title: Injuries, Death, and Disability Associated with 11 Years of Conflict in Baghdad, Iraq: A Randomized Household Cluster Survey.
abstract: BACKGROUND
  The objective of this study was to characterize injuries, deaths, and disabilities arising during 11 years of conflict in Baghdad.
  
  
  METHODS
  Using satellite imagery and administrative population estimated size for Baghdad, 30 clusters were selected, proportionate to population size estimates. Interviews were conducted during April and May 2014 in 900 households containing 5148 persons. Details about injuries and disabilities occurring from 2003 through May 2014 and resultant disabilities were recorded.
  
  
  RESULTS
  There were 553 injuries reported by Baghdad residents, 225 of which were intentional, and 328 unintentional. For intentional injuries, the fatality rate was 39.1% and the disability rate 56.0%. Gunshots where the major cause of injury through 2006 when blasts/explosions became the most common cause and remained so through 2014. Among unintentional injuries, the fatality rate was 7.3% and the disability rate 77.1%. The major cause of unintentional injuries was falls (131) which have increased dramatically since 2008, followed by traffic related injuries (81), which have steadily increased. The proportion of injuries ending in disabilities remained fairly constant through the survey period.
  
  
  CONCLUSIONS
  Intentional injuries added substantially to the burden of unintentional injuries for the population. For Baghdad, the phases of the Iraqi conflict are reflected in the patterns of injuries and consequent deaths reported. The scale of injuries during conflict is most certainly under-reported. Difficulties recalling injuries in a survey covering 11 years is a limitation, but it is likely that minor injuries were under-reported more than severe injuries. The in- and out-migration of Baghdad populations likely had effects on the events reported which we could not measure or estimate. Damage to the health infrastructure and the flight of health workers may have contributed to mortality and morbidity. Civilian injuries as well as mortality should be measured during conflicts, though not currently done.
authors.affiliation: Al Munstansiriya University, College of Medicine, Baghdad, Iraq.
authors.forename: Riyadh
authors.initials: R
authors.lastname: Lafta
authors.affiliation: Human Development and Training Center, Ministry of Health, Baghdad, Iraq.
authors.forename: Sahar
authors.initials: S
authors.lastname: Al-Shatari
authors.affiliation: The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Megan
authors.initials: M
authors.lastname: Cherewick
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Galway
authors.affiliation: Harborview Injury Prevention and Research Canter, University of Washington, Seattle, Washington, United States of America.
authors.forename: Charles
authors.initials: C
authors.lastname: Mock
authors.affiliation: School of Public Health, University of Washington, Seattle, Washington, United States of America.
authors.forename: Amy
authors.initials: A
authors.lastname: Hagopian
authors.affiliation: School of Public Health, University of Washington, Seattle, Washington, United States of America.
authors.forename: Abraham
authors.initials: A
authors.lastname: Flaxman
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
authors.forename: Tim
authors.initials: T
authors.lastname: Takaro
authors.affiliation: School of Medicine, University of Washington, Seattle, Washington, United States of America.
authors.forename: Anna
authors.initials: A
authors.lastname: Greer
authors.affiliation: The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Adam
authors.initials: A
authors.lastname: Kushner
authors.affiliation: The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Burnham
mesh_terms: D000058:Accidental Falls; D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D003643:Death; D003710:Demography; D006233:Persons with Disabilities; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007223:Infant; D007493:Iraq / Q000453:epidemiology; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries / Q000453:epidemiology*; D055815:Young Adult