Healthcare under Conflict
1 – Retaliatory Strikes: Russian attacks on healthcare in Ukraine
Melanie Sauter
University of Oxford; University of Oslo
Scott Gates
Peace Research Institute Oslo (PRIO)
Abstract: Recent studies on the micro-dynamics of conflicts have advanced our understanding of when and why civilians are attacked in irregular warfare, but the dynamics of modern interstate warfare are less understood. In this article, we ask when and why Russia targeted civilian infrastructure in Ukraine, with a specific focus on attacks against healthcare. We propose that Russia primarily directs its attacks on healthcare following its own battlefield losses. Such actions undermine the healthcare system, which not only poses long-term public health risks but also deprives already vulnerable populations of critical care. By disrupting healthcare services, Russia penalizes both the Ukrainian civilian population and the Ukrainian military, which relies on these services to treat its wounded soldiers. We test this argument with new data on attacks against healthcare in Ukraine, and find a positive effect immediately after military losses on the Russian side. In addition, we find Russian attacks on healthcare facilities and personnel occur long distances from the front-lines of the battle. This article highlights the punitive nature of Russia’s strategic approach to warfare, showing its strategic use of war crimes to punish the civilian population.
2 – Violent Conflict and Demand for Healthcare in Afghanistan
Olga Shemyakina
Georgia Institute of Technology
Abstract: This paper examines population demand for healthcare under conflict using the case of Afghanistan. We find that violent conflict is associated with a reduction in healthcare utilization by female patients and parents, primarily mothers, with young children. We combine daily data on the conflict in Afghanistan from the Armed Conflict Location and Event Data Project (ACLED) and the Global Terrorism Database datasets with data on healthcare use by women and children using visit date and facility location from the 2019-2019 Demographic and Health Survey (DHS-VII) collected at the facility level from November 2018 to January 2019. This paper contributes to the literature on the impact of shocks on the demand for healthcare, particularly the relationship between conflict exposure and measures of healthcare utilization. We seek to enhance an understanding of healthcare-seeking behavior in Afghanistan from the demand perspective and to provide insights into how individuals, in particular pregnant women and children, access healthcare services in the context of Afghanistan.
War Exposure and Cooperation
1 – War Exposure, Perpetrator Identity, and Attitudes towards Transitional Justice
Thorsten Rogall
Uppsala University
Abstract: What determines the demands for transitional justice in the aftermath of armed conflict? We draw on data from a survey experiment involving nearly 1,600 Sunni Arab refugees in Turkey. We randomly assign individuals to imagine in-group (Sunni) or out-group (Shia) members when answering questions about transitional justice demands. War exposure is measured comprehensively through a 16-item index (highlighting the many different possible factors), and participants indicate whether they attribute violence to in-group or out-group members. We find a pronounced in-group bias in transitional justice preferences: picturing in-group members increases the likelihood of endorsing restorative justice by 8% and decreases support for retribution by 2.5%. War exposure significantly influences these preferences, with higher exposure decreasing support for restoration and increasing support for retribution. Notably, identifying with the in-group moderates these effects, particularly among those who endured extensive war violence. Latent class analysis identifies three exposure groups, with the strongest in-group bias observed in those experiencing the most extensive violence. However, this bias diminishes when individuals attribute violence to in-group perpetrators and even turns into out-group bias. Our findings are robust to various specifications and controls. They highlight the nuanced dynamics shaping transitional justice demands among conflict-affected populations.