title: Pattern of injuries seen during an insurgency: a 5-year review of 1339 cases from Nigeria.
abstract: BACKGROUND
  When there is an insurgency, the use of force in the form of weaponry, is employed. This may lead to the total breakdown of law and order, resulting in destruction of life and property. Health workers may be killed or captured, and, health facilities destroyed or stretched beyond their functional capacity. This is a report of experience with injuries seen in a tertiary hospital in north eastern Nigeria, under an insurgency situation.
  
  
  METHODS
  After obtaining clearance from the medical Ethics Committee of UMTH, we reviewed the case files of all patients treated for injuries sustained as a result of the Boko Haram insurgency from January 2009 to December 2013. Those brought in dead, were not included in the study.
  
  
  RESULTS
  We reviewed the case files, theatre notes, admission and discharge registers of 1339 cases. 1223 (91.3%) of the victims were males, while 116 (8.7%) were females. Gunshot wounds accounted for 1229 (91.8%) of the injuries, bomb blast 90 (6.7%), others 15 (1.1%) knife (Cut throat) 4 (0.3%) and road traffic accident 1 (0.01%). Casualties were made up of civilians 1144 (85.4%), the joint task force (a force made up of the Military, Police, Customs and Immigration, against the insurgents) 117 (8.7%), and insurgents 22 (1.6%). The ages of the patients ranged from 1 to 80 years, peaking at the 21-40 age brackets (796 or 59.4%). The extremities were most affected, 734 (54.8%), followed by the torso 423 (31.6%), multiple injuries 93 (6.9%) and head and neck 89 (6.6%). 1226 (91.6%) of the victims survived while 113 (8.4%) died from their injuries. This followed massive blood loss from injuries to the torso 69 (61.1%) multiple injuries 15 (13.3) and extremities 6 (5.3%). Others causes were fatal injuries to the head and neck 22 (19.5%) and 90% burns following bomb blast 1 (0.9%).
  
  
  CONCLUSIONS
  Injuries resulting from insurgency will continue to be a problem in many developing countries because their health facilities in terms of personnel and materials are ill prepared for such a situation .
authors.affiliation: Department of Orthopaedics and Trauma Surgery, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria.
authors.forename: T M
authors.initials: TM
authors.lastname: Dabkana
authors.forename: B
authors.initials: B
authors.lastname: Bunu
authors.forename: H U
authors.initials: HU
authors.lastname: Na'aya
authors.forename: U M
authors.initials: UM
authors.lastname: Tela
authors.forename: A S
authors.initials: AS
authors.lastname: Adamu
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001753:Blast Injuries / Q000453:epidemiology; D002056:Burns / Q000453:epidemiology / Q000628:therapy; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005107:Explosions; D005121:Extremities / Q000293:injuries; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries; D009549:Nigeria; D010614:Pharynx / Q000293:injuries; D017678:Sex Distribution; D023481:Terrorism; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000145:classification / Q000453:epidemiology* / Q000628:therapy; D014948:Wounds, Gunshot / Q000453:epidemiology; D055815:Young Adult