The devastating impact of suicide bombs on both Iraqi civilians and coalition troops is detailed in an Article in this week's 9/11 special issue of The Lancet. The Article is by Dr Madelyn Hsiao-Rei Hicks, Institute of Psychiatry, King's College London, UK, and Iraq Body Count, London, UK, and colleagues.
The researchers analysed and compared suicide bomb casualties in Iraq that were documented in two datasets covering March 20, 2003, to Dec 31, 2010—one reporting coalition-soldier deaths from suicide bombs, the other reporting deaths and injuries of Iraqi civilians from armed violence. Documented suicide bomb events caused 19% (42 928 of 225 789) of overall civilian casualties, 26% (30 644 of 117 165) of injured civilians, and 11% (12 284 of 108 624) of civilian deaths. The injured-to-killed ratio for civilians was 2•5 people injured to one person killed from suicide bombs. Suicide bombers on foot caused 43% of documented suicide bomb deaths, while suicide bombers using cars caused 36%. Suicide bombers who used cars caused 40% of civilian injuries.
Of 3963 demographically identifiable suicide bomb fatalities, 75% were men, 11% were women, and 14% were children. Children made up a higher proportion of demographically identifiable deaths from suicide bombings than from general armed violence (9%). The injured-to-killed ratio for all suicide bombings was slightly higher for women than it was for men, but the ratio for children was lower than it was for both women and men, indicating lower survival of children than adults from suicide bombings. An Iraqi child died in at least 159 (16%) of 1003 suicide bombing events recorded, and the death of a woman or child in occurred in at least 211 (21%) of 1003 bombing events. Police officers, an occupational category overlapping with the demographic category of men and to a small extent women, constituted 14% of documented civilian deaths.
200 coalition soldiers were killed in 79 suicide bomb events during 2003. More Iraqi civilians per lethal event were killed than were coalition soldiers. These were recorded as follows: 175 US soldiers killed in 76 events, 16 Italian soldiers killed in one event, three British soldiers killed in one event, and four Bulgarian and two Thai soldiers killed in one event.
The authors say: "Rapid access to adequate hospital treatment is crucial for survival of blast injuries, but such access can be difficult for civilians in Iraq. Survival and recovery of Iraqis injured by suicide bombs could possibly have been worsened by Iraq's severe shortage of adequate emergency rooms, diagnostic equipment, trained paramedics and doctors, senior and specialty surgeons needed for complex blast injuries, intensive care units, rehabilitation, and supplies."
They conclude: "Our findings suggest that the Iraqi civilian population suffers a substantial public health burden because it is a primary chosen target of suicide bombers and those who deploy them…Our findings about the likelihood of surviving injuries, which was particularly low for children recorded in our dataset, need further study and draw attention to the need for improved monitoring, prevention, and interventions to reduce mortality from suicide bombs in Iraq."
In a linked Comment, Dr Gilbert Burnham, Johns Hopkins School of Public Health, Baltimore, MD, USA (and co-author on the 2006 Lancet report on deaths in Iraq) says: "Prevention of suicide attacks is difficult because of their complex origins. The military's approach of controlling access and attacking suspicious targets has protected coalition forces in Iraq, but the resulting deaths of innocent civilians have alienated many Iraqis. This action has played a part in shifting suicide attacks towards civilian targets. Attempts to stop bombers are often futile. Most effective is the elimination of conditions that cause popular support for terrorist groups. Interruption of jihadist networks and their financial support is also a successful approach. The changing habits of populations exposed to terror attacks (eg, the avoidance of high-risk locations) build resilience and individual coping capacities. Eventually, suicide attacks lose their strategic and psychological effect on a population, and insurgent groups shift to other methods."
Dr Madelyn Hsiao-Rei Hicks, Institute of Psychiatry, King's College London, UK, and Iraq Body Count, London, UK. T) +44 (0) 7806 265506 E) mjhhicks@aol.com Press Office, Institute of Psychiatry, King's College London, T) +44 (0)207 848 3202 E) iop-pr@kcl.ac.uk Dr Gilbert Burnham, Johns Hopkins School of Public Health, Baltimore, MD, USA. T) +1 410 955 7934 E) gburnham@jhsph.edu
Journal
The Lancet