In the last several decades, a significant shift has occurred in the global pattern of armed conflict. Since the late 1980s, approximately 25 to 30 intrastate wars have occurred each year, whereas the frequency of interstate wars declined to a level near zero (Eriksson, Sollenberg, & Wallensteen, 2002). Intrastate conflicts take a profound toll on civilians (Wessells, 1998a). As evidenced by the conflicts in the former Yugoslavia, Cambodia, Guatemala, Somalia, and Rwanda, fighting occurs increasingly not on well-defined battlefields, but in and around communities. Often it involves personalized acts of violence, rapes and other atrocities committed by former neighbors, and ethnic cleansing and genocide. As a result, the war-related civilian death rate has risen sharply. In the early part of this century and in previous centuries, it is estimated that civilians comprised approximately 20 percent of war-related deaths. By the 1990s, however, civilians comprised nearly 90 percent of war-related deaths (Garfield & Neugut, 1997; Sivard, 1996; UNICEF, 1996).