Civil War and Deaths in Yemen

Background: Conflict in Yemen have displaced millions and destroyed health infrastructure, ranking it as the world’s largest humanitarian disaster. In this paper, we examine mortality in Yemen to determine whether it has increased significantly since the conflict began in 2015 compared to the preceding period.   Methods: We analysed 91 household surveys using the SMART methodology, covering 2,864 clusters undertaken from 2012 – 2019 and deaths from ACLED database. We used a Poisson-Gamma model to estimate the posterior means for the pre-conflict (  , baseline value) and the conflict period (  ) to estimate nation-wide excess deaths and its association with security levels by governorate.  Findings: The national crude death rate/10 000 in the conflict period (PCDR) was 0.19, which is   higher than the baseline rate of 0.16. Applying the conflict period rate to the Yemeni population, we estimated 1,115,024 deaths occurred between 2015 and 2019. There was an 17.8% increase in deaths over the baseline during the conflict period. A large share (67.2%) of the excess deaths were due to combat-related violence. At the governorate level, PCDR varied across the country, ranging from 0.03 to 0.63 per 10,000 per day. Hajjah, Ibb, and Al Jawf presented the highest total excess deaths. Insecurity level was not statistically associated with excess deaths.   Interpretation: The health situation in Yemen was already poor before the crisis in 2015. During the conflict, intentional violence from air and ground strikes were responsible for more deaths than indirect or non-violent causes. Humanitarian aid may have kept increases in indirect deaths in check. Funding: None Declaration of Interest: The authors declare they have no conflicting interests.