Elsevier

The Lancet

Volume 378, Issue 9794, 3–9 September 2011, Pages 906-914
The Lancet

Articles
Casualties in civilians and coalition soldiers from suicide bombings in Iraq, 2003–10: a descriptive study

https://doi.org/10.1016/S0140-6736(11)61023-4Get rights and content

Summary

Background

Suicide bombs in Iraq are a major public health problem. We aimed to describe documented casualties from suicide bombs in Iraq during 2003–10 in Iraqi civilians and coalition soldiers.

Methods

In this descriptive study, we 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. We analysed deaths and injuries over time, by bomb subtype and victim demographics.

Findings

In 2003–10, 1003 documented suicide bomb events caused 19% (42 928 of 225 789) of all Iraqi civilian casualties in our dataset, 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% (5314 of 12 284) of documented suicide bomb deaths. Suicide bombers who used cars caused 40% (12 224 of 30 644) of civilian injuries. Of 3963 demographically identifiable suicide bomb fatalities, 2981 (75%) were men, 428 (11%) were women, and 554 (14%) were children. Children made up a higher proportion of demographically identifiable deaths from suicide bombings than from general armed violence (9%, 3669 of 40 276 deaths; p<0·0001). The injured-to-killed ratio for all suicide bombings was slightly higher for women than it was for men (p=0·02), but the ratio for children was lower than it was for both women (p<0·0001) and men (p=0·0002). 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 (12 vs 3; p=0·004).

Interpretation

Suicide bombers in Iraq kill significantly more Iraqi civilians than coalition soldiers. Among civilians, children are more likely to die than adults when injured by suicide bombs.

Funding

None.

Introduction

Analysis of deaths and injuries in the civilian population from a weapon improves understanding of its effect on public health and vulnerable demographic subgroups.1, 2, 3, 4 Inclusion of combatant casualties increases understanding of a weapon's effect and use in the context of armed conflict.2, 3 Findings from a study of suicide bomb attacks from 1980 to 2003 showed suicide bombing to be the deadliest form of terrorism used internationally,5 killing an average of 12 victims per attack, not including deaths from the suicide attack on the World Trade Center in New York, USA, on Sept 11, 2001.5 Suicide bombing in Iraq since 2003 has been described as the mass-destruction weapon of sectarian and insurgent combatants.6, 7, 8 In 2009, we analysed Iraqi civilian deaths from armed violence and showed that nearly 9000 Iraqi civilians were killed in 725 suicide bomb attacks during 2003–08.9 In a subsequent study of violent deaths of Iraqi civilians in 2003–08, we showed that suicide bombers attacking so-called soft, civilian targets killed, on average, 19 civilians per lethal attack—the highest death rate for any weapons used in the war. By contrast, suicide bombers attacking so-called hard, coalition-associated targets (eg, Iraqi security forces) killed eight civilians per lethal attack.1

In this Article, we analyse suicide bombings in Iraq in more detail from 2003 to 2010, expanding our analysis to include suicide bomb subtypes, civilian injuries, and coalition soldier deaths. Our specific aims were to analyse Iraqi civilian deaths and injuries documented from suicide bombs and bomb subtypes, distribution of casualties over time and demographic group, the lethality of suicide bombings with injured-to-killed ratios (ie, the number of individuals injured for every fatality),10 percent killed in those wounded or killed,11, 12 deaths generated per event,11 the proportion of children in demographically identifiable deaths, and documented deaths of coalition soldiers from suicide bombs in Iraq, with comparison to Iraqi civilians.

Section snippets

Data collection for Iraqi civilian casualties

The Iraq Body Count13 (IBC) database was prospectively developed by HD and JAS to document and collate all reported deaths of Iraqi civilians from armed violence beginning from the first day of the Iraq war on March 20, 2003. On a daily basis, the IBC systematically identifies reports of armed violence in Iraq that directly results in civilian deaths with search engines and subscription-based press and media collation services (mainly, LexisNexis, Reed Elsevier, London, UK) to scan reports from

Results

Table 1 shows documented Iraqi civilian casualties from suicide bombs, subtypes of suicide bomb, and all forms of armed violence (including suicide bombs) that occurred in Iraq between March 20, 2003, and Dec 31, 2010, in the IBC dataset. Of the total documented civilian casualties from armed violence in Iraq during 8 years of armed conflict, suicide bombs caused 19% (42 928 of 225 789) of all Iraqi civilian casualties, 26% (30 644 of 117 165) of injured civilians, and 11% (12 284 of 108 624)

Discussion

Our findings show a substantial direct public health effect from suicide bombings in Iraq from March 20, 2003, to Dec 31, 2010. In these 8 years, 12 284 Iraqi civilians were documented killed and 30 644 injured in more than 1000 suicide bomb attacks, which caused one-tenth of civilian deaths and one-quarter of civilian injuries documented from armed violence in our dataset. Other studies20 have shown that civilians with suicide bomb injuries, compared with civilians with non-conflict-related

References (33)

  • P Webster

    Reconstruction efforts in Iraq failing health care

    Lancet

    (2009)
  • MH Hicks et al.

    Violent deaths of Iraqi civilians, 2003–2008: analysis by perpetrator, weapon, time, and location

    PLoS Med

    (2011)
  • RM Coupland et al.

    Mortality associated with use of weapons in armed conflicts, wartime atrocities, and civilian mass shootings: literature review

    BMJ

    (1999)
  • CJL Murray et al.

    Armed conflict as a public health problem

    BMJ

    (2002)
  • World report on violence and health

    (2002)
  • RA Pape

    Dying to win: the strategic logic of suicide terrorism

    (2005)
  • D Gambetta

    Epilogue to the paperback edition

  • MM Hafez

    Suicide bombers in Iraq: the strategy and ideology of martyrdom

    (2007)
  • AS Hashim

    Insurgency and counter-insurgency in Iraq

    (2006)
  • MH Hicks et al.

    The weapons that kill civilians—deaths of children and noncombatants in Iraq, 2003–2008

    N Engl J Med

    (2009)
  • MS Goldberg

    Deaths and injury rates of US military personnel in Iraq

    Military Med

    (2010)
  • RF Bellamy et al.

    Assessing the effectiveness of conventional weapons

  • N Taback et al.

    Towards collation and modeling of the global cost of armed violence on civilians

    Med Confl Surviv

    (2005)
  • Documented civilian deaths from violence

  • H Dardagan et al.

    Iraq body count: a dossier of civilian casualties 2003–2005

  • Convention on the rights of the child

  • Cited by (50)

    • Pediatric casualties in contemporary armed conflict: A systematic review to inform standardized reporting

      2021, Injury
      Citation Excerpt :

      Children may also sustain different injury patterns than adults, particularly when injured by unexploded ordinance, improvised explosive devices, and land mines [11]. Children are reported to be more likely to sustain head and chest injuries, which have been associated with increased injury severity and mortality rates compared to adults [6,12–16]. Lower extremity injuries are also reported to be more frequent among children, and to more commonly result in amputation and reconstructive needs compared to similar injuries in adults [17,18].

    • Suicide bomber

      2016, Ciottone's Disaster Medicine
    • Childhood casualties during civil war: Syrian experience

      2015, Journal of Forensic and Legal Medicine
      Citation Excerpt :

      Studies on casualties of Iraq War which started in 2003 showed civil casualties were far higher than military deaths. Most of the civilians were killed by bombing from air attacks and suicide bombers.11–13 In this study injuries were distributed mostly as multiple part and head injuries, death was mostly caused by bombing with shrapnel injuries.

    View all citing articles on Scopus
    View full text