Press Release 19 As part of its special issue, 9/11: ten years on , British medical journal The Lancet has published a study on the impact of suicide bombs on Coalition forces and Iraqi civilians, with the latter based on IBC data. This represents the third IBC-based study to appear in medical journals since 2009 (the previous studies appeared in NEJM and PLoS Medicine), amidst growing recognition of the contribution that detailed data can make to a more acute understanding of the human toll of conflict.

Casualties of suicide bombings in Iraq, 2003-2010

Iraq Body Count data in new study in The Lancet shows huge and disproportionate toll on Iraqi civilians

A new study, Casualties in civilians and coalition soldiers from suicide bombings in Iraq, 2003—10 (free access) published Sep 3 2011 in the British medical journal The Lancet provides the first detailed account of the impact of suicide bombs in Iraq since the 2003 invasion of Iraq.

The study reveals that at least 1003 suicide bombings caused civilian casualties in Iraq from 2003 to 2010. Despite their high frequency and devastating impact, this is the first time that their effects have been rigorously examined in their own right.

For the first time, researchers describe the impact of suicide bombs on both Coalition military forces and Iraqi civilians. They found that that the disparity between the numbers killed has been vastly different between the two cases, with 60 times as many civilians killed as soldiers (12,284 vs. 200). This disparity is extreme by any standard, and evidence that civilians are not just the "collateral damage" of suicide bombers in Iraq but an intended target.

The findings in this study were made possible thanks to an analysis comparing detailed, weapon-associated deaths as found largely in two separate databases, the Iraq Coalition Casualty Count (for Coalition forces) and Iraq Body Count (for Iraqi civilians), allowing a specific focus on suicide bombings.

Other notable findings include that:

Suicide bombs have injured no fewer than 30,644 Iraqi civilians.

This is particularly concerning as suicide bomb injuries tend to be the terrible injuries typical of blast wounds: injuries that cause damage to multiple internal organs, bone fractures, burns, eye injuries often leading to blindness, parts of missing limbs or treatment that requires amputation, and multiple penetrating wounds from embedded fragments of metal, wood, and even pieces of the bomber.

Moreover, these severe and complex injuries typically require complex treatment and later physical rehabilitation, which is unavailable to many Iraqis, so their chances of later dying or being disabled or disfigured by their injuries is substantial. The implied clinical impact of this finding on the number of injured is alarming, particularly in view of Iraq's ongoing shortage of doctors and medical supplies.

Children are less likely to survive their suicide bomb injuries than adults.

For example, if a suicide bomber in a car detonates in a marketplace, the children who are injured are more likely to die of their injuries than the adults (i.e. civilians are highly vulnerable to suicide bombs, and children more so). Reviews of the medical literature indicate that lower survival of children than adults from wounds has been found in small clinical studies (e.g. from gunshot wounds) and from clinical observations by surgeons. But this has not been shown, prior to this study, for suicide bomb injuries specifically, or for wounds from armed violence using a substantial dataset.

Many of the treatments for children who survive a traumatic injury (e.g. a suicide bomb injury) must be specialized for children. In Iraq's healthcare system, which is starved of resources, this more highly specialized care and equipment is particularly hard to get.

For a another summary of the full study, please see Lancet's press release below:

The Lancet: Suicide bombs in Iraq have killed at least 12,000 civilians and 200 coalition soldiers between 2003 and 2010

The devastating impact of suicide bombs on both Iraqi civilians and coalition troops is detailed in an Article in this week’s 9/11 special issue of The Lancet. The Article is by Dr Madelyn Hsiao-Rei Hicks, Institute of Psychiatry, King’s College London, UK, and Iraq Body Count, London, UK, and colleagues.

The researchers analysed and compared suicide bomb casualties in Iraq that were documented in two datasets covering March 20, 2003, to Dec 31, 2010—one reporting coalition-soldier deaths from suicide bombs, the other reporting deaths and injuries of Iraqi civilians from armed violence. Documented suicide bomb events caused 19% (42 928 of 225 789) of overall civilian casualties, 26% (30 644 of 117 165) of injured civilians, and 11% (12 284 of 108 624) of civilian deaths. The injured-to-killed ratio for civilians was 2·5 people injured to one person killed from suicide bombs. Suicide bombers on foot caused 43% of documented suicide bomb deaths, while suicide bombers using cars caused 36%. Suicide bombers who used cars caused 40% of civilian injuries.

Of 3963 demographically identifiable suicide bomb fatalities, 75% were men, 11% were women, and 14% were children. Children made up a higher proportion of demographically identifiable deaths from suicide bombings than from general armed violence (9%). The injured-to-killed ratio for all suicide bombings was slightly higher for women than it was for men, but the ratio for children was lower than it was for both women and men, indicating lower survival of children than adults from suicide bombings. An Iraqi child died in at least 159 (16%) of 1003 suicide bombing events recorded, and the death of a woman or child in occurred in at least 211 (21%) of 1003 bombing events. Police officers, an occupational category overlapping with the demographic category of men and to a small extent women, constituted 14% of documented civilian deaths.

200 coalition soldiers were killed in 79 suicide bomb events during 2003–10. More Iraqi civilians per lethal event were killed than were coalition soldiers. These were recorded as follows: 175 US soldiers killed in 76 events, 16 Italian soldiers killed in one event, three British soldiers killed in one event, and four Bulgarian and two Thai soldiers killed in one event.

The authors say: “Rapid access to adequate hospital treatment is crucial for survival of blast injuries, but such access can be difficult for civilians in Iraq. Survival and recovery of Iraqis injured by suicide bombs could possibly have been worsened by Iraq’s severe shortage of adequate emergency rooms, diagnostic equipment, trained paramedics and doctors, senior and specialty surgeons needed for complex blast injuries, intensive care units, rehabilitation, and supplies.”

They conclude: “Our findings suggest that the Iraqi civilian population suffers a substantial public health burden because it is a primary chosen target of suicide bombers and those who deploy them… Our findings about the likelihood of surviving injuries, which was particularly low for children recorded in our dataset, need further study and draw attention to the need for improved monitoring, prevention, and interventions to reduce mortality from suicide bombs in Iraq.”