Papers

Incidence of weapon injuries not related to interfactional combat in Afghanistan in 1996: prospective cohort study

Markus Michael, health and relief coordinator, Asia and Latin America desk, ^a David R Meddings, epidemiologist, ^b Salah Ramez, surgeon, ^c Juan Luis Gutiérrez-Fisac, associate professor. ^d

^a Health Operations Division, International Committee of the Red Cross, 19 avenue de la Paix, 1202 Geneva, Switzerland, ^b Unit of the Chief Medical Officer, International Committee of the Red Cross, ^c International Committee of the Red Cross, Peshawar, Pakistan, ^d Department of Preventive Medicine and Public Health, Autonomous University of Madrid, Arzobispo Morcillo s/n, 28029 Madrid, Spain

Correspondence to: Dr Meddings dmeddings{at}icrc.org

Objective: To examine the descriptive epidemiology of weapon injuries not directly attributable to combat during armed conflict.
Design: Prospective cohort study.
Setting: Nangarhar region of Afghanistan, which experienced effective peace, intense fighting, and then peace over six months in 1996.
Subjects: 608 people admitted to Jalalabad hospital because of weapon injuries.
Main outcome measures: Estimated incidence of injuries from combat or otherwise (non-combat injury) before, during, and after the fall of Kabul.
Results: Incidence of non-combat injury was initially 65 per 100 000. During the intense military campaign for Kabul the incidence declined dramatically, and then differentially increased dependent on injury subcategorythat is, whether injuries were accidental or intentional and whether they were inflicted by firearms or fragmenting munitions. Non-combat injuries accounted for 51% of weapon injuries observed over the study period. Civilians were more likely to have non-combat injuries than combat injuries.
Conclusions: Weapon injuries that are not attributable to combat are common. Social changes accompanying conflict and widespread availability of weapons may be predictive of use of weapons that persists independently of conflict.