Injury burden during an insurgency: the untold trauma of infrastructure breakdown in Baghdad, Iraq.

BACKGROUND

Injuries as a result of the ongoing violence in Iraq have been a topic of both lay and academic interest. However, to date, attempts to quantify injuries in the country have focused primarily on direct mortality, which represents only a small portion of overall injury burden and ignores those injuries indirectly resulting from the conflict-induced breakdown of Iraqi infrastructure.

METHODS

We performed a cross-sectional household survey from October to November, 2009, within the Baghdad Governorate of central Iraq. Using two-stage cluster-sampling with a proportional-to-size methodology, we randomized a total of 60 clusters to Baghdad's five governmental districts. Within each cluster, we interviewed heads of households regarding all injuries during the last 3 months.

RESULTS

We surveyed 1,172 households, gathering information regarding 7,396 individuals. Only 8.4% of injuries were intentional, and fatalities represented only a small fraction (1.7%) of overall injury burden. The well-publicized intentional explosions in Baghdad, although accounting for close to half (44%) of all intentional injuries, made up only 4% of the total. Other injuries at least partially attributable to the conflict-induced breakdown of Iraqi infrastructure proved a much larger burden, for example, those from electric shock, unintentional explosions, unintentional gunshot wounds, and falls.

CONCLUSIONS

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.