The use of weapons against people or targets containing people inevitably has a direct impact on the health of those people. This impact is related to factors dependent on the design of weapons and on their use. The nature of injury is closely related to the design of the weapon; wounds from bullets, fragments, and buried anti-personnel mines are distinguishable. Factors dependent on the user, such as discipline and desire to avoid or injure civilians, determine the number and kind of people injured and may, in the case of bullets, determine which part of the body is injured. This century has seen an increased proportion of civilians injured during war

Coupland, Robin M.

Samnegaard, Hans O

English

JMU Scholarly Commons (James Madison Univ.)

Journal of Conventional Weapons Destruction Volume 3 Issue 3 The Journal of Mine Action Article 13 October 1999 Effect of Conventional Weapons on Civilian Injuries Robin M. Coupland Center for International Stabilization and Recovery at JMU (CISR) Hans O. Samnegaard Follow this and additional works at: https://commons.lib.jmu.edu/cisr-journal  Part of the Defense and Security Studies Commons, Emergency and Disaster Management Commons, Other Public Affairs, Public Policy and Public Administration Commons, and the Peace and Conflict Studies Commons Recommended Citation Coupland, Robin M. and Samnegaard, Hans O. (1999) "Effect of Conventional Weapons on Civilian Injuries," Journal of Mine Action : Vol. 3 : Iss. 3 , Article 13. Available at: https://commons.lib.jmu.edu/cisr-journal/vol3/iss3/13 This Article is brought to you for free and open access by the Center for International Stabilization and Recovery at JMU Scholarly Commons. It has been accepted for inclusion in Journal of Conventional Weapons Destruction by an authorized editor of JMU Scholarly Commons. For more information, please contact dc_admin@jmu.edu. ffect of Conventional Weapons on Civilian Injuries Analysis , of data from Red Cross hospitals by Robin M. Coupland and Hans 0. Samnegaard Introduction T he use of weapons against people or targets containing people inevitably has a dire~r impact on the health of chose people. Th1s impact is related w facwrs dependent on the design of weapons and on their use. The nature of injury is closely related to the design of the weapon; wounds from bullets, fragments, and buried antipersonnel mines are distinguishable. Facwrs dependent on the user, such as discipline and desire w avoid or injure civilians, determine the number and kind of people injured and may, in the case of bullets, determine which part of the body is injured. This centu ry has seen an increased proportion of civilians injured dur-ing war. This is usually ascribed to mili tary weapons passing into the hands of chose with no respect fo r the civilian population or the Fourth Geneva Con-vention, which protects civilians. In parallel , there has been an ex traordinary development of the military ef-ficiency of weapons. This generates a provocative question: to what extent is the weapon development chis century linked to the increased proportion of ci-vilians injured? This poses a further question: does increased ease with wh ich a weapo n can be used to achieve military objectives (military effi ciency) in-crease the potential for civilian casualties? The hallmarks of countries where most modern wars are foughr are poverty, destroyed social and eco-nomic infrastructure, and avai lability of a variety of weapons. D isciplined armies train their soldiers in the laws of war, which include respect for th e civilian population; by conrrast, modern wars tend to be foughr by forces that are poorly trained and may even rargec civilians. Another feature of these modern wars is chat competent medical facilities are few or non-existent. Care of those wounded during rhese con-fli cts has fallen ro international aid agencies. One of the few sources of data abour casualties in these wars is the hospitals run by rhe International Comm ittee of the Red Cross. We examined all the dara held by the Red Cross on wound injuries treated in irs hos-pitals from January 1991 to July 1998 w explore these rwo questions. We also examined data from the Kabul hospital during a period when the city of Kabul was under siege. • 30 . Patients and Methods Database The wound database of the International Com-mittee of the Red Cross was installed in January 1991 and originates from a system of data collection origi-nally designed w give the organization an indication of activ ities of its independent hospitals. All patients wounded in war who have been admitted to the Red Cross hospitals of Quetta (Afghan border of Paki-stan), Kabul and Khandahar (Afghanistan), Khao I Dang (Cambodian border of Thailand) , Butare (Rwanda), Novi Atagi (Chechenia) and Lokichokio (Sudanese bo rder of Kenya) have routinely had a data form filled our on thei r death or discharge from sur-gical wards. Age and sex, the cause of injury and the time lapsed between injury and adm ission are re-corded fo r each patient. Patients are nor asked whether they are combatants. Kabul T he Red Cross hospital in Kabul , functioned independently until the fall of the communist gov-ernment in mid- 1992. Ir was rhe first o f its kind to be in a city under siege rather rhan removed from the conflict over a border. Where the hospital was work-ing was rhus the same place as where patients were wounded. Patients were wounded in the city itself and at the front lines surrounding the city. Those wounded among the rebel forces besieging the city had access to the firs t-aid posts run by the Red Cross outside the city and chen were transported to the hospital by the organization's ambulances; few reached the hospital w ith in six hours. By contrast, chose wounded in the city reached a hospital usually with in an hour and certainly within six hours. Pa-tients in the city were representative of victims of urbanized, modern conflict, many were clearly civil-Ians. Analysis The parienrs' data were analyzed by age and sex and the cause of injury. As in previous studies, women and girls, boys (under 16 years of age) , and men of 50 or more were considered to be civilians. In this study, buller ind icates any gunshot wound, fragment indicates injury from shell, bomb, or mortar, and mine indicates injury from an anti-tank or anti-per-sonnel mine. Differences in rhe proportion of people injured by bullets in comparison with mortars o r mines were evaluated using the x2 test. {see table at right) Results A weal of 27 ,825 patients were registered be-tween January 1991 and july 1998. Of these, 18,877 were injured by bullets, bombs, shells, mortars, or mines; the rest were admitted because of burns or blunt trauma or for reconstructive surgery. Of the 18,877 who were injured by weapons, 2,012 were ad-mitted w rhe Kabul hospital in less rhan six hours after injury. Discussions limitations These data are probably the best available means of examining the direct human impact of the use of weapons in modern confl icts. Their validity and re-liabili ty have nor been ascertained by formal indepen-dent means because of the constraints imposed on collecting rhem under field conditions and there is obvious scope for misclassification. Some patients lie about how they were injured ro gain admission to hospital or they may no t know exactl y what injured them, and our means of classifying patients as com-batants or civilians is a potential source of error. Nev-ertheless, any misclassification in this setting is likely to have underestimated the numbers of civilians. The number of men aged 16- 49 who were civilians was probably greater than rhe combined number of women, boys and men over 49 who were combatants. Thus the proportion of civil ians is almost certainly higher than the proportions given here. Weapon type and civilian injuries To our knowledge, the implications for civilian injuries brought by d ifferent weapons have nor been fully examined before. These data show char facrors relating ro both the design of weapons and t he disci-pline or in tent of the user have implications for ci-vilian injuries. The higher proportion of civilians in-jured by fragments rarher than bullets is significant and may be exaggerated in a different context such as a city under siege, where ar leasr 61 percent of those injured by fragments were civilians. Likewise, the pro-portion of injured by mines is significa ntly higher than rhat injured by bullets. There must therefore be a link between the technology of weapons and who is wounded. Two points are important when consid-ering the nature of this link. Firstly, weap-ons char fragment can easily injure more than one person and mines remain after the confl ict, both increasing the likeli-hood of civilian injuries. Secondly, com-pared with using a rifle, there is distance and no visual contact between rhe user and the victim in space (shells, bombs, and mortars) o r time (mines). The user thus feels less respons ible for h is or her actions, the psychology of the user per-haps changing with the weapon used. At the rime these data were collected those besieging rhe city of Kabul reported that Tobit I Numbe n of patients admitted to all Red Cross ho>p~lals by ouse of injury (oust of injury No of patients No (%)of civiUom• Bullet 8432 1578 (18.7) fragment! 5759 1962 (34.1) Mine* 4686 1445 (30.8) Total 18877 4985 (26.4) 'Womtn ond girls, boys (under 16), men oged ~50. fln<iudesshtlis, bombs, and morton. /Antitank and onllptn01mel. Tobit 1 Numbe n of patient> admrlled to Red Cross hosprtalrn Kabul within six hou11 olrnjury by cau>< ol rnjury Couu of injury No of potienu No (%) of civilians' Bullet 699 273 (39.1) fragment! 837 507 (60.6) Mine* 476 262 (55.0) Total 2012 1042 (51.8) 'Women and girls, boys (under 16), men aged ~50. tJndudes shells, bombs, and mortofl. IAntironl ond ont iptflonnel. they kissed the rockers, shells, and mortars before they were loaded so that God would decide whether they hi t rhe enemy. Both increased destructive force and increased distance between user and victim are features of mili-tary efficiency of a weapon system. This study sup-ports the proposal of a fundamental principle: with greater military efficiency of weapons comes an in-herent and increased potential for injuring civi lians. The data from Kabul are pertinent to the global trend of urbanization of societies and show how the poten-tial of any weapon to injure civilians is exaggerated in urban settings. Weapons, law and medicine The process of making or promot-ing policy and law entails analyzing data that clarify the nature of the problem that the pol icy or law is trying to avoid. In-ternational humanitarian law is no excep-t ion. These dara show rhar the number of civilian injuries is related not only to whether weapons are in rhe hands of un-trained and undisciplined users but also to the rype of weapon in chose hands. This argues for a greater need to control rhe transfer o f weapons of increasing military efficiency and warrants urgent and serious examination of States' obli-gations under international humanitar-ian law in relation ro arms transfer. Such an examination should naturally follow the precedent set by the drawing up of a treaty banning rhe production, stockpil-ing, transfer and use of anti-personnel mines. The medical profession has a re-sponsibility ro examine the global weapon problem as a health issue; th is is a form of preventive medicine. • • 31 • + During war, mines and fragmenting munitions (mortars, bombs, and shells) are more likely than bullets to injure civilians + Civilians in a city under siege are particularly at risk of being injured by weapons whose users are not able to see the victim + The inherent nature of weapons may be a factor in determining whether civilians are killed or injured + There is a need for greater respect for the Fourth Geneva Convention and for greater controls on weapons being transferred to untrained and undisciplined forces. 1Coupland and Samnegaard: Effect of Conventional Weapons on Civilian InjuriesPublished by JMU Scholarly Commons, 1999

Effect of Conventional Weapons on Civilian Injuries

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Effect of Conventional Weapons on Civilian Injuries

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