Open Access Open Access  Restricted Access Subscription or Fee Access

Injury-related fatalities in selected governorates of Iraq from 2010 to 2013: Prospective surveillance

Oleg O. Bilukha, MD, PhD, Abdul-Salam Saleh Sultan, MBChB, DM, Ahmed Hassan, MBChB, FICMS, Syed Jaffar Hussain, MD, Eva Leidman, MSPH

Abstract


Objective: After several years of relative stability in Iraq, the emergence of the Islamic State militant group has spurred a resurgence of violence. This study explores the impact of the conflict on the overall injury profile to estimate the proportion of injury fatalities related to conflict and better understand how violence has affected nonconflict-related injuries.

Design: Routine prospective injury surveillance operated by the Iraqi Ministry of Health.

Setting: Surveillance data were collected from coroner offices in eight pilot governorates: Al-Anbar, Baghdad, Basrah, Erbil, Kerbala, Maysan, Ninevah, and Al-Sulaimaniya.

Participants: We analyzed all fatalities from external injury causes recorded between January 1, 2010 and December 31, 2013. Analysis included 32,664 fatal injuries.

Results: Of all injury fatalities reported, 27.1 percent were conflict-related fatalities, approximately the same proportion as road traffic-related fatalities (24.4 percent) and other unintentional injuries (27.5 percent). The proportion of fatalities from conflict was approximately three times higher among males than females (33.0 percent and 10.3 percent, respectively) and four times higher among adults than children (29.8 percent and 7.3 percent, respectively). The total number of injury fatalities remained stable between 2010 and 2012; an increase in injury fatalities in 2013 was driven primarily by increases in fatalities from both interpersonal violence and conflict.

Conclusions: From 2010 to 2013, nearly one in four injury fatalities in Iraq was attributable to conflict, a notably higher proportion than other conflict-affected countries in the region. The overall profile of nonconflict injuries in Iraq is also distinct from other countries of similar socioeconomic level that have not experienced violence.


Keywords


death certificates, information systems, international, mortality, surveillance

Full Text:

PDF

References


The Work Bank: Work Bank Country and lending groups. Secondary country and lending groups 2015. Available at https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-countryand-lending-groups. Accessed July 7, 2016.

Norton R, Kobusingye O: Injuries, N Engl J Med. 2013; 368(18): 1723-1730.

World Health Organization (WHO): Cause-specific mortality: Regional estimates for 2008. Geneva: World Health Organization. Available at http://www.who.int/healthinfo/global_burden_disease/estimates_regional_2004_2008/en/. Accessed July 7, 2016.

Bhalla K, Harrison JE, Shahraz S, et al.: Availability and quality of cause-of-death data for estimating the global burden of injuries. Bull World Health Organ. 2010; 88(11): 831-838C.

Hagopian A, Flaxman AD, Takaro TK, et al.: Mortality in Iraq associated with the 2003-2011 war and occupation: Findings from a national cluster sample survey by the university collaborative Iraq Mortality Study. PLoS Med. 2013; 10(10): e1001533.

Burnham G, Lafta R, Doocy S, et al.: Mortality after the 2003 invasion of Iraq: A cross-sectional cluster sample survey. Lancet. 2006; 368(9545): 1421-1428.

Roberts L, Lafta R, Garfield R, et al.: Mortality before and after the 2003 invasion of Iraq: Cluster sample survey. Lancet. 2004; 364(9448): 1857-1864.

Iraq Body Count (IBC): Iraqi deaths from violence 2003–2011: Analysis and overview from Iraq Body Count. 2012. Available at http://www.iraqbodycount.org/analysis/numbers/2011. Accessed November 1, 2015.

Hicks MH: Mortality in Iraq. Lancet. 2007; 369(9556): 101-102.

Iraq Body Count (IBC): Iraq 2014: Civilian deaths almost doubling year on year. 2015. Available at https://www.iraqbodycount.org/analysis/numbers/2014. Accessed November 1, 2015.

Bilukha O, Leidman E, Sultan AS, et al.: Deaths due to intentional explosions in selected governorates of Iraq from 2010 to 2013: Prospective surveillance. Prehosp Disaster Med. 2015; 30(6): 586-592.

Central Organization for Statistics and Information Technology (COSIT): Section 2: Population census. Annual abstract of statistics 2010-2011 2012. Available at http://cosit.gov.iq/AAS/section_2.php. Accessed November 1, 2015.

United Nations Joint Analysis Unit: Iraq Information Portal. Governorate Profile, 2012. Available at: http://www.iau-iraq.org/gp/. Accessed July 7, 2016.

Global Burden of Disease Study 2013: Global Burden of Disease Study 2013 (GBD 2013) Age-Sex Specific All-Cause and Cause-Specific Mortality 1990-2013. Seattle, WA: Institute for Health Metrics and Evaluation, 2014.

Institute for Health Metrics and Evaluation (IHME): GBD Compare. Seattle, WA: IHME, University of Washington, 2015. Available at http://vizhub.healthdata.org/gbd-compare. Accessed November 1, 2015.

Nordland R: An uncharacteristically upbeat general in Afghanistan. New York Times, January 24, 2001: Sect At War.

Archer D, Gartner R: Violent acts and violent times: A comparative approach to postwar homicide rates. Am Soc Rev. 1976; 41(6): 937-963.

Krug EG, Dahlberg LL, Mercy JA, et al.: World report on violence and health. Geneva: World Health Organization, 2002. Available at http://www.who.int/violence_injury_prevention/violence/world_report/. Accessed November 17, 2015.

Krug EG (ed.): Injury: A leading cause of the global burden of disease. Geneva: World Health Organization, 1999. Available at http://apps.who.int/iris/handle/10665/66160. Accessed November 17, 2015.

Akbari ME, Naghavi M, Soori H: Epidemiology of deaths from injuries in the Islamic Republic of Iran. East Mediterr Health J. 2006;12(3-4): 382-390.

Kipsaina C, Eze UO, Ozanne-Smith J: A standardised mortuary-based injury surveillance system: Lessons learned from the Ibadan Nigerian trial. Int J Inj Contr Saf Promot. 2015; 22(3): 193-202.

Bell J, Lugo L, Cooperman A, et al.: The World's Muslims: Religion, politics and society. Pew Research Center. 2013. Available at http://www.pewforum.org/2013/04/30/the-worlds-muslims-religion-politics-society-morality/. Accessed March 17, 2016.

De Leo D: Can we rely on suicide mortality data? Crisis. 2015; 36(1): 1-3.

Medico-Legal Law No. (37). Secondary Medico-Legal Law No. (37) for the year 2013. Available at http://www.iraq-lg-law.org/ar/taxonomy/term/108. Accessed November 1, 2015.

Ministry of Health Civil Status Directorate: Death Certificates: Reporting and registration of births and applying for copies of birth certificate: Iraq E-Government Portal, 2013. Available at http://www.egov.gov.iq/egov-iraq. Accessed November 1, 2015.

Al-Rabie AS: Registration of vital events in Iraq. Secondary registration of vital events in Iraq 1980. Available at http://www.cdc.gov/nchs/data/isp/010_Registration_of_%20Vital_Events_in_Iraq.pdf. Accessed November 1, 2015.

Farooq U, Majeed M, Bhatti JA, et al.: Differences in reporting of violence and deliberate self harm related injuries to health and police authorities, Rawalpindi, Pakistan. PloS One. 2010; 5(2): e9373.

Vyrostek SB, Annest JL, and Ryan GW: Surveillance for fatal and nonfatal injuries—United States, 2001. MMWR Surveill Summ. 2004; 53: 1-57.

Krug EG: Injury surveillance is key to preventing injuries. Lancet. 2004; 364(9445): 1563-1566.




DOI: https://doi.org/10.5055/ajdm.2016.0224

Refbacks

  • There are currently no refbacks.