Civilian deaths from weapons used in the Syrian conflict
BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4736 (Published 29 September 2015) Cite this as: BMJ 2015;351:h4736View an interactive graphic showing the impact of different weapon types on civilian men, women, and children in Syria.
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
We have three concerns about this article. First, the article apportions responsibility for casualties to particular perpetrator organizations based on a single snapshot of territorial control that ignores the numerous (and well-documented) changes in this phenomenon over time. Second, combining Syrian Opposition Groups and Islamic State groups into one category (non-state armed groups; NSAG) obscures the fact that these groups are actively fighting each other. Finally, our work with Syrian human rights groups has taught us that their ability to document the conflict varies as a function of which armed groups are in control of each region. Therefore, the very high rate of missing data is likely to result in distorted patterns in the observed data. We will address these concerns in order in this response.
First, the authors present their findings stratified by geographic areas controlled by NSAG and the Syrian Government. This geographic stratification is based on a map of territorial control published by the BBC. The map shows areas controlled by different factions, and where high frequency conflict was reported between October and December 2014. Although they do not state this explicitly, this stratification choice implies an assessment of proportional responsibility. Such assessments will undoubtedly be important in a post-conflict transition and must be able to withstand scrutiny.
Over the course of the conflict, frontlines, battlefields and control of territory have changed rapidly across Syria. For example, analyses conducted by the Syria Conflict Mapping Project at the Carter Center have found that in the past year alone there have been close to 1,000 documented changes in territorial control among the areas they are monitoring. If they are to be accurate, quantitative claims about the geographic dynamics of violence require that analysts understand the detail of which groups controlled which areas, and when those lines of control changed. Occasionally, analysts may also have to recognize that territorial control at a particular time and place is too uncertain to attribute responsibility to a particular group. Instead of adjusting for territorial control over time, this article extrapolates backward three years from the static BBC map and forward six months from the same map. Similarly, temporal comparisons, as made in Figure 2 of the article, have not been adjusted to reflect temporal variation in territorial control. It is vital that any analyses based on territorial control take into account these rapid changes.
Our second concern pertains to the conflation of Islamic State and Syrian Opposition Groups. Since late 2013 these groups have been fighting each other. As a result, geographic regions that are treated in this analysis as being under homogenous territorial control are actually experiencing active armed confrontations between Islamic State and Syrian Opposition Groups. For example, the Washington Post describes community celebrations in February 2014 when the Free Syrian Army regained control over the town of Azaz after a “…five-month reign of terror” by factions of the Islamic State [1].
Lastly, as shared with us directly by Syrian human rights groups and described in “Stolen Futures” by the Oxford Research Group/Every Casualty [2], these groups’ ability to collect data varies dramatically depending on who has control over a territory. Data collection on both killed civilians and combatants is actively impeded by the Syrian government in areas controlled by their forces. In work previously published on estimating the dark figure in Syria [3] we provide evidence for higher levels of underreporting of fatalities in the immediate aftermath of territorial gains by the government.
The authors acknowledge these challenges in Appendix C: 'Conflict deaths in government controlled areas may be more under-reported than those in opposition-controlled areas.' 'Access to bodies and access to the communications resources needed to report such casualties may be easier in urban areas compared to rural areas.' 'In this dataset the numbers of executions of civilians reported in government-controlled areas was extremely low...Underreporting of executions may be even higher in this area than for other deaths from weapons due to the highly controlled and secretive environment of executions...' In other words, reporting rates for weapon types may be correlated with geography generally and territorial control specifically. Curiously, though, the authors present odds ratios in this paper without reflection about how they may be distorted by reporting issues. This is a serious methodological problem.
We agree that more attention should be drawn to the use of indiscriminate weapons and the possibility that already vulnerable populations may be disproportionately affected by such weapons. However, the analyses presented here rest on too many unexamined assumptions, uncontrolled biases, and inadequate data. Analyses such as the ones presented in this paper have the potential to influence the accountability efforts that will likely take place in the future. Without appropriate consideration of their potential limitations, they are more likely to mislead than to inform about important questions regarding culpability, reparation, reconciliation, and ultimately justice.
[1] https://www.washingtonpost.com/world/syria-extremists-retreat-from-key-t...
[2] Salama, Hana, and Hamit Dardagan. "Stolen futures: the hidden toll of child casualties in Syria." (2013).
[3] Price, Megan, Anita Gohdes, and Patrick Ball. "Documents of war: Understanding the Syrian conflict." Significance 12.2 (2015): 14-19.
Megan Price, Human Rights Data Analysis Group
Anita Gohdes , Human Rights Data Analysis Group/Harvard Kennedy School
Jay D. Aronson, Carnegie Mellon University, Center for Human Rights Science
Christopher McNaboe, Carter Center, Syria Conflict
Mapping Project
Competing interests: No competing interests
Dear Martin,
Thank you for your comment.
We think that it is important to differentiate between data description and more advanced epidemiological analysis. Both are complementary but they have different purposes and thus answer different questions.
We did not hide the data from men. We discussed the importance of civilian men among the author group several times. We were also conscious that international humanitarian law (IHL) requires that combatants should minimize harm to non-combatants and this also motivated us to look at the deaths of women and children, and although we were careful not to specifically allege any breach of IHL we were conscious that data on the ratio of deaths of probable non-combatants to probably combatants might suggest non-compliance.
Even if the aim of the paper was to investigate death likelihoods in children and women by weapons used in the Syrian conflict ("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"), we clearly stated the death share in men early in the paper:
"Although the majority of deaths were of men, nearly 25% of Syrian civilians killed were women and children (see tables B1 and B2 in appendix on thebmj.com)".
In addition, tables B1 and B2, which describe deaths in men, women, and children by the weapons used are available in the appendix.
We also wrote early in our paper conclusions:
"On the other hand, civilian men constituted the largest share of the civilian death toll, mostly being killed by shells, shootings, and executions".
or
"Our findings show the ongoing, severe impact of war on the deaths of children, women, and men in the civilian population related to the continued disregard of these resolutions"
Moreover, compared to women and children, death likelihoods for men were higher for shootings and executions as stated in one of our "key messages":
"Women were the second most likely to die due to explosive weapons. Men were mostly killed by shootings and executions"
On a final note, we only used throughout the article odds ratios and not, as you mentioned in your response, relative risks. They require different data, are calculated differently, and have also a different interpretation.
Jose M Rodriguez-Llanes and Louis Lillywhite, on behalf of all the authors.
Competing interests: No competing interests
Why is this article trying to hide the actual numbers and only showing relative risks? By using relative risk given that the subject is already dead, you do not take into account the total number of deaths.
"[We] found that the likelihoods of death were significantly higher for children than for men for air bombardments, shells, ground level explosives, and chemical weapons"
The authors make it sound as if more children die from these causes than men. Your actual data are children vs men for air bombardments 3945 vs 8675, for shells 5598 vs 16747, for explosives 464 vs 1750 and for chemical weapons 128 vs 544 (from Appendix B of the article).
"Women were significantly more likely to die from chemical intoxication (4.72 (3.93 to 5.67)) than men, as were children (2.11, 1.69 to 2.63). Our findings indicate that the use of chemical weapons in NSAG controlled areas was particularly harmful to women and children"
Again, from your own numbers: 128 children, 297 women and 544 men. How is that "particularly harmful to women and children"?
Imagine a hypothetical scenario with 1 child and 10 men dead. If the child and 5 of the men had been stabbed, the other 5 men died from other causes. Is the risk of getting stabbed really twice as high if you are a child?
Martin
Competing interests: No competing interests
Useful article and the analysis is well done.
How does this compare with civilian deaths and especially children's deaths incurred in the Gaza massacres by Israel in 2008 and in 3012?
It is important for future study of massacre and torture that such comparisons are made.
Competing interests: No competing interests
Cheap infantry mortar high explosive rounds, artillery cluster shells, armour piercing projectiles, rocket-propelled grenades, multiple rocket launchers, are widespread all over the World and easily trafficable, without being traced.
Rebel militants and terrorist factions can use them from a distance of many kilometres, and destroy entire towns.
$1 billion buys 2,000,000-3,000,000 of such projectiles, enough to destroy an entire Country.
Entirely plastic anti-personnel mines, impossible to trace, are sold for only a few dollars, and can infest vast areas, for decades.
Improvised bombs and mines can even be constructed by cheap industrial explosives.
Expensive laser guided GPS-oriented fancy missiles released from airplanes could be banned from city areas, after International Treaties, but all the rest of the destructive weaponry is still going to be used, unfortunately.
Competing interests: No competing interests
Re: Civilian deaths from weapons used in the Syrian conflict
Thank you for your comments. A number of the stated concerns seem to be based on mistaken assumptions that we hope to clarify here and that are addressed in our article and the published Appendices. We answer the comment point-by-point:
Price et al. start their commentary with the following assumption albeit incorrect: “First, the article apportions responsibility for casualties to particular perpetrator organizations.” The methodology that we adopted most definitely does not attribute responsibility for casualties to any specific perpetrator. The potential attribution of perpetrators from our data was discussed extensively during the peer-review process of the paper and judged unfeasible. In one case, a specific form of aerial bombardment - barrel bombs dropped by helicopter - is attributed in our text to government forces based on cited evidence and because, as of the date of the study, helicopter-delivered barrel bombs were not a weapon type used by non-government forces in the Syrian conflict but were used by the government. We took particular care that our analysis did not over-reach the data by attributing responsibility to perpetrator groups.
Price et al. go on to write that this is “based on a single snapshot of territorial control that ignores the numerous (and well-documented) changes in this phenomenon over time” and that this is based on a map of territorial control published by the BBC. The map is presented early in the paper with the sole intention of showing the main parties involved in the conflict. We recognise that control of areas is fluid, as we illustrate in the example of the map, and our selection of the term non-state armed group (NSAG) recognizes the fact that there are multiple, and shifting, NSAGs acting and interacting within areas of the conflict. Although we hope to see systematically territory-adjusted and time-adjusted Syrian casualty analyses in the future by Price et al., and hope that they will also examine deaths from different weapon types among different civilian demographic groups, we also expect that any attribution of deaths to specific perpetrators will be moderated by recognition of the many biases and data gaps that are known to occur in perpetrator attribution.
Price et al. express concern about the potential effects of underreporting, particularly in government controlled areas, citing as we did sources that indicate casualty reporting in Syria can be affected by who has control over a territory. In our paper we address the issue of underreporting specifically as it relates to our odds ratios findings. In the case of execution deaths, we describe the limitations affecting reporting and do not include executions in government controlled areas in models, as noted in the footnote of Table B2, because the very low reported numbers do not support statistical analysis for comparisons between children, men and women. We do report the odds of death by execution for children vs. men and vs. women in the NSAG controlled areas, which had substantial numbers of reported executions, as we do for all areas with sufficient data on deaths from a weapon type.
The commentators miss an important point here. One of the most consistent and key aspects of our analysis that seems to be overlooked by Price et al. is the similarity of the odds ratios for civilian deaths by weapons used across both NSAG controlled and government controlled areas (i.e., shells, ground level explosives and shooting, table B3 in the supplement). This is not a study to estimate total number of civilian deaths from the conflict but a study to understand the relative likelihood of death by weapon type. As such the point is not whether underreporting exists, but rather whether associated bias may exist. We show that, even if under-reporting might have been more frequent in government controlled areas, the odd ratios of civilian deaths by similar weapons provided results consistent with those in NSAG controlled areas. This reinforces the main point of our paper, which is that explosive weapons used in populated areas are extremely dangerous for civilians, especially for children and women. We acknowledge that more research should be done on this area and we hope that Price et al., and other researchers, will soon re-analyse this topic in-depth.
Whilst International Humanitarian Law (IHL) recognises that non-combatants might be killed or injured in a conflict, there is a duty on combatants, whoever they are, to minimise such death and injuries. Drawing attention to the impact of certain weapons on vulnerable population groups, for example the relative dangers of explosive weapons to children in a war, should stimulate a debate on whether sufficient attention is given to this aspect of IHL. Seeking to use our paper to attribute responsibility misses the point - the paper highlights the high cost that non-combatants are paying. Whilst we leave it to others to consider whether this is so high that it breaches IHL, we believe that our main recommendation, that further thought is given to the use of explosive weapons in built up areas, is not undermined by the comments by Price et al.
As physicians and epidemiologists, we strongly reject the suggestion that we should await future political and legal accountability efforts before drawing attention to the ongoing serious impact of weapons on civilians. We also reject the suggestion that we should not draw attention to inappropriate suffering in case of its misinterpretation in what the commentators vaguely describe as a "post-conflict transition" or because it might "mislead important questions regarding culpability, reparation, reconciliation, and ultimately justice". To us, seeking to prevent the death and injury of civilians today takes priority over future legal processes which may or may not occur. Given that there is no tangible political settlement to the conflict in sight, every effort should be made to highlight and continuously monitor the human costs and abuses committed by all sides.
Madelyn Hicks
Louis Lillywhite
Jose M Rodriguez-Llanes
Adam Coutts
Fouad M Fouad
Debarati Guha-Sapir
Competing interests: No competing interests