Terrorism and Child Mortality

How does terrorism affect child mortality? Based on data for 52 African countries for the 2000-2017 period, Daniel Meierrieks and Max Schaub conclude that more terrorism leads to higher levels of child mortality. Rather than affecting child mortality directly through death and destruction, terrorism has an indirect effect by changing the behavior of parents and other caregivers.

Since the early 2010s, terrorism has become an ever-growing threat in many African countries. Whereas the continent saw around 300 terrorist attacks per year between 2001 and 2011 according to data from the Global Terrorism Database (GTD), the annual average exceeded 2,000 from 2012 onwards. The attacks can be attributed to militant separatist movements, including the Oromo Liberation Front in Ethiopia or the Front for the Liberation of the Enclave of Cabinda in Angola, and to increased Islamist militancy by groups such as Al-Qaeda in the Islamic Maghreb or Boko Haram, which are active in various North and West African countries (e.g. Algeria, Mali, Nigeria, Niger and Chad).

As research has shown, terrorism has a negative impact on multiple socio-economic variables. For example, terrorist attacks lead to less foreign direct investment, increased emigration, capital flight and slow economic growth. Countries with limited resources and weak institutions are particularly vulnerable to the socio-economic consequences of terrorism – a description that fits most countries in Africa. Our study adds another dimension to this research agenda: the impact of terrorism on health, especially on the health of children under five – and thus on child mortality.

In theoretical terms, two perspectives may be distinguished. On the one hand, it is possible that terrorism has a direct negative effect on child mortality. Children may be injured or killed by attacks or their parents or doctors may fall victim to terrorism. Terrorism may also damage or destroy health infrastructure such as hospitals and pharmacies, which negative knock-on effects on child health. However, according to empirical studies, these direct effects of terrorist activities tend to be rather limited, especially when compared to those of other forms of political violence like large-scale war.

That is why we are primarily interested in the indirect effects of terrorism on child mortality. These indirect effects emerge from the behavioral response of a variety of actors, including parents (especially mothers), doctors, aid workers, government employees, and other groups of people who are important for child health. We expect that terrorism fuels people’s fear of future violence and that this fear triggers behavioral changes that negatively impact children’s health. Indeed, the production of fear and intimidation for political leverage is a major goal of terrorist organizations. Various behavioral responses are conceivable that might have a negative impact on children’s health. For example, parents may forego seeing a pediatrician out of fear of terrorism and thus miss out on important preventive measures (e.g. vaccinations). Doctors, medical staff, and international aid workers might stay away from or leave areas affected by terrorism. Government employees might increasingly use already scarce public resources to fight terrorism and spend less on public health.

To empirically investigate the terrorism-child mortality nexus, our study draws on data for 52 African countries for the 2000-2017 period. The prevalence of terrorism is determined using data from the Global Terrorism Database. Data on child mortality, measured as the probability for a given child to die before reaching the age of five, is taken from a 2019 study published in Nature by a team led by researcher Roy Burstein. Both the terrorism and the infant mortality data are geocoded, meaning they can be tracked to a specific location (longitude and latitude). Geocoding allows us to assign terrorism and infant mortality data to a specific local area (grid cells of about 55 x 55km size), meaning that we can investigate the relationship between terrorism and infant mortality at a subnational level and with great precision.

The figure below illustrates the geographical distribution of both phenomena in Africa. It highlights the major differences in child mortality across different parts of Africa and within individual African states. The map also shows the hotspots of terrorist activity, including parts of Algeria, Nigeria, Somalia, Egypt and Uganda. Already upon visual inspection of the map it becomes clear that areas heavily affected by terrorism also seem to have a high child mortality rate.