War Related Injuries: Fact Sheet

What is the Public Health Problem?

In 25 conflicts during the 20th century, 72 million deaths were conflict-related and nearly half of these deaths were civilians.

• In 2000, more than 300,000 people died from war-related injuries worldwide.

Overall, civilians account for 35% to 65% of war-related deaths and injuries.

• Between 1987 and 1997, 2 million children were killed and 4-5 million were seriously injured as a result of armed conflicts.

Injuries from landmines represent a significant public health concern in conflict areas.

• Afghanistan is one of the most heavily mined countries in the world. 2,000 to 3,000 persons are killed or injured by landmines each year, while 2 of every 1000 persons are permanently disabled.

In recent years there has been an increased frequency of rape and sexual violence reported in conflict and post-conflict settings.

• In Bosnia, estimates of women who were raped as a result of the conflict in that country ranged from 10,000 to 25,000.

What has the CDC Accomplished?

CDC has provided support to organizations assisting survivors of traumatic limb-loss recover from their injuries, gain vocational skills and support other survivors.

In cooperation with the World Health Organization (WHO) and the Pan American Health Organization (PAHO), CDC has assisted in establishing war-related injury surveillance programs in Azerbaijan, Colombia, Iraq, Jordan, Nicaragua, El Salvador, Honduras, Colombia, Sri Lanka, Sudan, Ethiopia, Chechnya, and Mozambique.

• By working through the ministries of health in each of these countries, emergency room-based surveillance systems were established to track both fatal and nonfatal injuries.
• Data from these projects are being used to identify risk factors and develop injury intervention programs.
• Information gained from these countries will assist in developing procedural guidelines for the implementation of injury surveillance systems in conflict and post-conflict settings.

In partnership with the United Nations Children’s Fund (UNICEF), the Vietnam Veterans of America Foundation (VVAF), the International Rescue Committee (IRC), and the Mine Clearance Planning Agency (MCPA) of Afghanistan, CDC implemented a nationwide war-related mortality, injury, disability, and mental health survey in Afghanistan.

• Using cluster survey methodology, data were collected from over 6,000 persons.
• This information was used to establish national estimates of mortality, injury, disability, and mental health status.
• This project was the largest, war-related injury survey in a post-conflict setting.

CDC has also organized several war-related injury and public health conferences held in conjunction with the World Injury Conference.

• At the most recent conference, CDC sponsored 30 scholarship candidates from conflict settings.
• These individuals and other conference participants took part in a three-day workshop that addressed topics such as landmines, unexploded ordnance, sexual violence, small arms, surveillance, and survey methodology.

At the request of UNICEF, CDC organized and conducted epidemiology training courses for mine risk educators.

• This training provided mine risk educators with the skills necessary to incorporate epidemiology and other public health practices into the development, implementation, and evaluation of mine risk education and other prevention programs.
• The courses were conducted over a 1-2 week period and included topics such as surveillance, survey design, and evaluation.

What are the Next Steps?

A primary component of landmine/UXO prevention programs is mine risk education, designed to teach individuals to identify and avoid contact with landmines and other UXO.

• In collaboration with UNICEF and International Committee of the Red Cross (ICRC), CDC will assist in the evaluation of several of the most commonly implemented mine risk education strategies to determine their effectiveness.

CDC will continue efforts to measure the impact of sexual violence in the context of war through surveillance and surveys in conflict and post-conflict settings.

CDC will contribute to the prevention of violent injuries among children impacted by armed conflict through public health leadership, research, programs, and policies that translate science into practice. As an initial step, CDC will collaborate with other partners to develop standardized definitions, indicators, tools and methods to measure the impact of violent injuries among children in conflict settings.

The prevention of conflict-related violent injuries among children will address the following five topic areas:

• Landmines, cluster munitions, unexploded ordnances and improvised explosive devices
• Small arms, light weapons
• Sexual violence
• Physical violence
• Psychological trauma
• Child Soldiers

CDC will continue to provide assistance to the United Nations and other non-governmental organizations in their efforts to prevent war-related injuries.

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