Manipur is a state in northeastern India and in civil war for > 45 years. Healthcare delivery and access is affected due to poor security, restricted accessibility, and the incapacity of this fragile state.

The burden of morbidity and mortality in the conflict area of Manipur was estimated using data sources (hospital attendance, hospital inpatient, and death registries, national family and health registries, and in-depth interviews of healthcare providers) and compared to national averages. These findings were co-related with violent events reported in the local newspaper.

Excess mortality was observed in the 21–50 year age group, but not in females or the elderly. The major causes of deaths were non-communicable diseases, cerebrovascular accidents, and chronic pulmonary disease. Chronic conflict increased the burden of alcohol liver disease and of mental health diseases. Suicidal deaths were common in the mid-twenty age group and usually due to agricultural pesticide consumption. These deaths were higher in men, and suicide attempts were higher in women. The prevalence of intravenous drug users and of HIV was reported to be five times as higher than the national average. High rates of disappearances, mutilation, torture, kidnapping, and hostage-taking, spousal physical violence and attacks on healthcare facilities and medical personnel were events of concern. There were no reported events of suicide bombers.

Protracted conflict dramatically changes the demographics and disease burden. Humanitarian space constantly is under threat of attack and the insecurity interferes with the provision of sustained preventive and curative services. Recommendations to be implemented would measures to continue treatment in the insecure environment through telephonic or online medical helplines, vaccination, and drug supplies during negotiated ceasefires or curfew times and protecting humanitarian spaces. However, militarization of healthcare may not be favorable solution.