title: Seen but not heard: injuries and deaths from landmines and unexploded ordnance in Chechnya, 1994-2005.
abstract: BACKGROUND
  Due to more than a decade of armed conflict and civil unrest, Chechnya is among the regions most affected by landmines and unexploded ordnance worldwide.
  
  
  OBJECTIVE
  The study was performed to assess the magnitude of injuries and deaths due to landmines and unexploded ordnance in Chechnya between 1994 and 2005 and to describe epidemiologic patterns and risk factors for these events.
  
  
  METHODS
  Surveillance data that included 3,021 civilian non-combatants injured by landmines and unexploded ordnance in Chechnya during 1994-2005 were analyzed. Local non-governmental organizations in collaboration with the United Nations Children's Fund conducted victim data collection using trained staff to interview victims or their families. Surveillance data were used to describe injury trends, victim demographics, injury types, risk behaviors, and types of explosives related to landmine and unexploded ordnance events.
  
  
  RESULTS
  The largest number of injuries occurred in 2000 (716, injury rate 6.6 per 10,000) and 2001 (640, injury rate 5.9 per 10,000). One-quarter of all victims were younger than 18 years, and 19% were females. The case-fatality rate was 23%. Approximately 40% of victims were injured by landmines, 30% by unexploded ordnance, and 7% by booby traps. A large proportion of children and adults were injured while traveling or performing activities of economic necessity; 29% of children were injured while tampering with explosives or playing in a contaminated area. The proportion of victims with lower limb amputations was similar among children and adults (14% and 17%, respectively), whereas the proportion ofvictims with upper limb amputations was three times higher in children than in adults (12% and 4%, respectively). Most accidents that occurred while the victim was traveling or performing activities of economic necessity were caused by landmines, while most accidents that occurred while the victim was playing near an explosive device or tampering with it were caused by unexploded ordnance.
  
  
  CONCLUSIONS
  Civilians in Chechnya experienced the highest rates of injury from landmines and unexploded ordnance ever documented, 10 times higher than injury rates reported from such highly affected countries as Afghanistan, Angola, or Cambodia. Urgent efforts to identify, mark, and clear mined areas and/or areas contaminated with unexploded ordnance are needed to prevent further civilian injuries and deaths.
authors: International Emergency and Refugee Health Branch, Division of Emergency and Environmental Health Services, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. OBilukha1@cdc.gov
authors: Oleg O
authors: OO
authors: Bilukha
authors: Muireann
authors: M
authors: Brennan
authors: Mark
authors: M
authors: Anderson
authors: Zaur
authors: Z
authors: Tsitsaev
authors: Eliza
authors: E
authors: Murtazaeva
authors: Ramzan
authors: R
authors: Ibragimov
mesh_terms: D000293:Adolescent; D000328:Adult; D001753:Blast Injuries / Q000145:classification / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D053834:Explosive Agents; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012426:Russia / Q000453:epidemiology; D014857:Warfare
chemical_list: D053834:Explosive Agents