Injury Burden During an Insurgency: The Untold Trauma of Infrastructure Breakdown in Baghdad, Iraq

Abstract

Past and current fighting in Baghdad continues to adversely affect the Iraqi populace, where the indirect effects of infrastructure breakdown are likely the primary source of injury. When measuring the burden of large-scale violence, health researchers should account for the full injury burden, including both injury morbidity and indirect injuries.

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.…”

Road traffic injuries in Baghdad from 2003 to 2014: results of a randomised household cluster survey

“…A similarly performed population-based study of civilian injury over a 3-month period in Baghdad in 2009 reported that RTIs comprised 10% of all injuries reported 9. We report that RTCs were responsible for 16% of injuries overall, and were increasing in recent years (ie, 2010–2013).…”

“…We report that RTCs were responsible for 16% of injuries overall, and were increasing in recent years (ie, 2010–2013). Complicating national efforts to reduce RTIs is the ongoing conflict, which undermines the rule of law, alters safe behaviour, diminishes efforts to support injury prevention and erodes road infrastructure 9 33. The conflict has resulted in more than 3.2 million internally displaced persons and refugees in Iraq, many of whom have fled to Baghdad 34 35.…”

“…Given potential barriers to care, we did not exclude individuals who might have required care but were not able to access the care required 16–18. In keeping with other population-based studies from LMICs that rely on recall, we did not ask respondents to consider deaths within a specific time period (ie, 30 days after RTC); we asked to attribute a person's death to a cause 9 19–22…”

“…Despite a growing need to prevent and treat injury among civilians living amid conflict globally, few community-based studies have characterised the epidemiology of these coexisting problems, and none have described both mortality and morbidity over time 9 10. Moreover, details of RTI mechanisms during insecurity have not been previously reported.…”