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One and a half billion people live in conflict-affected and fragile states. At the last estimate in 2012, 172 million people were directly affected by war, including refugees, internally displaced people and those who were affected but did not flee. (1,2) Children are twice as likely to be malnourished and twice as likely to die by the age of five years in low-income countries affected by conflict compared with similar but stable countries. Their families are twice as likely to live without clean water. (3) Conflict does more than short-term damage; it decimates a countryu0027s infrastructure and impairs the social contract between the state and citizens. Food supplies are disrupted; health services collapse. Pregnant women and people who are ill do not receive the life-saving services they need. (4) Less often measured are the long-term consequences of conflict on peopleu0027s mental health and social functioning. People made vulnerable by conflict are being bypassed by global progress. The World Bank warned in 2011 that no low-income, conflict-affected country was on course to achieve any of the millennium development goals (MDGs). (3) Indeed, four years later, of 55 conflict-affected and fragile states, 37 (67%) had met only two or fewer of the 15 MDG targets. (5) The inequity is not simply about the differences between stable and unstable countries. Even within countries, conflict-affected areas fare worse than areas with less or no conflict. In the Democratic Republic of Congo, for example, under-five mortality in the conflict-affected South Kivu province is nearly double that of Kinshasa province. (6) Despite this experience, the sustainable development goals (SDGs) for the year 2030 include barely more guidance on conflict than did the MDGs, which did not specifically mention conflict. SDG 16 explicitly recognizes the need to resolve conflict and mitigate its circumstances, but this intention does not translate into specific action points for other SDGs, such as SDG 3, which focuses on health. Unless we learn how to achieve the targets in conflict settings, the benefits of the SDGs will not reach many of the people who need them most. The first question is whether the list of 17 SDGs and 169 targets should be adapted by each country. There is experience of simpler, more modest goals being associated with greater success. In Afghanistan, the government and its partners worked together to adapt the MDGs to meet their needs, setting more realistic interim targets and agreeing on objectives and approaches adapted to the countryu0027s unique realities. (7) Methods of measurement need to be realistic too. Widely used mechanisms to monitor progress in health at a national scale, such as the demographic and health surveys and the multiple indicator cluster surveys, sometimes leave out whole conflict-affected areas and routinely exclude internally displaced persons and refugees. (8) There are alternatives, such as data collected by nongovernmental organizations that work in conflict zones. These data, which are collected to identify needs and monitor the progress of humanitarian interventions, are arguably underused for monitoring development goals. (8) Population data are also scarce among displaced and disrupted communities, although humanitarian organizations commonly conduct and update small-scale censuses of difficult-to-access areas. Using these sources, while not a solution to the problem, could be a first step towards better monitoring. We also need to be more realistic about the level of investment needed to effect even modest changes. Conflict-affected countries often have greater needs both in terms of capital costs to rebuild destroyed infrastructure and of recurring costs to operate in environments with transport and security challenges. Yet conflict-affected countries have received less investment than others. In 2012, for example, the Central African Republic received one-fifth the per-capita direct assistance for health that Malawi did. …

How can the sustainable development goals improve the lives of people affected by conflict?