Injuries, Death, and Disability Associated with 11 Years of Conflict in Baghdad, Iraq: A Randomized Household Cluster Survey

Abstract

BackgroundThe objective of this study was to characterize injuries, deaths, and disabilities arising during 11 years of conflict in Baghdad.MethodsUsing satellite imagery and administrative population estimated size for Baghdad, 30 clusters were selected, proportionate to population size estimates. Interviews were conducted during April and May 2014 in 900 households containing 5148 persons. Details about injuries and disabilities occurring from 2003 through May 2014 and resultant disabilities were recorded.FindingsThere were 553 injuries reported by Baghdad residents, 225 of which were intentional, and 328 unintentional. For intentional injuries, the fatality rate was 39.1% and the disability rate 56.0%. Gunshots where the major cause of injury through 2006 when blasts/explosions became the most common cause and remained so through 2014. Among unintentional injuries, the fatality rate was 7.3% and the disability rate 77.1%. The major cause of unintentional injuries was falls (131) which have increased dramatically since 2008, followed by traffic related injuries (81), which have steadily increased. The proportion of injuries ending in disabilities remained fairly constant through the survey period.InterpretationIntentional injuries added substantially to the burden of unintentional injuries for the population. For Baghdad, the phases of the Iraqi conflict are reflected in the patterns of injuries and consequent deaths reported. The scale of injuries during conflict is most certainly under-reported. Difficulties recalling injuries in a survey covering 11 years is a limitation, but it is likely that minor injuries were under-reported more than severe injuries. The in- and out-migration of Baghdad populations likely had effects on the events reported which we could not measure or estimate. Damage to the health infrastructure and the flight of health workers may have contributed to mortality and morbidity. Civilian injuries as well as mortality should be measured during conflicts, though not currently done.

The burden of war-injury in the Palestinian health care sector in Gaza Strip

“…The vast majority of injuries were due to blast or explosion, consistent with findings of the effect of conflict on injury patterns in Baghdad from 2003 [30]. …”

Averted health burden over 4 years at Médecins Sans Frontières (MSF) Trauma Centre in Kunduz, Afghanistan, prior to its closure in 2015

“…While we are unable to infer the epidemiology of injury in the population from these hospital-based data, the findings support other studies from Iraq that suggest unintentional injuries predominate in populations affected by prolonged insecurity. [19][20][21] A population-based survey of injuries in Baghdad from 2003-2014 reported that falls, road traffic crashes, and mechanical injuries were more common than all violence-related injuries combined. 20 The authors concluded that deterioration of infrastructure, changes in safe behavior, and a lack of injury prevention and control programs contribute to this epidemiology.…”

Estimating mortality from external causes using data from retrospective surveys: A validation study in Niakhar (Senegal)

“…They measure mortality by asking respondents to report deaths among their relatives. Questions asking whether the deaths of these relatives are due to injuries, accidents, or conflicts have been asked in several surveys, such as DHS in Zimbabwe and Zambia, the WHO's World Health Survey (Obermeyer, Murray, and Gakidou 2008), and postconflict surveys (Hagopian et al 2013;Lafta et al 2015). A few studies have compared estimates of conflict-related deaths derived from such surveys to estimates from other sources (Obermeyer, Murray, and Gakidou 2008).…”