Modern conflict is increasingly urban, protracted and complex. From the Boston Marathon bombings to Sri Lanka’s Easter Suicide Attacks to the devastation of Homs and Ukraine, explosive violence causes catastrophic harm to civilians, with a disproportionate impact on women and children. This threat is growing - the use of explosive weapons in populated areas (EWIPA) has become the defining feature of 21st-century armed conflict, where improvised explosive devices (IEDs), car and suicide bombing, indiscriminate airstrikes and shellings in populated areas are commonplace. Over the last decade, civilians made up more than 90% of those killed or injured by EWIPA. Civilian infrastructure is destroyed by improvised and factory-made munitions alike, impacting, amongst others, the essential services of healthcare, sanitation, transportation and education. These threats occur in tandem with those of prior fields of battle that are littered with explosive remnants of war and landmines disrupting civilian livelihoods for years to come.
Clinical Challenges
The clinical challenges associated with blast events are innumerable. Civilian blast injury patterns are diverse and devastating, exacerbated by a broad demographic, none of whom are protected by body armour. Many patients with severe wounds die before reaching a health facility. Blast, fragmentation (e.g. shrapnel) and burns that do not kill immediately cause severe injuries that result in life-long reliance on healthcare. Such events overwhelm stressed healthcare systems; especially fragile facilities that lack the resources, capacity or capability to cope. Furthermore, the sequelae of blast injury, including long-term functional disability and psychological trauma (e.g. PTSD), impedes victims’ ability to return to normal life, generating a life-long need for rehabilitative services that are often misunderstood or absent.
Data
Data collection on the harm caused by explosive violence has been constantly raised as a critical issue. Specifically, data disaggregated by gender, disability, age and weapon type. Data collection needs to improve to better support health systems in their preparedness and response.
A Global Priority
EWIPA is a priority issue for the United Nations (UN), where the Irish Government is championing a Political Declaration to protect civilians from EWIPA. The IBRN is informing this consultation process. The UN Institute for Disarmament Research (UNIDIR) has produced a framework for analysing the immediate and long-term impacts of EWIPA, aligned with the UN Sustainable Development Goals, and the International Committee of the Red Cross (ICRC) has designated EWIPA as a key priority and is currently advocating for avoidance policies. These efforts are designed to raise awareness and recommendations for monitoring EWIPA. While such advocacy is critical, it must be substantiated by methodologically rigorous research to inform practical solutions that mitigate harm and nurture sustainable health system improvements.