Background The missile injuries of the cranium and brain in the modern era have shifted from soldiers to the civilians and from the battle grounds to the populated zones due to increase in the terrorist and military strikes. The management of the victims depends on the resuscitation at the site of injury and the distance and transportation to the tertiary care centre. This article presents the details of the missile injuries to the brain, the third-world problems and the management. Material and methods A retrospective analysis of 3794 craniocerebral missile injuries, managed by the Department of Neurosurgery at Sher-I-Kashmir Institute of Medical Sciences (SKIMS) Kashmir, India, over a period of more than 21 years from September 1988 to September 2009. Patients were triaged in emergency CT-room, resuscitated and operated. Statistical software programme SPSS 11.5 was used to derive the numerical significance. Results Revealed an overall mortality of 87.69% (3327 out of 3794). Most of the deaths 79.14% (2633 out of 3327) occurred within 30 minutes of the patient's arrival to the hospital and only 694 patients lived beyond one hour of arrival. Conclusion Presently the quantum of outcome i.e, survival and good recovery in craniocerebral missile injuries appears a meager heap compared to the huge amount of death and disability. And the situation will continue to be so unless tertiary care hospitals are set up within and around the armed and conflict zones, war torn areas and battle fields, rather than risking transportation, time of resuscitation, intervention and the results.