Quantifying Conflict and its Association with Cholera in Yemen

Project Summary Since 2014, Yemen has been embroiled in a protracted conflict that has left over 80% of its population in need of humanitarian aid and protection. Yemen faced significant vulnerabilities before the conflict, including a poor economy, food insecurity, fragile healthcare system, and insufficient water, sanitation, and hygiene infrastructure. Now, over 4 million individuals have been displaced, and most of the population is impoverished. Communicable diseases have increased during conflict; the clearest example of this is the cholera outbreak that began in 2016, which is considered the largest cholera outbreak in recent history with over 2.5 million cases and 4,000 related deaths. Only half of Yemen's health facilities are considered fully functional, making the health system insufficient to meet this increased demand for care. Much of this reduced functionality comes from air raids on the facilities, which have become a central component of the conflict's violence. However, existing measures do not capture the full extent of conflict's effect on infrastructure, which is critical in the mechanism between conflict and increased disease incidence. This includes infrastructural rebuilding, which is an important consideration in protracted conflicts as it can help reduce further spread of disease. The overall goal of this proposal is to quantify and assess the association between conflict and cholera in Yemen. The first Aim towards this end is to build a model that measures the association between conflict and cholera while incorporating environmental, economic, demographic, and spatial factors relevant to cholera's epidemiology. The second Aim will utilize earth observation tools, including nighttime light and synthetic aperture radar, to measure infrastructure changes and assess whether this conflict measurement better predicts cholera cases. I will also use data from this aim to incorporate infrastructural rebuilding into the first Aim's model. Lastly, my findings from Aims 1 and 2 will be used to project future cholera outbreaks under different conflict, climate, and economic scenarios. Overall, these findings will have important implications for understanding conflict's role in driving Yemen's cholera epidemic, how we measure conflict, infrastructure's role in disease dynamics, and enhancing preparedness efforts. This F31 training fellowship will enable me to expand upon my background in conflict and health research and learn new skills in disease ecology, earth observation, and advanced statistical methods during my PhD dissertation work at the University of California, Irvine. I will be mentored by a team of subject-matter and methodology experts who will help me develop the skills necessary to complete this proposed research. This fellowship will also allow me to gain invaluable experience to prepare for a career as an independent researcher, including grant writing and team management, which would otherwise be difficult to obtain due to teaching commitments. Together, this fellowship and supported training will aid in my career goals of robust research on the conflict and health nexus that can fuel preparedness, support advocacy, and reduce morbidity and mortality.