Date of Award

January 2022

Document Type


Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Kaveh Khoshnood


AbstractIntroduction: Cause-specific population mortality data is one of the most useful metrics used to monitor and evaluate the severity of a crisis. However, the unique context of fragile and protracted armed conflicts creates obstacles for establishing a mortality surveillance system. When CRVS are not feasible, VA can be used to generate high-quality mortality rate estimates. There is currently little documentation of implementation and evaluation of mortality surveillance systems in conflict settings, and guidance for both is extremely limited. This thesis aims to contribute to these two knowledge gaps by providing an evaluation plan for a mortality surveillance system in Northwest Syria that uses VA as the main method for data collection. Methods: The evaluation will be conducted post implementation and will assess the mortality surveillance system’s effectiveness, performance, and value through seven of the system’s attributes – timeliness, representativeness, acceptability, flexibility, stability, simplicity, and usefulness. Data will be collected through in-depth interviews, surveys, and document reviews. Discussion and Limitations: The unique context of fragile and protracted armed conflicts introduced limitations to the evaluation as gold standards for surveillance are not feasible in these settings. These limitations were accounted for in the evaluation plan by modifying the CDC and ECDC’s surveillance system evaluation guidelines. Conclusions: The execution of this evaluation plan could result in highly valuable information about both the mortality surveillance system and the evaluation plan. Findings could help guide improvements to the mortality surveillance system in Northwest Syria and could also help guide stakeholders in similar contexts implement their own mortality surveillance systems. Next steps include assessing the function and feasibility of the evaluation plan itself and developing standardized interviews, surveys, and processes for document review.


This thesis is restricted to Yale network users only. It will be made publicly available on 05/19/2023