armed conflict epidemiology methodology spatial

To address this gap, we systematically reviewed the literature to identify records that described injuries sustained by civilians and local combatants in twenty-first century armed conflict. As there is no centralized trauma registry to provide insight into the needs of these patients, few data exist to guide resource allocation and quality improvement programming. Like civilians, local combatants from poorly resourced militaries are often unprotected by body armor and may seek care from a similar assortment of health-care facilities. Whereas coalition military forces are almost exclusively young and healthy, civilians wounded in conflict include young and elderly patients, pregnant females, and individuals with preexisting comorbidities. The injuries of US and NATO military personnel are likely different from those sustained by civilians and local combatants. Injury patterns among these individuals have not been systematically characterized, and currently available data are inadequate to inform the planning and organization of trauma systems capable of addressing the unmet needs of this population. However, in contrast to data regarding wartime injuries among US, North Atlantic Treaty Organization (NATO) and coalition military personnel detailed by the Department of Defense Trauma Registry (DODTR), the epidemiology of injuries sustained by civilians and local combatants is incompletely understood. Advances in military and civilian trauma care have been possible largely because of quality improvement programs that rely on systematic data collection. However, planning and maintaining trauma systems requires an understanding of target population needs as well as resource constraints. Organized trauma systems reduce preventable death and disability. During active conflict, organized health systems often break down or become impaired, leaving wounded civilians to rely on care provided by an uncoordinated, ad hoc patchwork of actors including local hospitals and international humanitarian non-governmental organizations (NGOs) that are rarely able to meet the needs of affected populations. Substantial loss of civilian lives has resulted, both directly by violence and indirectly by incapacitation of fragile civil, safety, and health infrastructure.

Contemporary conflicts such as those in Syria, Yemen, and Libya are characterized by protracted fighting in civilian centers and have been refractory to typical de-escalation strategies. Civilians are increasingly vulnerable to injury on the modern battlefield.

Armed conflict epidemiology methodology spatial