The effect of violent conflict on calorie consumption and dietary quality in Iraq
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Parigi, Marta Article — Published Version The effect of violent conflict on calorie consumption and dietary quality in Iraq Journal of Agricultural Economics Provided in Cooperation with: John Wiley & Sons Suggested Citation: Parigi, Marta (2023) : The effect of violent conflict on calorie consumption and dietary quality in Iraq, Journal of Agricultural Economics, ISSN 1477-9552, Wiley, Hoboken, NJ, Vol. 75, Iss. 1, pp. 341-361, https://doi.org/10.1111/1477-9552.12560 This Version is available at: https://hdl.handle.net/10419/290154 Standard-Nutzungsbedingungen: Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden. Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen. Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Terms of use: Documents in EconStor may be saved and copied for your personal and scholarly purposes. You are not to copy documents for public or commercial purposes, to exhibit the documents publicly, to make them publicly available on the internet, or to distribute or otherwise use the documents in public. If the documents have been made available under an Open Content Licence (especially Creative Commons Licences), you may exercise further usage rights as specified in the indicated licence. https://creativecommons.org/licenses/by-nc-nd/4.0/
J Agric Econ. 2024;75:341–361. | 341 wileyonlinelibrary.com/journal/jage Received: 20 December 2022 | Revised: 29 May 2023 | Accepted: 20 June 2023 DOI: 10.1111/1477-9552.12560 ORIGINAL ARTICLE The effect of violent conflict on calorie consumption and dietary quality in Iraq MartaParigi Faculty of Business, Economics and Social Sciences, University of Hohenheim, Stuttgart, Germany Correspondence Marta Parigi, Faculty of Business, Economics and Social Sciences, University of Hohenheim, Stuttgart, Germany. Email: [email protected] Abstract By combining 2012 Living Standard Measurement Survey crosssectional survey responses and georeferenced conflict data, this study quantifies the effect of violent conflict on food security and dietary quality in Iraq. Specifically, it estimates the effect of physical insecurity on different food security dimensions, including caloric consumption and household dietary diversity. Because disrespecting warrelated foreign national cemeteries is a war crime that discourages nearby fighting, instrumenting conflict intensity by the exogenous variation in distance between these sites and household place of residence addresses potential sources of bias. The instrumental variable analysis confirms the positive (negative) effect of conflict— deriving from state, nonstate and onesided violence (e.g., attacks by the Islamic State)— on per capita caloric consumption (household dietary diversity), which although counterintuitive is unsurprising given Iraq's relatively highincome levels and changes in dietary pattern. Given that the primary driver of conflict's positive effect on calories is increased consumption of carbohydrates and, to a lesser extent, saturated fat, these results suggest that in countries transitioning to Westernstyle diets, violent conflict may drive the population toward an unhealthier diet, contributing heavily to a growing national prevalence of nutritionrelated noncommunicable diseases. KEYWORDS conflict, food security, instrumental variables, Iraq JEL CLASSIFICATION C21, D12, I19, Q12 This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2023 The Author. Journal of Agricultural Economics published by John Wiley & Sons Ltd on behalf of Agricultural Economics Society.
342 | PARIGI 1 | INTRODUCTION In the first two decades of the twentyfirst century, the victims of war in the SWANA region1 numbered over 800,000; 150,000 of them were in Iraq (Uppsala Conflict Data Program,2021). Over the same period, as most other world regions saw a decreasing trend in food insecurity, SWANA countries registered worsening achievements (World Bank,2020), with exposure to violence and political instability inevitably disrupting all food security dimensions, from food production to supply stability to household access to healthy diet. In this context, understanding the complex dynamics that underlie this relation is crucial, especially in understudied countries such as Iraq. Thus, the aim of this study is to identify the effect of conflict exposure on food security in the Iraqi context. In particular, the focus here is on whether physical insecurity leads to greater calorie consumption as a consequence of an increased purchase of cheap carbohydrates. A growing stream of literature demonstrates exposure to violence's negative impact on proxies of food access such as the Household Dietary Diversity Score (HDDS), Food Consumption Score (FCS) and calorie consumption (Lin et al.,2021; Marchesi & Rockmore,2023; Muriuki et al.,2023). For example, whereas Dabalen and Paul(2014) document the negative relation between measures of selfreported conflictrelated victimisation and Ivorian household food security, George et al.(2020) use a fixed effects estimator to illustrate how exposure to Boko Haram violence in Nigeria limits both the variety and portion sizes of food eaten. This latter mirrors the significant drops in both food expenditure and household caloric consumption induced by four decades of war and civil unrest in Afghanistan (D'Souza & Jolliffe,2013), a negative effect on calorie supply which Hitzhusen and Jeanty(2006) document in 28 other developing nations. Evidence also abounds of armed conflict's negative effect on other dimensions of food security, such as food utilisation proxied by both short- and longterm child malnutrition (Akresh et al.,2011; Brown,2018; Koppensteiner & Manacorda,2016; Oskorouchi,2019). For instance, Minoiu and Shemyakina(2012) document a causal link between the 2002– 2007 civil conflict in Côte d'Ivoire and a half a standard deviation reduction in child heightfor- age zscores (stunting), an effect immediately relatable to the negative association documented by Dabalen and Paul(2014). Likewise, Martin- Shields and Stojetz(2019), in their comprehensive review of studies that use robust methodology to establish a causal nexus between conflict and food security, demonstrate that the latter has both a short- and longterm negative effect on anthropometrics. Another stream of literature underscores how conflict lowers food availability by disrupting food production (Adelaja & George,2019; Fadare et al.,2022; Nillesen,2016), as illustrated by satellite imagery of a 17% drop in winter wheat production induced by the ongoing war in Ukraine (Deininger et al.,2023). Unfortunately, as regards the post- 2003 effects of the US invasion of Iraq, only a few related studies use nationally representative data, with Acharya et al.(2020) being a rare exception. These authors, by coupling individuallevel microdata from the 2011 UNICEF Multiple Indicator Cluster Survey with the Empirical Study on Conflict database, pinpoint an association between an additional populationweighted violent event and a 0.006– 0.019 standard deviation lower child heightfor- age zscore (stunting) driven primarily by maternal stress and child– mother malnutrition. Evidence from a crosssectional survey of four primary schools in Baghdad further underscores the lower nutritional status of children living in unsafe neighbourhoods as measured by body mass index (BMI; Ghazi et al.,2013, 2014). As this work suggests, research into conflict's effect on food security mostly employs measures of undernutrition and/or focuses on lowincome countries in which conflictrelated insecurity is likely to cause undernutrition and calorie scarcity. The contribution of 1This acronym for Southwest Asia and North Africa typically denotes an area extending from Morocco to Afghanistan.
| 343 THE EFFECT OF CONFLICT ON FOOD SECURITY IN IRAQ the present study is therefore twofold: first, it tests whether a middleincome context results in the nexus between conflict and nutrition being more complex than a mere drop in food consumption; second, it expands the analysis of conflict exposure's interaction with food security beyond (aggregated) measures of calorie consumption and diet diversity to examine changes in the consumption of specific macronutrients. This shift to a middleincome context broadens the knowledge base by exploring how conflict affects caloric consumption2 and dietary diversity when malnutrition is caused more by micronutrient deficiency than by scarcity of available calories (Woertz,2020). In Iraq, for example, in contrast to settings of extreme poverty, physical insecurity might lead to lower intake of unprocessed foods and more frequent consumption of cheap, easy to store, high calorie products, as particularly evidenced by rates of adult overweight (65%), obesity (30%) and child stunting (12%) (NCD Risk Factor Collaboration,2017; UNICEF, WHO, & World Bank,2020). The focus on specific macronutrient consumption thus extends the analysis beyond quantification of conflict's effect on dietary diversity and calorie consumption to detail its relation to the consumption of carbohydrate, fat and saturated fat. To achieve this, I combine crosssectional information from the Living Standard Measurement Survey (LSMS) Iraq (2012) with the Uppsala Conflict Data Program Georeferenced Database to estimate the conflict's effect on per capita caloric consumption, household dietary diversity and diet quality, as measured by carbohydrate and total and saturated fat consumption in kilocalories (Kcal). To measure conflict in the period of interest (2011– 2012), I include all fatalities stemming from state violence, nonstate violence and onesided violence, where the latter includes all armed attacks against civilians by a state or organised armed group, which for Iraq refers to the violent attacks carried out by the socalled Islamic State (IS) in 2011 and 2012. Because endogeneity in the naïve ordinary least squares (OLS) estimates may stem from nonrandom measurement error in the count of fatalities (i.e., because of different reporting standards across the country), the conflict intensity values assigned to some groups (e.g., those living in remote areas) may be systematically lower. Moreover, if food insecurity is itself a cause of more violence, the OLS estimates could suffer from reverse causality. To address these potential sources of bias, I employ an instrumental variable (IV) strategy that relies on the prohibition (by both Islamic and international law) of violating mortal remains to construct an exogenous instrument for conflict intensity. The remainder of the article is organised as follows: Section2 provides a background on the conflict in Iraq and a theoretical framework; Section3 describes the data used in the empirical analysis; Section4 presents the base econometric model, construction of the main variables, the potential sources of bias, and the instrumental variable approach; Section5 outlines the main results; and Section6 concludes the paper with a discussion of their implications. 2 | RESEARCH CONTEXT 2.1 | Historical background 2.1.1 | The first Gulf War and the sanctions period Since the start of the war with Iran in 1980, Iraq has seen no prolonged periods of peace and stability. Following its 1990 invasion of Kuwait, in particular, Iraq entered a decadeslong period of 2Because calorie computation is based on food purchase records that may include wasted or bulk purchases stored by households for several weeks (e.g., food rations), food consumption here does not necessarily equal food intake.
344 | PARIGI violence, economic collapse and deterioration of both its social fabric and the population's living conditions. First, the US- led First Gulf War, despite its short duration (August 1990– February 1991), imposed more damage on the country's economy and infrastructure than the 8- year Iran– Iraq conflict (Tripp,2010). Subsequently, the UN imposed on Iraq one of the harshest embargos in modern history, one whose sanctions, by initially including food items, not only prevented the import of key agricultural inputs but hindered the global trade in food on which Iraq now became heavily dependent. These sanctions, which disrupted every aspect of Iraqi life (Halliday,1999; Santisteban,2005), led to severe food price inflation (Field,1993), prompting the government's introduction of the still operative Public Distribution System (PDS), a food rationing scheme designed to guarantee sufficient caloric consumption to the entire population. 2.1.2 | The 2003 US invasion of Iraq In 2003, Iraq's alleged ownership of weapons of mass destruction motivated a US- led coalition to invade the country, further destabilising the insecurity induced by decades of war and sanctions (Ali,2018). The invasion generated several conditions that paved the way for politicisation of sectarian divisions (Ismael & Ismael,2015), which later led to the outbreak of civil conflict. One such catalyst was the almost complete dismantling of the pre- 2003 state apparatus— translated, for example, into the process of de- Baa'thification3— which left 400,000 trained military personnel and thousands of civil servants unemployed (Ismael & Ismael,2015). Another was the Coalition Provisional Authority's (CPA's) imposition of a series of neoliberal reforms, which, combined with the establishment of a confessional quota system (mohassasat) for allocating government positions, facilitated and institutionalised sectarian divides (Ismael & Ismael, 2015; Sommer- Houdeville, 2017). Until 2004, the war that followed the Anglo- American invasion saw the fragmented insurgent groups fighting mainly US- led occupation forces. In response, the coalition worked for a progressive ‘Iraqization’ of the conflict using the newly established Iraqi army to repress the insurgency (Sommer- Houdeville,2017). This attempted repression led to an increase in direct clashes between the regular army and Iraqi insurgent groups, evolving into an actual civil war by 2005. Over the 2006– 2007 period, the level of violence reached a dramatic peak, decreasing consistently after the United States withdrew its troops from Iraq at the end of 2011. Although the 2011 conflict was categorised as one of minor intensity, the violence continued to affect numerous areas of Iraq. In particular, it affected the central regions including Baghdad and the region bordering Iran, as well as the northern region close to the border with Turkey. Over the 2011– 2012 period of interest for this analysis, 2806 people lost their lives through conflict (Uppsala Conflict Data Program,2021), most as a result of fighting between the Iraqi State and IS, as well as confrontations between Iran or Turkey and Kurdish parties. As regards onesided violence, IS attacks against civilians— which together with military operations intensified in 2012 after the armed group gained more power— claimed the lives of 1091 Iraqi civilians. 2.2 | Theoretical framework The generalised climate of violence— from both regular army and guerrilla activities— together with the dismantling of the pre- 2003 state apparatus and political economy, heavily affected Iraq's food system. Because the beginning of armed confrontations coincided not only with the end of sanctions but also with structural economic reforms, this effect must be 3A Coalition Provisional Authority policy that removed all public employees affiliated with the Baa'th Party from their positions.
| 345 THE EFFECT OF CONFLICT ON FOOD SECURITY IN IRAQ considered in the light of former shocks. Hence, in the paragraphs below, after explaining how these economic changes relate to the state of Iraqi food security and agricultural production, I present a theoretical framework that justifies how conflict could have driven Iraqis to adopt diets lower in nutritional quality and higher in calorie consumption. 2.2.1 | Liberalisation and the end of sanctions The changes in food security engendered by conflict need to be understood within the framework of the important economic reforms occurring in Iraq after 2003. In particular, the increased competition induced by CPA food system policies like privatising public agricultural enterprises (Sommer- Houdeville,2017) and coercively promoting multinational agricultural corporation access into the Iraqi market (Docena,2004)— which was worsened by international organisations' food provision at subsidised prices (Gibson et al.,2012)— drove many small farmers out of the market. As a result, local production decreased, increasing dependence on imported food. Yet the seemingly positive increased caloric availability from greater food imports did not automatically translate into healthier diets. Rather, it spurred a shift toward a nutrition transitional stage in which a fat- and sugarrich Westernstyle diet progressively replaced diverse local seasonal fare (Golzarand et al.,2012). Hence, although changes in dietary patterns usually go hand in hand with economic development— a potential outcome of Iraq's 1980s economic boom— the decadelong sanctions created a situation of food scarcity that delayed the nutritional transition. Such a dietary pattern shift was particularly widespread following the 2003 lifting of sanctions when, as in other middleincome countries in the region, a Westernstyle diet became more accessible for a larger share of the population. Overweight and obesity therefore increased sharply during the subsequent two decades, with an incidence comparable to that of some highincome countries (NCD Risk Factor Collaboration,2017). 2.2.2 | Conflict → food supply To determine the extent to which physical violence and insecurity might have contributed to these important nutritional changes in Iraq, I identify two primary and interrelated channels for this assumed relation; namely, reduced local food production (supply) and difficulties in the capillary distribution of food, especially of more perishable food items. As regards the first, the years after the Iraq invasion saw a decrease in local production because the insecurity and violence made it difficult for Iraqi farmers to work their fields or store their harvests (FAO,2017), with a share also losing crops to heavy military operations (Picotte & Campbell,2010). The protracted conflict also deeply affected the country's food distribution system, not only through destruction of physical infrastructure but also via the installation of checkpoints and inaccessible military areas, whose interconnections were made particularly risky and cumbersome by the high level of physical insecurity (Rawaf et al.,2014). Particularly challenging in the context of a progressively less localised food supply and dependence on food imports was access to insecure areas, which reduced local availability of, and accessibility to, more perishable food. 2.2.3 | Conflict → food prices The shifting dietary patterns in Iraq reflect two welldocumented dynamics: First, higher production and transportation costs tend to inflate local food prices, especially for smallerscale farms. Second, greater availability of imported staples and processed and
346 | PARIGI semiprocessed food encourages the population to replace local fresh food with cheaper imported items of lower nutritional quality (e.g., rich in refined carbohydrates and fat). Such unbalanced diets heavily reliant on refined carbohydrates are documented as leading to high rates of obesity and chronic malnutrition among West Saharan refugees in Algeria (Grijalva- Eternod et al.,2012). 2.2.4 | Potential heterogeneous effects Although the above theoretical framework attributes higher calorie and less balanced diets to Iraq's insecurity, the effects could nonetheless differ for certain strata of the population. That is, conflict's negative effects might be especially severe for the poorest households, which may have difficulties accessing even the relatively cheaper food items. It would therefore not be unexpected to observe heterogeneous effects of the conflict– food security nexus based on household economic status, especially for the 11% (20%) of Iraqi households living below the food (food and nonfood) national poverty line. According to the theoretical assumptions presented above, for the relatively better off (i.e., the great majority of the Iraqi population), exposure to conflict may imply a substitution effect from healthier but more expensive food items to more caloriedense and fat filled produce, resulting in an ultimately positive average effect on calorie consumption but a decrease in dietary diversity. 3 | DATA 3.1 | Survey data The analytic dataset comprises household socioeconomic and food purchase information from the LSMS 2012 administered by the Central Organisation for Statistics and Information Technology (COSIT) and the Kurdistan Region Statistics Organisation (KRSO) in collaboration with the World Bank (COSIT, KRSO, & World Bank,2012). This database provides a rich set of household variables, including demographics, socioeconomic status and food purchases. After first stratifying the sample by qadha (district, second administrative division), the researchers randomly selected 215 participant households from each qadha, regardless of population. The initial nationally and divisionally representative sample included 25,146 households comprising 176,042 individuals, which, after deletion of implausible and missing values, yielded a final sample of 22,376 households. To compute the consumption of select macronutrients and calories from the LSMS householdlevel data on quantities of 265 food items purchased in the week before interview, I draw primarily on the Food and Agriculture Organisation's Food Composition Tables for the Near East, which provide conversion factors from quantities to caloric content for various micro- and macronutrients (FAO,1982). For the 67 food items missing from this database, I use the corresponding nutritional values from the USDA Food Data Central composition tables (US Department of Agriculture,2018) and the Bahreini Food Composition Tables (FCT) (Musaiger,2011). 3.2 | Conflict data The Uppsala Conflict Data Program Georeferenced Event Dataset (UCDP GED) (Sundberg & Melander,2013) provides georeferenced information on violent events collected from both primary and secondary sources, including but not limited to NGOs, local experts, police and media reports. The database also records violent event characteristics, such as the number of
| 347 THE EFFECT OF CONFLICT ON FOOD SECURITY IN IRAQ casualties, identifiers for the parties involved, location, date and the degree of geographic and temporal precision for each event (Croicu & Sundberg,2016). In this study, I consider only the 96% of violent events identifiable at least at the district level. 3.3 | Population and aid data Because the Iraqi Statistical Bureau provides no districtlevel population estimates, I derive per capita conflict intensity by exploiting Gridded Population of the World raster image estimates at 30 arcsecond resolution (Center for International Earth Science Information Network [CIESIN],2018). I then use an Iraqi shapefile of secondary administrative level (OCHA, 2017) to convert these finegrained data into numeric values aggregated at the district level. For data on international aid, I employ the Iraq AIMS Geocoded Database (Research Release version 1.3.1) of all international development assistance to Iraq from 2003 to 2014 (AidData,2016). 3.4 | Potential crop yield data To construct a district level measure of potential crop yield with a 5 arcminute resolution, I use the raster dataset provided by Galor and Özak(2016), which captures the average potential crop yield measured in calories per hectare per year. The authors provide a Caloric Suitability Index value for each cell that proxies land suitability. To derive the district level data, I convert the raster data into numeric values and again use the second administrative division Iraqi shapefile to associate a potential crop yield value with each district. 4 | MATERIALS AND METHODS 4.1 | Basic regression framework To quantify the effect of conflict on various dimensions of food security as measured by per capita daily caloric supply, an HDDS and specific measures of diet quality, I estimate the naïve econometric OLS model expressed in Equation1, where Y is alternatively a food security or a diet quality measure and vector Hi is a control for household characteristics. The main independent variable of interest, fatalities(t− 1 )i , is a continuous populationadjusted indicator of conflict intensity measured at the district level (n) in the oneyear period before interview. One methodological shortcoming of this approach, and a weakness common to other studies using a similar empirical strategy (D'Souza & Jolliffe,2013; Oskorouchi,2019), is the inability to control for district fixed effects whose inclusion would overfit the model and result in high multicollinearity. To overcome this weakness, all model specifications control for a vector Dn of districtlevel controls, and all regression estimates have standard errors corrected at the district level, which both accounts for survey design complexity and allows for heteroscedasticity. (1) Y i=𝛽0+𝛽1fatalities(t−1),i+ 15 ∑ k=2 𝛽kHi+ 18 ∑ w=16 𝛽wDn+ei
348 | PARIGI 4.2 | Variable descriptors 4.2.1 | Dependent variables Daily per capita calorie consumption To compute householdlevel daily per capita calorie consumption, I merge each food item listed in the LSMS Iraq weekly food records module4 with its FAO table counterpart (or USDA/Bahraini FCT counterpart for missing items). In the rare case of an item missing from both food composition tables, I proxy its caloric content and other selected nutritional values by computing the average quantity of interest of similar food items; for example, assigning the LSMS item ‘cherry plum’ the average nutritional content of other plum varieties. I assign the nutritional values to processed food items based on one or more similar products in either the USDA food database (for common snacks such as crisps, chips, cake, biscuits, flavoured juice and icecream) or the Bahrain Food Consumption Tables (Musaiger,2011) (for Middle- Eastern foods such as regional pastries and beverages). Admittedly, because nutritional values for processed food are only approximations, the outcome variable could still be subject to measurement error; however, any such error would only generate attenuation bias. Another limitation of LSMS Iraq, however, is that it reports no quantities— only monetary values— for food items that are explicitly categorisable but labelled ‘other’ (19 cases). To overcome this issue, I follow San Ahmed and Holloway(2017) and Vu(2008) by first calculating the average price per unit for each food category (fruit, vegetable, meat) in the district of residence and then deriving the missing food quantity by dividing the total purchase value per item by the corresponding food category- and districtspecific average price. To compute total daily caloric consumption at the household level, I multiply the quantity of each food item purchased by its corresponding caloric value from the food consumption table and divide by 7 days. I then further divide this value by the household size in adult equivalency. In this computation, each member weighs the ratio of their daily recommended caloric intake (from WHO,1985) over that of a medium active male adult aged 18– 30. I drop implausible values, defined as households with daily calorie consumption below 500 Kcal per adult equivalent. Household dietary diversity To measure diet quality in terms of food group variety, I categorise the LSMS food module items into 21 groups5 and assign an HDDS based on the number recorded by a household in the week before interview. Given the research focus and the Iraqi context, instead of the standard HDDS, I use a more disaggregated version to better proxy micronutrient adequacy. Specifically, I employ the categories proposed by Arimond et al.(2010), which are not only more disaggregated than FAO's HDDS but also exclude food categories with limited micronutrient value (cf. FAO Women DDS), including sweets, oils and fats, spices and beverages (FAO,2013). It should be noted that, following the FAO guidelines, I categorise almost all the processed food items in the Iraq LSMS data as either condiments, or sweets and beverages.6 4Here, households report not only food obtained through purchase but also rations from the PDS, gifts, selfconsumption from own production, and food received as a feefor- work. If the household did not pay for a specific food item, the respondent is asked to provide an estimate of the price they would have paid at the local market. 5Grains, other starchy staples, cooked dry beans and peas, soybeans and soy products, nuts and seeds, milk and yogurt, cheese, organ meat, eggs, small fish eaten whole, large whole fish, shell fish and other seafood, red meat, white meat, insects and other small animals, vitamin A rich vegetables and tubers, vitamin A rich dark green leafy vegetables, vitamin A rich fruits, vitamin C- rich vegetables, vitamin C- rich fruits, other fruits and vegetables. 6The LSMS Iraq sample consumes the following process food items: artificially flavoured juice, assorted sweets, biscuits, cake, chewing gum, chips, chocolate, fruit juice, gaseous beverages, icecream, jam kahi (local millefeuille), ketchup, klecha (local pastry), mustard, other fruit soft drinks, other sugar products, pizza, sandwich, sauces and flavours, sherbet (local sweet beverage).
| 355 THE EFFECT OF CONFLICT ON FOOD SECURITY IN IRAQ per 100,000 inhabitants in the year prior to interview increases the caloric consumption by 61.3 Kcal, an outcome partially due to the conflict's positive effect on carbohydrate and saturated fat consumption. Most notable, each additional fatality translates on average into an increase from carbohydrates of 44.3 Kcal and an increase from saturated fat of 14 Kcal. As regards TABLE 2 Effect of conflict on food security: OLS estimates. Model (1) (2) (3) (4) (5) Dependent variable KcalbHDDS Kcal CarbbKcal Fatb Kcal Saturated Fatb Fatalitiesa10.58*** −0.02*** 3.72*5.54*** 1.38*** (3.22) (−4.19) (1.82) (4.33) (3.43) Controls Yes Yes Yes Yes Yes Observations 22,376 22,377 22,376 22,376 22,376 F- stat (pvalue) *** *** *** *** *** R- squared 0.13 0.13 0.12 0.08 0.07 Note: Results based on Iraq 2012 LSMS, UCDP GED, Gridded Population of the World (GPWv4), AidData, and Galor and Özak(2016) data. T- statistics in parentheses corrected for survey design. All models include dummies for sex, unemployment status of household head, urban residency, migration status, and season of interview, and continuous controls for nonfood expenditure, household size, dependency ratio, education and age of household head, Paasche index, districtlevel aid, Caloric Suitability Index and poverty headcount ratio, and distances in minutes to the nearest hospital, ration agent, paved road, market. Full results in AppendixS1: Table A2. aFatalities per 100,000 inhabitants. bKcal per day/adult equivalent. *p < 0.1; **p < 0.05; ***p < 0.01. TABLE 3 Effect of conflict on food security: IV estimates. Model (1) (2) (3) (4) (5) Dependent variable KcalbHDDS Kcal CarbbKcal Fatb Kcal Saturated Fatb Fatalitiesa61.28** −0.09*** 44.3** 11.90 14.00*** (2.06) (−2.59) (2.45) (0.94) (3.10) Controls Yes Yes Yes Yes Yes Observations 22,376 22,377 22,376 22,376 22,376 Firststage F- stat 55.95 55.95 55.95 55.95 55.95 Note: Results based on Iraq 2012 LSMS, UCDP GED, Gridded Population of the World (GPWv4), AidData, and Galor and Özak(2016) data. T- statistics in parentheses corrected for survey design. All models include dummies for sex, unemployment status of household head, urban residency, migration status, and season of interview, and continuous controls for nonfood expenditure, household size, dependency ratio, education and age of household head, Paasche index, districtlevel aid, Caloric Suitability Index and poverty headcount ratio, and distances in minutes to the nearest hospital, ration agent, paved road, market. Full results in AppendixS1: Table A3. aFatalities per 100,000 inhabitants. bKcal per day/adult equivalent. *p < 0.1, **p < 0.05, ***p < 0.01.
356 | PARIGI the HDDS, the IV models show an average conflictrelated decrease of 0.09 food categories. Because no other study reports a positive effect of conflict on calorie consumption, comparing these coefficients with other research output is infeasible. However, to truly understand the magnitude of this effect, it is worth considering it relative to an average adult meal of 600 Kcal, which indicates a conflictinduced increase in meal size of 10%. These results confirm the hypotheses outlined in Section2 that in a situation of physical insecurity, with limited local production and high dependency on foreign products, households cope with the scarcity and unaffordability of more perishable items by reorganising their diets, with a preference for cheaper, easy- to- store and more available food items. The estimated effects thus indicate that visà- vis a decrease in dietary diversity, households gravitate toward cheaper more caloriedense food as evidenced by the conflict's positive effect on carbohydrate and saturated fat consumption (Table3). This dynamic makes sense in the Iraqi context not only because a minority of the population lives below the poverty line, but because a nutritional transition is underway that will likely accelerate with the increased availability of refined carbohydrates, fat and processed food. Nevertheless, because 11% of the Iraqi population does live below the food poverty line, the effect of conflict on calorie consumption may be heterogeneous, a hypothesis I verify using the main model in Equation1 by interacting the conflict variable with a dummy equal to one if the household falls below the national poverty line (zero otherwise). According to the results, although conflict has a negative effect on calorie and macronutrient consumption for poor households, for the nonpoor this effect remains positive (see Table4). Moreover, in line with the extant literature, although conflict negatively affects the HDDS of both poor and nonpoor households, this effect is more pronounced for the former. Nonetheless, because this heterogeneous analysis relies on exogenous variation in the distance to the closest cemetery and TABLE 4 Effect of conflict on food security: IV estimates of interaction with poverty. Model (1) (2) (3) (4) (5) Dependent variable KcalbHDDS Kcal CarbbKcal Fatb Kcal Saturated Fatb Fatalitiesa83.89*** −0.06** 57.68*** 18.70 16.37*** (2.74) (−2.36) (3.10) (1.45) (3.56) Fatalitiesa × Poorc−255.26*** −0.31*** −151.10*** −76.85*** −26.72*** (−10.28) (−8.49) (−9.78) (−9.76) (−12.69) Controls Yes Yes Yes Yes Yes Observations 22,376 22,377 22,376 22,376 22,376 Firststage F- stat 55.95 55.95 55.95 55.95 55.95 Note: Results based on Iraq 2012 LSMS, UCDP GED, Gridded Population of the World (GPWv4), AidData, and Galor and Özak(2016) data. T- statistics in parentheses corrected for survey design. All models include dummies for sex, unemployment status of household head, urban residency, migration status, and season of interview, and continuous controls for nonfood expenditure, household size, dependency ratio, education and age of household head, Paasche index, districtlevel aid, Caloric Suitability Index and poverty headcount ratio, and distances in minutes to the nearest hospital, ration agent, paved road, market. Full results are given in AppendixS1: Table A4. aFatalities per 100,000 inhabitants. bKcal per day/adult equivalent. cDummy variable. *p < 0.1; **p < 0.05; ***p < 0.01.
| 357 THE EFFECT OF CONFLICT ON FOOD SECURITY IN IRAQ its interaction with the poverty dummy variable, given poverty's endogeneity, its interaction coefficient must be interpreted with caution. Two additional sets of regressions check the robustness of the IV results: falsification tests that verify IV exogeneity, and IV model estimations that exclude households with at least one migrating member in the year before the interview. The first robustness check, which uses only the subsample of households who experienced no fatalities in the year prior to interview, alternatively regresses each outcome variable of interest on the IV, together with the full set of control variables. A statistically significant IV effect on any outcome variable would signal that the household to closest war cemetery distance has a direct effect on food security and diet quality, a violation of the exclusion restriction. In fact, as AppendixS1: Table A5 shows, this variable has no statistically significant impact on any of the outcome variables, with the magnitude of the IV coefficients always statistically irrelevant. The second check, running the IV models with migrant households excluded, tests for the potential presence of nonrandom measurement errors due to household migration history (see AppendixS1: Table A6). These results confirm the main estimates from Table3, with the conflict coefficients remaining virtually unchanged both in magnitude and statistical significance. As an additional validation of the identification strategy, I check for result sensitivity using two alternative measures of conflict exposure: number of violent events in the year prior to interview and number of fatalities during the 2 years prior to interview, both expressed in per 100,000 inhabitants. When I use the number of conflict events as the main explanatory variable, the coefficients are larger in magnitude but nonetheless consistent with those in the original estimates (see AppendixS1: Table A7). That is, once the coefficients are divided by the average 7.5 fatalities caused by each event, they conform better to those derived using the previous measure. For the regressions using conflict in the 2 years prior to interview, the results remain significant and with the expected sign, although the magnitude decreases, possibly because the longer timeframe increases the incidence of nonrandom measurement error (see AppendixS1: Table A8). The results also hold when the regressions exclude households that may have purchased food in bulk because, for example, they receive large food rations (identified here as households with a daily caloric consumption above 6 standard deviations; see AppendixS1: Table A10). 6 | DISCUSSION AND CONCLUSIONS To contribute to the growing stream of literature on the conflictfood security nexus, I assess the impact of warrelated fatalities on calorie consumption and diet diversity in the case of Iraq, which, unlike most previously studied contexts, is a middleincome country transitioning to diets high in calories and fat. In particular, I examine the hypothesis that under these socioeconomic conditions, conflict intensity can negatively affect nutrition by decreasing dietary diversity while increasing overall caloric consumption, especially from carbohydrates. The quasiexperimental method used to address endogeneity empirically confirms these assumptions, documenting that households living in conflictaffected areas not only exhibit lower dietary diversity but also increase their calorie purchases by 61 Kcal for each per capita fatality exposure. Admittedly, assigning nutritional values to the processed and ultraprocessed foods in the household purchase record is not straightforward and requires a certain degree of approximation. Thus, my estimates may suffer from an uncertain attenuation bias. These results thus partially confirm the external validity of previous findings in the dietary diversity literature for lowincome countries. For example, Dabalen and Paul(2014), George et al.(2020), and Tranchant et al.(2021) all document a negative effect of conflict on dietary quality, while D'Souza and Jolliffe(2013) and Tranchant et al.(2021) show a negative impact of war exposure on calorie intake. My results provide additional support for the hypothesis
358 | PARIGI that in waraffected middleincome countries in which diets are transitioning toward refined carbohydrates, fat, processed food, and high calorie consumption, the relation between conflict and food security may be more complex than a simple drop in food consumption. In these contexts, households tend to increase their caloric consumption by purchasing cheap, easily storable products while having more difficulty accessing a diversified diet. I further validated this trend in an additional analysis of incomebased heterogeneous effects, which confirms that households living below the poverty line retain the negative effect observed in lowincome countries where large portions of the population cannot meet their basic needs. Conversely, the positive effect on calories and macronutrients persists for relatively richer households. This shift toward a less diversified, caloriedense diet, my analysis demonstrates, is due partially to the current level of physical insecurity, a link that neither national nor international public health authorities should underestimate in the face of high rates of adult overweight and obesity and a recent increase in noncommunicable diseases (Hussain & Lafta,2019; NCD Risk Factor Collaboration,2017). Additional barriers also exist, however, to Iraqi households' access to a diversified, nutritious and balanced diet. For example, Iraq's limited food sovereignty and consequent heavy dependence on food imports make it more difficult for its warimpacted communities to access high quality foodstuffs, an obstacle overcome in other contexts by sustaining locally produced and smaller scale agriculture (Ecker,2018; Jones et al.,2014). To attain such relief, the Iraqi government might consider gradually redesigning its PDS by better targeting beneficiaries, replacing certain staples with fresh and/or micronutrient rich foods— particularly traditional comestibles— and promoting their consumption. As Muhialdin et al.(2021) qualitatively illustrate, traditional Iraqi foodstuffs, being mostly plant based, nutrition rich and easily storable, served as an important source of calories for households coping with food scarcity during the siege of Mosul. Admittedly, the extreme deterioration of Iraq's infrastructure, agricultural land and food storage and distribution systems by over 30 years of conflict, foreign occupation, and sanctions makes meeting these goals in the currently insecure context extremely difficult. Yet given the rising obesity and overweight in the country, together with the increase in noncommunicable diseases (NCD Risk Factor Collaboration, 2017), both national and international actors should work toward removing dietary hurdles, not only via a reduction in violence but also through policies that favour local agricultural and a healthier food rationing system. If no timely action is taken, an obesity epidemic like those in other middleincome countries will soon add to Iraq's already extensive woes. ACKNOWLEDGMENTS The survey data used in this study were collected by the Iraq Central Bureau of Statistics, the Kurdistan Central Bureau of Statistics and the World Bank. I would like to express my gratitude to Hamid R. Oskorouchi, Alfonso Sousa- Poza and the participants of the 2021 University of Hohenheim doctoral seminar in economics for their valuable comments and suggestions. I would also like to extend my appreciation to the editor, Dr David Harvey, and the anonymous reviewers for their constructive feedback on a previous version of this manuscript. Open Access funding enabled and organized by Projekt DEAL. ORCID Marta Parigi https://orcid.org/0000-0002-1766-1644 REFERENCES Acharya, Y., Luke, N., Naz, S. & Sharma, D. (2020) Exposure to conflictrelated violence and nutritional status of children in Iraq. SSM – population Health, 11, 100585. Available from: https://www.scien cedir ect.com/scien ce/ artic le/pii/S2352 82731 9303659
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