Mortality associated with use of weapons in armed conflicts, wartime atrocities, and civilian mass shootings: literature review

BMJ 1999;319:407-410 ( 14 August )

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Mortality associated with use of weapons in armed conflicts, wartime atrocities, and civilian mass shootings: literature review

Robin M Coupland, surgeon, David R Meddings, epidemiologist.

Unit of the Chief Medical Officer, International Committee of the Red Cross, 19 avenue de la Paix, 1202 Geneva, Switzerland

Correspondence to: R Coupland rcoupland{at}icrc.org

Objective: To determine the implications of variationin mortality associated with use of weapons in differentcontexts.
Design: Literaturereview.
Settings: Armed conflicts and civilian mass shootings,1929-96.
Main outcome measure: Mortality fromwounds.
Results: During the fighting of war the number of peoplewounded is at least twice the number killed and may be 13 timesas high; this ratio of the number wounded to the number killedresults from the impact of a weapon system on human beings inthe particular context of war. When firearms are used againstpeople who are immobilised, in a confined space, or unable todefend themselves the wounded to killed ratio has been lower than1 or even0.
Conclusions: Mortality from firearms depends not only onthe technology of the weapon or its ammunition but also on thecontext in which it is used. The increased mortality resultingfrom the use of firearms in situations other than war requiresa complex interaction of factors explicable in terms of woundballistics and the psychology of the user. Understanding thesefactors has implications for recognition of war crimes. In addition,the lethality of conventional weapons may be increased if combatantsare disabled by the new non-lethal weapons beforehand; this possibilityrequires careful legal examination within the framework of theGenevaConventions.

Key messages

Mortality from firearms varies according to the context in which they are used
In war the number of people wounded is at least twice the number killed
The number killed may be greater than the number wounded when firearms are used against people who are immobilised, in a confined space, or unable to defend themselves
Recognising how the wounded to killed ratio varies has implications for recognising war crimes
Combining use of weapons that are designed to incapacitate with use of conventional weapons requires examination under the law of war

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