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Table 1 Historical events that led to conflicts in some of the countries included in our analysis

From: Impact of service provision platforms on maternal and newborn health in conflict areas and their acceptability in Pakistan: a systematic review

Afghanistan [6]

The era of armed conflicts started in Afghanistan with the Soviet army invasion in December 1979 to support the Communist government. Although the Soviets left in 1989, Afghanistan has remained in the grip of violence as a result of various political and religious conflicts. In 2001, a new international conflict developed as a result of war against terrorism. In the 1990s the Mujahidin and the Taliban forces were constantly at war in their struggle for power. After the Taliban took control, the war against terrorism was aimed at driving the Taliban forces out of Afghanistan. This led to another prolonged era of war and conflicts leading to suffering for Afghan people.

The war resulted in considerable destruction of infrastructure. In rural areas, whole villages were destroyed together with their orchards, irrigation systems and fields. A million people are said to have died and 700,000 women were widowed by the end of the war. By 1989, there were 3.7 million documented refugees in Pakistan and almost three million in Iran. Huge numbers of people were internally displaced within the country. A large proportion of professionals, including health professionals, and many other educated people left the country.

The Democratic Republic of Congo [17]

During the Congo wars from 1996 to 1997 and 1998 to 2003, the conflict involved nine countries and more than 40 rebel groups. Today three main categories of armed groups operate in eastern Congo: the Rwandan Hutu FDLR; the Rwanda and Uganda-backed M23; and various local armed “Mai Mai” groups. In addition, the Congolese army has committed many human rights abuses. All of these groups have attempted to seize control of natural resources in order to continue fighting. The conflicts begin after the outpouring of refugees into DRC as a consequence of the ‘Rwanda genocide’. These refugees formed a rebellious group and led to the first and second Congo wars when the government of DRC decided to purge all Rwanda elements from the system.

Since the beginning of 2012, ethnic tensions and inequitable access to land have led to renewed violence in the east and north-east of DRC resulting in the displacement of more than 2.2 million people inside the country. In addition, almost 70,000 people have crossed the border into neighbouring Rwanda and Uganda.

At the same time, in the first half of 2012, some 15,000 refugees from the DRC returned home, mainly to Equateur province. Their reintegration will be supported by UNHCR through community-based projects and targeted assistance to individuals to enhance their livelihoods. More than 400,000 Congolese refugees currently remain outside the DRC. Since the beginning of the conflicts over 5.4 million people have died and over two million have been displaced.

Sudan [18]

Since gaining independence from Britain and Egypt in 1956, Sudan has experienced more years of conflict than peace. The first civil war, from 1955 to 1972, was between the Sudanese government and southern rebels who demanded greater autonomy for southern Sudan. The war ended with the 1972 Addis Ababa Agreement, which granted significant regional autonomy to southern Sudan on internal issues. The second civil war erupted in 1983 due to longstanding issues heightened by then President Jaafar Nimeiri’s decision to introduce Sharia law. Negotiations between the government and the Sudan People’s Liberation Movement/Army (SPLM/A) of southern Sudan took place in 1988 and 1989, but were abandoned when General Omar al-Bashir took power in the 1989 military coup. Bashir remains president of Sudan today. These internal ensions drove the country’s decades-long civil war, which led to South Sudan’s secession from Sudan on July 9, 2011. Despite this turn of events, numerous internal conflicts continue in Sudan and South Sudan.

The war has left two and a half million people dead and four million people displaced.

Pakistan [19]

Pakistan comprises five broadly distinct regions: Punjab in the north-east, Gilgit-Baltistan and Azad Kashmir in the north, Sindh in the southeast, Balochistan in the south-west, and Khyber Pakhtunkhwa (KP) province and the Federally Administered Tribal Areas (FATA) which border Afghanistan in the Pashtun north-west. Since its creation in 1947, Pakistan has experienced alternating periods of civilian and military rule. Pakistan faces enormous challenges on a range of fronts, including security and terrorism, sectarian and ethnic violence, a troubled economy and recurrent natural disasters. Military intervention by the US and NATO in neighbouring Afghanistan since 2001 and Pakistan’s alignment with the US against al-Qaida and the Taliban has fomented opposition to the government. Islamist armed groups seek to overthrow tribal governance structures in the north-west and the government has struggled to maintain law and order. Indiscriminate suicide attacks, the use of improvised explosive devices, targeted killings and intimidation by non-state armed groups continue, claiming more than 360 civilians’ lives in KP alone in 2012. Military operations against non-state armed groups, most notably Tehrik-eTaliban Pakistan, have escalated since 2007.

An estimated five million people have been displaced by conflict, sectarian violence and wide-spread human rights abuses in the north-west as a whole since 2004. Today, Pakistan faces a renewed displacement crisis fuelled by massive new forced population movements in FATA, the current focus of conflict in the region. More than 415,000 people were newly displaced in 2012 alone.

Guatemala [20]

Guatemala is a mainly mountainous country in Central America. When Spanish explorers conquered this region in the 16th century, the Mayans became slaves in their own homeland. They are still the underprivileged majority of Guatemala’s population. Civil war existed in Guatemala since the early 1960s due to inequalities existing in economic and political life. In the 1970s, the Maya began participating in protests against the repressive government, demanding greater equality and inclusion of the Mayan language and culture; ultimately resulting in a guerrilla movement. In 1980, the Guatemalan army instituted “Operation Sophia,” which aimed at ending insurgent guerrilla warfare by destroying the civilian base in which they hid. This programme specifically targeted the Mayan population, who were believed to be supporting the guerrilla movement.

Over the next three years, the army destroyed 626 villages, killed or “disappeared” more than 200,000 people and displaced an additional 1.5 million, while more than 150,000 were driven to seek refuge in Mexico. The violence faced by the Mayan people peaked between 1978 and 1986.

After 36 years, the Guatemalan armed conflict ended in 1996 when the government signed a peace accord (the Oslo Accords) with the insurgent group, the Guatemalan National Revolutionary Unity.

Myanmar (Burma) [21]

Myanmar (aka Burma) has been in a state of constant civil war since independence in 1948. Myanmar is one of the most ethnically-diverse countries in the world with key non-Burma ethnic groups demanding equality with the Burmans in the three public realms, specifically the protection of ethnic culture, language, and religion, the devolution of tangible executive, legislative, and judicial power to the ethnic states within a true federal union, and a democratic form of government. With their demands unmet, the ethnic groups turned to armed insurgency. The civil war and the perceived threat of secession by ethnic states from Myanmar led in 1962 to a military coup. Since then, the military has dominated the affairs of the country seeing itself as the sole force capable of holding the country together.

The major non-Burman ethnic groups are the Arakanese, Chin, Kachin, Shan, Karenni, Karen, and Mon, all of which have their own states in which they are the dominant ethnic group. All these states have ethnic insurgent activities of varying intensities against the Myanmar military (aka Tatmadaw). The Tatmadaw has been employing a counterinsurgency strategy which attempts to deny the ethnic insurgents access to food, funding, information, and recruits. Also the Myanmar regime policies have led to the impoverishment of and human rights abuses toward the ethnic peoples leading hundreds of thousands of them to seek safety in adjacent countries – Thailand, China, India, and Bangladesh, through resettlement in other countries, and as internally displaced persons in the jungle inside Myanmar.

Currently there are at least 450,000 IDPs living all over Myanmar. There were 166,000 new IDPs registered alone in 2012.