title: Injury burden during an insurgency: the untold trauma of infrastructure breakdown in Baghdad, Iraq.
abstract: BACKGROUND
  Injuries as a result of the ongoing violence in Iraq have been a topic of both lay and academic interest. However, to date, attempts to quantify injuries in the country have focused primarily on direct mortality, which represents only a small portion of overall injury burden and ignores those injuries indirectly resulting from the conflict-induced breakdown of Iraqi infrastructure.
  
  
  METHODS
  We performed a cross-sectional household survey from October to November, 2009, within the Baghdad Governorate of central Iraq. Using two-stage cluster-sampling with a proportional-to-size methodology, we randomized a total of 60 clusters to Baghdad's five governmental districts. Within each cluster, we interviewed heads of households regarding all injuries during the last 3 months.
  
  
  RESULTS
  We surveyed 1,172 households, gathering information regarding 7,396 individuals. Only 8.4% of injuries were intentional, and fatalities represented only a small fraction (1.7%) of overall injury burden. The well-publicized intentional explosions in Baghdad, although accounting for close to half (44%) of all intentional injuries, made up only 4% of the total. Other injuries at least partially attributable to the conflict-induced breakdown of Iraqi infrastructure proved a much larger burden, for example, those from electric shock, unintentional explosions, unintentional gunshot wounds, and falls.
  
  
  CONCLUSIONS
  Past and current fighting in Baghdad continues to adversely affect the Iraqi populace, where the indirect effects of infrastructure breakdown are likely the primary source of injury. When measuring the burden of large-scale violence, health researchers should account for the full injury burden, including both injury morbidity and indirect injuries.
authors.affiliation: Department of Emergency Medicine, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California 90509, USA. ross@rossdonaldson.com
authors.forename: Ross I
authors.initials: RI
authors.lastname: Donaldson
authors.forename: Yuen Wai
authors.initials: YW
authors.lastname: Hung
authors.forename: Patrick
authors.initials: P
authors.lastname: Shanovich
authors.forename: Tariq
authors.initials: T
authors.lastname: Hasoon
authors.forename: Gerald
authors.initials: G
authors.lastname: Evans
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007407:Interviews as Topic; D007493:Iraq / Q000453:epidemiology; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries / Q000401:mortality*