Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-17T21:23:06.716Z Has data issue: false hasContentIssue false
  • English
  • Français

Fatalities from Firearm-Related Injuries in Selected Governorates of Iraq, 2010-2013

Published online by Cambridge University Press:  18 May 2017

Maximilian P. Nerlander ,
Eva Leidman ,
Ahmed Hassan ,
Abdul-Salam Saleh Sultan ,
Syed Jaffar Hussain ,
Lauren B. Browne  and
Oleg O. Bilukha
Maximilian P. Nerlander
Affiliation:
Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GeorgiaUSA Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GeorgiaUSA
Eva Leidman*
Affiliation:
Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GeorgiaUSA
Ahmed Hassan
Affiliation:
Medical Operations and Specialized Services Directorate, Operations Department, Ministry of Health, Baghdad, Iraq
Abdul-Salam Saleh Sultan
Affiliation:
Human Resources Training and Development Center, Ministry of Health, Baghdad, Iraq
Syed Jaffar Hussain
Affiliation:
World Health Organization, International Zone, UNAMI Compound, Baghdad, Iraq
Lauren B. Browne
Affiliation:
Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GeorgiaUSA Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GeorgiaUSA
Oleg O. Bilukha
Affiliation:
Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GeorgiaUSA
*
Correspondence: Eva Leidman, MSPH, Epidemiologist Emergency Response and Recovery Branch Division of Global Health Protection Center for Global Health, Centers for Disease Control and Prevention 1600 Clifton Road, MS E-22 Atlanta, Georgia 30345 USA E-mail: eleidman@cdc.gov
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

In Iraq, where Islamic State of Iraq and Syria (ISIS) and other groups have contributed to escalating violence in recent years, understanding the epidemiology of intentional firearm-related fatalities is essential for public health action.

Methods

The Iraqi Ministry of Health (MoH; Baghdad, Iraq) compiles surveillance of fatal injuries in eight of Iraq’s 18 governorates (Baghdad, Al-Anbar, Basrah, Erbil, Kerbala, Maysan, Ninevah, and Al-Sulaimaniya). Information is collected from coroner’s reports and interviews with family members. Analysis was performed on intentional firearm-related injuries, excluding injuries from intentional self-harm or negligent discharges, that occurred during 2010-2013, a subset of all fatal injuries, and compared to previously published explosive-related fatalities.

Results

Overall, the dataset included 7,985 firearm-related fatalities. Yearly fatalities were: 2010=1,706; 2011=1,642; 2012=1,662; and 2013=2,975. Among fatalities, 86.0% were men and 13.7% women; 83.4% were adults and 6.2% children <18 years of age. Where age and sex were both known, men aged 20-39 years accounted for 56.3% of fatalities. Three “high-burden” governorates had the highest fatality rate per 100,000 population—Baghdad (12.9), Ninevah (17.0), and Al-Anbar (14.6)—accounting for 85.9% of fatalities recorded in the eight governorates. Most fatalities occurred in the street (56.3%), followed by workplace (12.2%), home (11.3%), and farm/countryside (8.4%). Comparing the ratio of firearm-related fatalities to explosives-related fatalities revealed an overall ratio of 2.8:1. The ratio in Baghdad more than doubled from 2.9 in 2010 to 6.1 in 2013; the highest ratios were seen outside the high-burden governorates.

Conclusions

Firearm-related fatalities remained relatively stable throughout 2010-2012, and almost doubled in 2013, correlating with increased ISIS activity. Three governorates contributed the majority of fatalities and experienced the highest fatality rates; these saw high levels of conflict. Firearm-related fatalities disproportionately affected younger men, who historically are over-represented as victims and perpetrators of violence. More than one-half of fatalities occurred in the street, indicating this as a common environment for conflict involving firearms. Firearms appear to account for more fatalities in Iraq than explosives and largely accounted for escalating violence in Baghdad during the study period. The high ratio observed outside the high-burden governorates is reflective of very low numbers of explosives-related fatalities; thus, violence in these governorates is likely non-conflict-related. These observations provide valuable public health information for targeted intervention to prevent violence.

NerlanderMP, LeidmanE, HassanA, SultanASS, HussainSJ, BrowneLB, BilukhaOO. Fatalities from Firearm-Related Injuries in Selected Governorates of Iraq, 2010-2013. Prehosp Disaster Med. 2017;32(5):548–555.

Keywords

fatal outcomefirearmsIraqmortality public health surveillancewounds/injuries
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 32 , Issue 5 , October 2017 , pp. 548 - 555
Copyright
© World Association for Disaster and Emergency Medicine 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Conflicts of interest: All authors declare they have no competing interests; no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention (Atlanta, Georgia USA), the World Health Organization (Geneva, Switzerland), or the Ministry of Health, Iraq (Baghdad, Iraq).

References

1. Small Arms Survey. 2015. Global Burden of Armed Violence 2015: Every Body Counts. http://www.smallarmssurvey.org/publications/by-type/global-burden-of-armed-violence.html. Accessed April 6, 2016.Google Scholar
2. Obermeyer, Z, Murray, CJ, Gakidou, E. Fifty years of violent war deaths from Vietnam to Bosnia: analysis of data from the world health survey program. BMJ. 2008;336(7659):1482-1486.CrossRefGoogle Scholar
3. Fire Support, Protection, and Other Support. In: Department of the Army. The Infantry Weapons Company. Military Bookshop; 2008:1.Google Scholar
4. Riedel, M, Welsh, WN. Criminal Violence: Patterns, Explanations, and Interventions. New York USA: Oxford University Press, USA; 2015.Google Scholar
5. Zawitz, MW. Guns Used in Crime. Washington, DC USA: US Department of Justice: Bureau of Justice Statistics Selected Findings; 1995; Publication NCJ-148201.Google Scholar
6. Hennop, E. Illegal firearms in circulation in South Africa. Society Under Siege: Managing Arms in South Africa. 2000: 13-22.Google Scholar
7. Archer, D, Gartner, R. Violent acts and violent times: a comparative approach to postwar homicide rates. Am Sociol Rev. 1976;41(6):937-963.CrossRefGoogle ScholarPubMed
8. Hagopian, A, Flaxman, AD, Takaro, TK, et al. Mortality in Iraq associated with the 2003-2011 war and occupation: findings from a national cluster sample survey by the university collaborative Iraq Mortality Study. PLoS Med. 2013;10(10):e1001533.Google Scholar
9. BBC. Iraq Profile - Timeline. December 9, 2015. http://www.bbc.com/news/world-middle-east-14546763. Accessed March 24, 2016.Google Scholar
10. Knights, M. ISIL’s Political-Military Power in Iraq. Washington, DC USA: Institute for the Study of War; 2013: 2-4.Google Scholar
11. Lewis, J. AQI’s Soldier’s Harvest Campaign. Washington, DC USA: Institute for the Study of War; 2013: 4.Google Scholar
12. Department of Defense. DoD Authorizes War on Terror Award for Inherent Resolve Ops. 31 October 2014. http://www.defense.gov/News-Article-View/Article/603569/dod-authorizes-war-on-terror-award-for-inherent-resolve-ops. Accessed May 5, 2016.Google Scholar
13. Butchart, Alexander, Mikton, C, Krug, E. Country Profile: Iraq. Global Status Report on Violence Prevention 2014. Geneva, Switzerland: World Health Organization (WHO), United Nations Office on Drugs and Crime (UNODC), and United Nations Development Program (UNDP). 2014.Google Scholar
14. Central Organization for Statistics and Information Technology (COSIT). Section 2: Population Census. Annual Abstract of Statistics 2010-2011. http://cosit.gov.iq/AAS/section_2.php. Accessed April 30, 2015.Google Scholar
15. Bilukha, OO, Leidman, EZ, Sultan, AS, Jaffar Hussain, S. Deaths due to intentional explosions in selected governorates of Iraq from 2010 to 2013: prospective surveillance. Prehosp Disaster Med. 2015;30(6):586-592.Google Scholar
16. Iraq Government. Death certificates: reporting and registration of births and applying for copies of birth certificate (2013). http://www.egov.gov.iq/egov-iraq. Accessed April 30, 2015.Google Scholar
17. Al-Rabie, AS. Registration of Vital Events in Iraq. Bethesda, Maryland USA: International Institute for Vital Registration and Statistics; 1980.Google Scholar
18. Medico-Legal Law No. (37) for the year 2013: Law Library Iraqi Local Governance; 2013. http://www.iraq-lg-law.org/ar/taxonomy/term/108. Accessed April 30, 2015.Google Scholar
19. Al Madni, O, Kharosha, MAA, Shotar, AM. Firearm fatalities in Dammam, Saudi Arabia. Med Sci Law. 2008;48(3):237-240.CrossRefGoogle ScholarPubMed
20. Elfawal, M, Awad, O. Firearm fatalities in Eastern Saudi Arabia: impact of culture and legislation. Am J Forensic Med Pathol. 1997;18(4):391-396.CrossRefGoogle ScholarPubMed
21. Goren, S, Subasi, M, Tirasci, Y, Kemaloglu, S. Firearm-related mortality: a review of four-hundred forty-four deaths in Diyarbakir, Turkey between 1996 and 2001. Tohoku J Exp Med. 2003;201(3):139-145.CrossRefGoogle ScholarPubMed
22. Amiri, A, Sanaei-Zadeh, H, Zavarei, HT, Ardestani, FR, Savoji, N. Firearm fatalities. A preliminary study report from Iran. J Clin Forensic Med. 2003;10(3):159-163.Google Scholar
23. Understanding the Urban Environment. In: Urban Operations. Washington, DC USA: Department of the Army; 2006:1-7.Google Scholar
24. Gregory, D. Seeing red: Baghdad and the event-full city. Political Geography. 2010;29(5):266-279.Google Scholar
25. Eastridge, BJ, Mabry, RL, Seguin, P, et al. Death on the battlefield (2001-2011): implications for the future of combat casualty care. J Trauma Acute Care Surg. 2012;73(6 Suppl 5):S431-S437.CrossRefGoogle ScholarPubMed
26. Bogen, KT, Jones, ED. Risks of mortality and morbidity from worldwide terrorism: 1968-2004. Risk Anal. 2006;26(1):45-59.CrossRefGoogle ScholarPubMed
27. Iraq Body Count. Iraqi Deaths from Violence in 2012. https://www.iraqbodycount.org/analysis/numbers/2012/. Accessed April 30, 2016.Google Scholar
28. United Nations Office on Drugs and Crime. Global Study on Homicide. 2016. https://www.unodc.org/gsh/en/data.html. Accessed May 31, 2016.Google Scholar
29. Hassan, Q, Shah, MM, Bashir, MZ. Homicide in Abbottabad. J Ayub Med Coll Abbottabad. 2005;17(1):78-80.Google ScholarPubMed
30. Bashir, MZ, Saeed, A, Khan, D, Aslam, M, Iqbal, J, Ahmed, M. Pattern of homicidal deaths in Faisalabad. J Ayub Med Coll Abbottabad. 2004;16(2):57-59.Google Scholar
31. Beekley, AC, Martin, MJ, Spinella, PC, Telian, SP, Holcomb, JB. Predicting resource needs for multiple and mass-casualty events in combat: lessons learned from combat support hospital experience in Operation Iraqi Freedom. J Trauma Acute Care Surg. 2009;66(4):S129-S137.Google Scholar
32. Depoortere, E, Checchi, F, Broillet, F, et al. Violence and mortality in West Darfur, Sudan (2003-2004): epidemiological evidence from four surveys. Lancet. 2004;364(9442):1315-1320.Google Scholar
33. Herp, MV, Parqué, V, Rackley, E, Ford, N. Mortality, violence and lack of access to healthcare in the Democratic Republic of Congo. Disasters. 2003;27(2):141-153.Google Scholar
34. Bhalla, K, Harrison, JE, Shahraz, S, Fingerhut, LA. Availability and quality of cause-of-death data for estimating the global burden of injuries. Bull World Health Organ. 2010;88(11):831-838.Google Scholar
35. DiMaio, VJ. Gunshot Wounds: Practical Aspects of Firearms, Ballistics, and Forensic Techniques. 2nd ed.. Boca Raton, Florida USA: CRC Press; 2015: 1-377.Google Scholar
36. James, D, Dyer, J. Rifle Marksmanship Diagnostic and Training Guide. United States Army Research Institute for the Behavioral and Social Sciences. http://www.dtic.mil/dtic/tr/fulltext/u2/a544533.pdf. Published 2011. Accessed June 27, 2016.CrossRefGoogle Scholar