Mortality Estimation in Conflict-Affected Settings: A Scoping Review of the Methodological Landscape

Abstract Background Mortality is the primary signal of crisis severity, yet systematic mortality estimation in conflict-affected settings remains largely unachieved. Methodological constraints, inadequate data infrastructure, and political barriers collectively limit the reach and reliability of available methods. No comprehensive mapping of the full landscape of direct and indirect approaches has previously been conducted. Objectives This scoping review aimed to map direct mortality estimation methods and indirect, composite, and mortality-adjacent approaches used in conflict-affected settings; to characterise their methodology, level of application, and geographic scope; and to identify evidence and methodological gaps, with particular attention to feasibility at subnational level. Methods We searched six academic databases and ten grey literature repositories, restricted to 1990–2026 with no language restriction. Screening and data extraction used a pre-specified eligibility framework based on Population, Concept, Context criteria. The unit of analysis was the methodology rather than the individual study. Results Searches retrieved 14,869 records; 103 academic papers and 12 grey literature methods were included following removal of duplicates and screening. Twenty-six distinct methods were identified: 13 direct estimation methods, which measure mortality through field-based data collection, community reporting, or physical documentation of deaths, and 13 indirect, composite, and mortality-adjacent approaches, which infer mortality from secondary data, composite severity indicators, or mortality-adjacent signals. The evidence gap map reveals that no indirect or composite method has documented application at community or locality level. Conclusions The methodological landscape is more diverse than previously documented but structurally constrained by data infrastructure gaps, geographic concentration in accessible settings, and political barriers to measurement. Innovations address specific access constraints but remain disconnected from existing severity assessment frameworks. A practical framework for local mortality monitoring will require contextually calibrated combinations of approaches, sustained investment in secondary data systems, and governance solutions to the structural pathway failures identified.