access to medical care, among others. Correlational analysis assessed whether historical conflict exposure predicts current fragility, either negatively or positively- improving or deteriorating a county’s condition.
RESULTS:
Preliminary analysis would predict that counties that were espoused to high levels of battle exposure during the 2013-2018 civil war displayed elevated fragility scores in both the 2023 and 2024 report. These findings suggest a geographical correlation to conflict exposure and durability of health systems and resilience, as the closer to a county that faced higher levels of violence, the worse that county is.
CONCLUSIONS:
South Sudan’s civil war has left a lasting health footprint that continues to shape county-level fragility today. Conflict-exposed counties remain disproportionately vulnerable, underscoring the importance of incorporating historical conflict patterns into humanitarian planning and public health system strengthening. Recognizing the long-term legacy of war violence is essential for building resilient health systems in post-conflict settings.
| eISSN: | 2654-1459 |
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