Abstract
IntroductionMost epidemiological studies from conflicts are restricted to either combatants or civilians. It is largely unknown how the epidemiology differs between the two groups. In 2016, an Iraqi-led coalition began retaking Mosul from the terrorist group Islamic State of Iraq and Syria. One key institution that received trauma patients from Mosul was Emergency Management Center (EMC) in Erbil, 90 km away. The aim of this study was to describe the epidemiology, morbidity, and mortality of civilians and combatants admitted during the ongoing conflict.MethodThis retrospective cohort study utilized routinely collected data on patients with conflict-related injuries who were admitted to EMC between October 16, 2016, and July 10, 2017. Data processing and analysis was carried out using JMP 13. Categorical variables were compared using Fisher’s exact test.ResultsThe analysis included 1725 patients, out of which 46% were civilian. Ordnance accounted for most injuries (68%), followed by firearms (18%) and improvised explosive devices (IEDs) (14%). The proportion of IED-related injuries among combatants were almost three times that of civilians. The proportions of abdominal injuries, need for surgery, laparotomies, and amputations were significantly higher among civilians than among combatants. The mortality rate was 0.5%.DiscussionThe fact that civilians had greater surgical needs than combatants may be explained by several factors including a lack of ballistic protection. The extremely low mortality rate indicates significant gaps in prehospital care and transport. Our results may provide useful information to guide medical preparedness and response during future conflicts.Clinicaltrials.gov IDNCT03358758.
Highlights
Most epidemiological studies from conflicts are restricted to either combatants or civilians
Between October 16, 2016, and July 10, 2017, an internationally supported coalition involving the Iraqi Security Forces (ISF), Kurdish Peshmerga, and Shia militias reclaimed the city of Mosul from the terrorist organization Islamic State of Iraq and Syria (ISIS)
Most patients had been injured by ordnance (68%) followed by firearms (18%) and improvised explosive devices (IEDs) (14%)
Summary
Most epidemiological studies from conflicts are restricted to either combatants or civilians. The aim of this study was to describe the epidemiology, morbidity, and mortality of civilians and combatants admitted during the ongoing conflict Method This retrospective cohort study utilized routinely collected data on patients with conflict-related injuries who were admitted to EMC between October 16, 2016, and July 10, 2017. The total number of patients who were in need of surgery remains unknown, but a lack of advanced trauma care close to the conflict was a significant problem, especially during the first months of fighting. During this time, injured patients had to be transported to Erbil for surgical trauma care, 90 km away. A report by the Johns Hopkins Bloomberg School of Public Health (BSPH) estimates that between 1500 and 1800 lives were saved thanks to these efforts [2]
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