Explore publications.

Armed conflict significantly disrupts public health systems, yet the mechanisms linking violence to endemic disease outbreaks remain insufficiently understood. This study examines how violent conflict affects disease governance and health service delivery across Sudan’s conflict-affected regions between 2000 and 2024. Using a spatial panel dataset that combines geo-referenced conflict events from the Armed Conflict Location and Event Data Project (ACLED), epidemiological surveillance records, environmental indicators, and subnational governance measures, the analysis evaluates the relationship between conflict intensity, governance capacity, and endemic disease incidence. The results indicate that areas experiencing higher levels of violence exhibit significantly greater incidence of malaria, cholera, and measles. These effects are particularly pronounced where health infrastructure has been damaged and administrative capacity has weakened. Regions with stronger local governance demonstrate greater resilience, maintaining partial vaccination coverage and disease surveillance despite ongoing conflict. Spatial models further reveal significant spillover effects, with outbreaks spreading along displacement corridors and border regions. The findings highlight the central role of governance capacity in mediating health outcomes during armed conflict and underscore the importance of conflict-sensitive health interventions. Strengthening decentralized health governance, protecting health infrastructure, and improving cross-regional disease surveillance are essential for mitigating endemic disease risks in fragile and conflict-affected settings.