Citation

Guha-Sapir D, Rodriguez-Llanes JM, Hicks MH, Donneau AF, Coutts A, Lillywhite L, Fouad FM. BMJ 2015; 351: h4736.

Affiliation

Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Lebanon.

Copyright

(Copyright © 2015, BMJ Publishing Group)

DOI

10.1136/bmj.h4736

PMID

26419494

Abstract

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. 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. These areas differ vastly in terms of service delivery capacity, number of trained staff, and access to essential medicines.

Indirect conflict related deaths have arisen from poor sanitation and severe disruption to Syria’s healthcare system. In December 2014, 20% of Syria’s public hospitals were completely non-functional, and another 35% provided only partial services. 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.

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 conflict at the time.

Population surveys can provide estimates of overall deaths and excess fatalities in a war. But epidemiological analyses of war deaths from specific weapon types have been hampered by small sample sizes and uncertainties that limit their usefulness. Associations between weapon types and victim characteristics in armed civil conflicts are not well understood and are rarely studied....

Language: en