Date Published: April 24, 2018
Publisher: Public Library of Science
Author(s): Michael Spagat
Abstract: In a Perspective linked to the Research Article by Haar and colleagues, Michael Spagat discusses the challenges and importance of conducting research on mortality in regions affected by violent conflicts.
Partial Text: Haar and colleagues show that violent, often lethal, attacks on health infrastructure, workers, and patients were very common in northern Syria in 2016 . Though the scope of this study was limited to four governorates, this violence almost certainly continues to the present throughout much of the country. Moreover, such attacks occurred more frequently than we might reasonably have believed based on the prior evidence that was available . These carefully documented events represent serious and widespread violations of International Humanitarian Law (IHL) with tragic and morally reprehensible consequences. To be sure, the 297 deaths documented in the paper constitute a small percentage of total violence in Syria in 2016 (see, for example, the database of the Violations Documentation Center in Syria  and the analysis of ). Indeed, attacks in Syria frequently kill children [1,3,4], with the widespread use of explosives in densely populated areas posing a particular hazard [3,4]. Children, medical units, and personnel are all specially protected under IHL [8,9,10], so the violations documented in the paper and [1,3,4] have special salience. Moreover, these attacks on health infrastructure might have exacerbated effects on health by impeding people in a conflict-affected environment from seeking and providing medical care. Indeed, a striking observation of Haar and colleagues  is that only a low proportion of medical facilities and vehicles are labelled as such in Syria, rendering them hard to find both for potential patients and would-be attackers, perhaps intentionally in the latter case.
The work of PHR, SAMS, and conflict data projects in general could benefit greatly from deeper research into event matching across the two databases. Moreover, Haar and colleagues mention in passing that there is a third data-collection system operated by the UN Health Cluster for northern Syria. A three-way matching comparison would be better still.