Measuring conflict related mortality in ten countries of the WHO Eastern Mediterranean Region (2004-2024): A scoping review.

Armed conflict is an important contributor to the global burden of disease through direct and indirect morbidity and mortality. Yet, reliable, up-to-date, and broadly accepted estimates of the human toll are scarce. We conducted a scoping review to map methods used to estimate conflict-related deaths in ten countries of the WHO Eastern Mediterranean region using publicly available data sources. We searched three bibliomedical and scientific databases, manually searched conflict-related death databases and government websites, and reviewed websites of key humanitarian partners. In total, 69 peer-reviewed articles (from 2004 to 2024), 23 databases, 12 government sources, and 114 nutrition and mortality survey reports (from 2004 to 2024) were included. Iraq (32/69, 46%) was the most frequently studied country in the peer-reviewed literature, followed by Syria (16/69, 23%) and Yemen (14/69, 20%). About two-thirds of the studies in the peer-reviewed literature used secondary data (45/69, 65%), frequently from passive surveillance (28/69, 41%) and were national in scope (40/69, 58%). Total number of deaths was the most reported outcome in the peer-reviewed literature (63/69, 91%), followed by crude mortality rate (22/69, 32%). In 54 out of 69 studies (78%), the first author was affiliated with an institution outside the region. Among these 54 studies, only 19 had at least one co-author affiliated with an institution from the region. Databases were mostly based on passive surveillance compiling data from media reports (14/23, 61%), humanitarian organizations (9/23, 39%) and Government sources (8/23, 35%). Nutrition and mortality surveys were based on primary data collection, mostly sub-national and in some cases surveyed more frequently countries under-represented in the peer-reviewed literature. The extensive use of databases suggests a strong interest in comparable longitudinal data on mortality in conflict settings. There may be an untapped opportunity for greater use of survey data by a wider audience.