The extent to which armed conflicts—events such as civil wars, rebellions, and interstate conflicts—are an important driver of child mortality is unclear. While young children are rarely direct combatants in armed conflict, the violent and destructive nature of such events might harm vulnerable populations residing in conflict-affected areas. A 2017 review estimated that deaths of individuals not involved in combat outnumber deaths of those directly involved in the conflict, often more than five to one. At the same time, national child mortality continues to decline, even in highly conflict-prone countries such as Angola or the Democratic Republic of the Congo. With few notable exceptions, such as the Rwandan genocide or the ongoing Syrian Civil War, conflicts have not had clear reflections in national child mortality trends.

 The Global Burden of Disease study estimated that, since 1994, conflicts caused less than 0·4% of deaths of children younger than 5 years in Africa, raising questions about the role of conflict in the global epidemiology of child mortality. The extent to which conflict matters to child mortality therefore remains largely unmeasured beyond specific conflicts. In Africa, conflict-prone countries also have some of the highest child mortality, but this might be a reflection of generalised underdevelopment resulting in proneness to conflict as well as high child mortality, rather than a direct relationship. In this analysis we aimed to shed new light on the effects of armed conflict on child mortality in Africa. We established the effects on child mortality of armed conflict in whom conflict-related deaths are not the result of active involvement in conflict, but of other consequences of conflict. We examined the duration of lingering conflict effects, and the geographical breadth of the observed effects, using geospatially explicit information on conflict location and number of conflict-related casualties. We then used our findings to estimate the burden of armed conflict on children younger than 5 years in Africa.