Political scientists have conducted only limited systematic research on the consequences of war for civilian populations. Here we argue that the civilian suffering caused by civil war extends well beyond the period of active warfare. We examine these longer-term effects in a cross-national (1999) analysis of World Health Organization new fine-grained data on death and disability broken down by age, gender, and type of disease or condition. We test hypotheses about the impact of civil wars and find substantial long-term effects, even after controlling for several other factors. We estimate that the additional burden of death and disability incurred in 1999, from the indirect and lingering effects of civil wars in the years 1991–97, was approximately equal to that incurred directly and immediately from all wars in 1999. This impact works its way through specific diseases and conditions and disproportionately affects women and children.We thank the Weatherhead Initiative on Military Conflict as a Public Health Problem, the Ford Foundation, and the World Health Organization, NIA (P01 17625-01), for financial support and Gary King, Thomas Gariepy, Melvin Hinich, Kosuke Imai, Roy Licklider, Jennifer Leaning, Greg Huber, Lisa Martin, Christopher Murray, Joshua Salomon, and Nicholas Sambanis for comments. Our data are available at http://www.yale.edu/unsy/civilwars/data.htm and at the Virtual Data Center web site, http://TheData.org, when it becomes operative.