Injury and death during the ISIS occupation of Mosul and its liberation: Results from a 40-cluster household survey

Abstract

BackgroundMeasurement of mortality and injury in conflict situations presents many challenges compared with stable situations. However, providing information is important to assess the impact of conflict on populations and to estimate humanitarian needs, both in the immediate and longer term. Mosul, Iraq’s second largest city, was overrun by fighters of the Islamic State of Iraq and Syria (ISIS) on June 4, 2014. In this study, we conducted household surveys to measure reported deaths, injuries, and kidnappings in Mosul, Iraq, both during the occupation of the city by fighters of ISIS and the months of Iraqi military action known as the liberation.Methods and findingsMosul was overrun by ISIS forces on June 4, 2014, and was under exclusive ISIS control for 29 months. The military offensive by Iraqi forces, supported by coalition artillery and airstrikes, began on October 17, 2016, in east Mosul and concluded in west Mosul with the defeat of ISIS on June 29, 2017. We conducted a 40-cluster population-based survey as soon as the security forces permitted access for the survey team. The objective of the survey was to measure reported deaths, injuries, and kidnappings in Mosul households during 29 months of ISIS-exclusive control (June 2014–October 2016) and the nine months of Iraqi military action known as the liberation (October 2016–June 2017). In east Mosul, the survey was conducted from March 23 to March 31, 2017, and in west Mosul from July 18 to July 31, 2017. Sampling was based on pre-ISIS population distribution, with revisions made following the extensive destruction in west Mosul. The 1,202 sampled households included 7,559 persons: 4,867 in east Mosul and 2,692 in west Mosul. No households declined to participate. During the time from June 4, 2014, to the time of the survey, there were 628 deaths reported from the sampled households, of which 505 were due to intentional violence, a mortality rate of 2.09 deaths per 1,000 person-months. Over the entire time period, the group with the highest mortality rates from intentional violence was adults aged 20 to 39: 1.69 deaths per 1,000 person-months among women and 3.55 among men. In the 29 months of ISIS-exclusive control, mortality rates among all males were 0.71 reported deaths per 1,000 person-months and for all females were 0.50 deaths per 1,000 person-months. During the nine months of the military liberation, the mortality rates jumped to 13.36 deaths per 1,000 person-months for males and 8.33 for females. The increase was particularly dramatic in west Mosul. The leading cause of reported deaths from intentional violence was airstrikes—accounting for 201 civilian deaths—followed by 172 deaths from explosions. Reported deaths from airstrikes were most common in west Mosul, while reported deaths from explosions were similar on both sides of Mosul. Gunshots accounted for 86 cases, predominantly in west Mosul where ISIS snipers were particularly active. There were 35 persons who were reported to have been kidnapped, almost entirely prior to the military offensi...

Household recovery in Mosul one year after the defeat of ISIS

“…A household was defined as a group of people living together, eating from a common kitchen and living in a structure with a separate entrance from the street. The sampling process is described more fully elsewhere [3]. For the one-year follow up survey reported here, 30 households were selected from each of 12 clusters randomly chosen from the original 25 in east Mosul, and from eight clusters of the previous 15 west Mosul clusters.…”

“…The ISIS control ended with the devastating military campaign known as the "liberation," which started in east Mosul in October 2016. During military operations there was widespread civilian death and destruction [3]. On the 10th of July 2017, Iraqi Prime Minister Al-Abadi formally announced the liberation of Mosul.…”

“…While the damage to east Mosul was extensive, west Mosul, the old city, took the brunt of the devastating military assault. Many neighborhoods were still largely uninhabited [3]. An estimated 7.6 million tons of debris remain in Mosul, much contaminated with unexploded ordnance and booby traps [4].…”

“…Early marriage was common, arising from fears of forced marriage of Mosul residents to foreign fighters. During the liberation period there were far more deaths among Mosul residents than occurred during the ISIS years, especially in west Mosul [3]. Most of the damage and death was caused by air strikes.…”

Health and Health Seeking in Mosul During ISIS Control and Liberation: Results From a 40-Cluster Household Survey

“…The extent of deaths and injuries during control by ISIS and during the liberation had been reported by us elsewhere. 15 It received approval from the Scientific and Technical Committee of Al-Mustansiriya University, and the Institutional Review Board at Johns Hopkins Bloomberg School of Public Health declared that analysis of data without personal identifiers as exempt.…”