Cluster bomb vs. antipersonnel mine related injuries. An experience from the Kuwaiti-Iraqi border from June 1998 to November 2000

Abstract

Zusammenfassung. Grundlagen: Seit dem letzten Jahrzehnt kommen auf den Schlachtfeldern in aller Welt die Submunition enthaltenden Cluster Bombs (SB) zum Einsatz. Sie stellen somit eine neue Herausforderung fü r die Kriegschirurgie dar.Methodik: 32 Patienten wurden entweder durch Antipersonen-Minen (AP) oder SB verletzt und in einem Feldspital behandelt. Das Verletzungsmuster wurde mittels der Klassifikation des internationalen Komitees vom Roten Kreuz und mittels Gustilos Klassifikation fü r offene Frakturen beschrieben.Ergebnisse: Man beobachtete insgesamt 95 Wunden; 72 wurden durch SB verursacht, 23 durch AP. Die Mortalitä tsrate (MR) fü r die SB-Gruppe lag bei 6=24 (25,0%), fü r die AP-Gruppe bei 2=8 (25,0%). Drei SB-Patienten fielen sofort, was zu einer MR der an der Verwundung Verstorbenen von 3=24 (12,5%) bei der SB-Gruppe und einer Gesamt-MR von 5=32 (15,6%) fü hrte.Schlussfolgerungen: Es wurde eine Verä nderung von verheerenden Unterschenkelverletzungen einer AP zu mehrfachen, den gesamten Kö rper betreffenden, Wunden einer SB beobachtet.Schlü sselwö rter: Kriegschirurgie, Verletzungsmuster, Antipersonenminen, Cluster Bomben.Summary. Background: During the last decade cluster bombs containing submunition bomblets (SB) have appeared on battlefields resulting in a new challenge to war surgery.Methods: Thirty-two patients either wounded by antipersonnel landmines (AP) or SB were treated in a field hospital. The patterns of injuries were described by applying the scoring system of the International Committee of the Red Cross and by Gustilo's classification of open fractures.Results: A total of 95 wounds were observed; 72 caused by SB, 23 by AP. Mortality rate (MR) for the SB group was 6=24 (25.0%), for the AP group 2=8 (25.0%). Three SB patients (12.5%) were ''killed in action'', leading to a MR of victims ''died of wounds'' of 3=24 (12.5%) in the SB group and a total MR of 5=32 (15.6%).Conclusions: From devastating lower limb injuries of AP, a change to multiple wounds affecting the whole body caused by SB has been observed.

The effect of explosive remnants of war on global public health: a systematic mixed-studies review using narrative synthesis

“…22 More men were injured or killed by landmines or UXO than were women (0-30•6% women) (appendix pp 5-6). 13,16,[19][20][21][22]25,[28][29][30]33,36,38,41,42,46,50,51,53,55,56,58,[60][61][62]63,65 The mean ages of casualties (range 18•5 years to 38•1 years) in all included studies falls into the economically productive age range (15-64 years). 16,17,25,28,30,33,38,46,50,53,57,[55][56][57][58][59][61][62][63] This finding matches with the type of activity that the victim was doing at the time of injury and the economic effect on victims and their families.…”

“…60 Four studies 17,19,22,63 reported higher case fatality ratios for children injured by landmines or UXO than for adults, whereas two 20,51 reported higher case fatality ratios for adults than for children (appendix p 8). The proportion of casualties of landmines or UXO younger than 18 years ranged from 22% to 55% across twelve studies; 13,14,16,17,20,25,28,33,46,50,53,[58][59][60]62,63,65 Landmines resulted in more amputations from the hip to the foot than did UXO (21•7% caused by landmines vs 5•5% caused by UXO in one study; 65 29•2% vs 8•1% in another 63 ), whereas UXO caused more amputations relating to the arms, upper body, and head than did landmines (27•8% caused by UXO vs 8•7% caused by landmines in one study; 65 22•1% vs 6•5% in another 63 ). Children were more likely to be injured by UXO than were adults in five studies.…”

Problems with "out of area evacuations" from areas of unrest. A need for uniform and simple-to-apply outcome predictors

“…During armed conflict civilian victims suffer not only from the direct effects of military weaponry, but also due to a breakdown of civilian medical institutions [19] and the lack of safe means of evacuation to and from hospitals in the conflict zone. As a result, these patients appear hours to many days later at medical institutions that were hastily set up and that serve as first treatment point and triage place.…”

Cluster munitions: a threat to health and human rights

“…Victims should also receive rehabilitation services, including mental health care and physiotherapy. Many of these services are unavailable or scarce in conflict zones, and the added burden of these patients can overwhelm an already strained health system, especially in post-conflict settings 12,13 . Victims also need assistance with integration back into society.…”