Research Mentor Name

Carmen Messerlian

Research Mentor Email Address

Institution / Department

Harvard T.H. Chan School of Public Health (Department of Epidemiology)

Document Type

Research Abstract

Research Type


Level of Research


Type of Post-Bachelor Degree

Masters of Science


Introduction: Armed conflict is a major cause of ill health and mortality which disproportionately impacts women and children. The 2020 War between Armenia and Azerbaijan over the territory of Nagorno-Karabakh occupied by ethnically Armenian population, provides an example of how conflict impacted health during COVID-19. We hypothesize that exposure to crises will correspond to decreased healthcare utilization rates and worse health outcomes of the maternal and infant population in Armenia, and that these trends will be compounded during the pandemic period.

Methods: Following a historic case study approach, we used ecological level data from 1980-2020 to evaluate trends in battle related deaths (BRD), COVID-19 cases, and maternal and infant health indicators during periods of conflict and peace in Armenia. We interviewed 10 key informants to learn about unmet needs, maternal health seeking behaviors, and priorities during the war, and identified recommendations to mitigate the effects of future crisis on maternal and infant health.

Results: BRDs were highest in the 2020 War compared to the previous Nagorno-Karabakh conflicts. Periods of active conflict between 1988-2020 had increased rates of sick infant mortality, neonatal mortality, and pre-eclampsia/eclampsia. The weekly average of COVID-19 cases increased 7-fold during the 2020 Nagorno-Karabakh War. The main concerns for key informants were the effects of stress and grief on maternal health and pregnancy outcomes. The most common recommendation made by key informants was investment in healthcare system reform. Participants also stressed the synergistic effects of the war and COVID-19, noting healthcare capacity concerns and the importance of a strong primary care system.

Conclusions: The 2020 Nagorno-Karabakh War the war coincided with negative impacts on maternal and infant health, exacerbated by the COVID-19 pandemic. To mitigate effects of future crises on maternal and infant health in Armenia, there should be an investment in healthcare system reform focused on primary care promotion.


Epidemiology | Maternal and Child Health | Medicine and Health Sciences