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War-Time Mortality in Sudan: A Capture-Recapture Analysis
37 Pages Posted: 12 Nov 2024
More...Abstract
Background: Since April 2023 war has resulted in a largely unmeasured impact on the lives and livelihoods of Sudanese people. Existing data on wartime mortality are sparse and lack methodological rigour, reflecting limited pre-war vital registration and challenges to identify decedents during the war. Our study aimed to describe wartime all-cause and intentional-injury mortality in Sudan.
Methods: We conducted a retrospective observational study collecting individual decedent lists from three sources: 1) a survey disseminated through public social media, 2) a survey disseminated through private key informant networks and 3) public social media obituaries. We matched decedent records to merge duplicates within lists and decedents across lists. We describe patterns of mortality observed nationally and estimate mortality for Khartoum State using capture-recapture analysis.
Findings: Intentional-injury deaths were disproportionately high in Kordofan and Darfur Regions. We estimate that61,202 all-cause deaths occurred in Khartoum state (95% CI: 22286 - 209152), of which 26,024 (95% CI: 12571- 58704) due to intentional injuries.
Interpretation: Our findings suggest contrasting mortality patterns across Sudan, with a predominance of intentional injuries in Darfur and Kordofan regions. The estimated intentional-injury deaths in Khartoum are significantly higher than killings reported for the entire country during the same period, highlighting substantial underreporting. Urgent diplomatic efforts to end the war, scaled-up and conflict-adapted humanitarian interventions, as well as continued efforts to document human rights violations are urgently needed to mitigate a largely preventable death toll across the country and support post-conflict recovery and reconciliation.
Funding: This study and publication were co-funded by the US Centers for Disease Control and Prevention of the US Department of Health and Human Services (HHS) [Award U01GH002319] and the UK Foreign, Commonwealth and Development Office (FCDO).
Declaration of Interest: The authors declare that they have no competing interests.
Ethical Approval: Approval was granted by the London School of Hygiene & Tropical Medicine (LSHTM) Observational Research Ethics Committee (REC# 29595). Management of identifier data was compliant with the UK Data Protection Act 2018 and pursuant regulations. All participants provided written consent to participate in the study.
Keywords: Capture-recapture, conflict, mortality, webRDS, Sudan, conflict-attributable, multiple systems estimation, MSE
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