Conflict-related intentional injuries in Baghdad, Iraq, 2003–2014: A modeling study and proposed method for calculating burden of injury in conflict

• Published in: PLoS medicine Vol. 18; no. 8; p. e1003673
• Main Authors: Jensen, Guy W, Lafta, Riyadh, Burnham, Gilbert, Hagopian, Amy, Simon, Noah, Flaxman, Abraham D
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 05.08.2021; Public Library of Science (PLoS)
• Subjects: Age; Biology and Life Sciences; Data collection; Datasets; Disability; Economic aspects; Fatalities; Households; Injuries; Life expectancy; Life span; Long-term effects; Medicine and Health Sciences; Methods; Mortality; People and Places; Population; Questionnaires; Social aspects; War; War wounds; Iraq; Baghdad Iraq
• ISSN: 1549-1676; 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1003673

Previous research has focused on the mortality associated with armed conflict as the primary measure of the population health effects of war. However, mortality only demonstrates part of the burden placed on a population by conflict. Injuries and resultant disabilities also have long-term effects on a population and are not accounted for in estimates that focus solely on mortality. Our aim was to demonstrate a new method to describe the effects of both lives lost, and years of disability generated by a given conflict, with data from the US-led 2003 invasion and subsequent occupation of Iraq. Our data come from interviews conducted in 2014 in 900 Baghdad households containing 5,148 persons. The average household size was 5.72 persons. The majority of the population (55.8%) were between the ages of 19 and 60. Household composition was evenly divided between males and females. Household sample collection was based on methodology previously designed for surveying households in war zones. Survey questions were answered by the head of household or senior adult present. The questions included year the injury occurred, the mechanism of injury, the body parts injured, whether injury resulted in disability and, if so, the length of disability. In this study, we propose a methodology to perform burden of disease calculations for conflict-related injuries (expressed in DALYs) in Baghdad from 2003 to 2014. We go beyond previous reports of simple mortality to assess long-term population health effects of conflict-related intentional injuries. Ongoing disability is, in cross section, a relatively small 10% of the total burden. Yet, this small proportion creates years of demands on the health system, persistent limitations in earning capacity, and continuing burdens of care provision on family members.