Intended for healthcare professionals


Civilian deaths from weapons used in the Syrian conflict

BMJ 2015; 351 doi: (Published 29 September 2015) Cite this as: BMJ 2015;351:h4736
Weapons of war
View an interactive graphic showing the impact of different weapon types on civilian men, women, and children in Syria.

  1. Debarati Guha-Sapir, professor of disaster epidemiology1,
  2. Jose M Rodriguez-Llanes, epidemiologist, research fellow1,
  3. Madelyn H Hicks, associate professor2,
  4. Anne-Françoise Donneau, biostatistician3,
  5. Adam Coutts, public health policy specialist, honorary research fellow4,
  6. Louis Lillywhite, senior consulting fellow, retired lieutenant general5,
  7. Fouad M Fouad, assistant research professor of public health6
  1. 1Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
  2. 2Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
  3. 3Department of Public Health, University of Liège, Liège, Belgium
  4. 4Department of Politics and International Studies (POLIS), University of Cambridge, UK
  5. 5Chatham House Centre for Global Health Security, London, UK
  6. 6Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Lebanon
  1. Correspondence to: D Guha-Sapir debarati.guha{at}
  • Accepted 11 August 2015

The ongoing Syrian conflict is one of the largest humanitarian crises of the 21st century so far. Debarati Guha-Sapir and colleagues analyse the impact of weapons on civilian deaths, with a focus on women and children

What started as a peaceful uprising in Syria in March 2011 escalated quickly to an armed conflict. By 2012 conflict had become the leading cause of death of Syrians.1 Health systems have been reshaped, now being separated into areas controlled by the government, the opposition, or self proclaimed Islamic State factions—we group the last two as non-state armed groups (NSAG; fig 1). These areas differ vastly in terms of service delivery capacity, number of trained staff, and access to essential medicines.2

Fig 1 Areas controlled by different factions in the Syrian conflict. Source: BBC

Indirect conflict related deaths have arisen from poor sanitation and severe disruption to Syria’s healthcare system.3 4 5 In December 2014, 20% of Syria’s public hospitals were completely non-functional, and another 35% provided only partial services.4 Direct conflict related deaths are those that are caused by weapons and other violent methods used in warfare.

In this article we assess the direct conflict related deaths (hereafter termed violent deaths) of women and children among civilians killed in the Syrian conflict, because they are identified as vulnerable populations in public health and under specific laws of war such as the Geneva Conventions.6 7 8 9

War related deaths in Syria

Violent deaths have been considerable in Syria. A report commissioned by the United Nations found that from March 2011 to April 2014 over 191 369 verifiable violent deaths of individuals had occurred, including both combatants and civilians. Individuals were identified by their name and the date and location of their death, thus representing the minimum number of violent deaths from the Syrian …

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