K. Chawla1, E. Habermann2, D. Jenkins3, A. L. Kushner4,5,6 1Mayo Medical School,Rochester, MN, USA 2Mayo Clinic,Robert D. And Patricia E. Kern Center For The Science Of Health Care Delivery,Rochester, MN, USA 3Mayo Clinic,Division Of Trauma, Critical Care And General Surgery,Rochester, MN, USA 4Johns Hopkins Bloomberg School Of Public Health,Department Of International Health,Baltimore, MD, USA 5Columbia University College Of Physicians And Surgeons,Department Of Surgery,New York, NY, USA 6SurgeonsOverSeas,New York, NY, USA
Introduction: Cluster munitions (CM) are weapons of war that consist of multiple explodable subunits. Undetonated subunits frequently cause death and injury in civilians, mostly women and children. An international treaty banning the use of CM went into force in 2010; despite this, their use, though decreased, still continues. The goal of this study was to identify countries where civilians were most at risk of CM injuries and review the medical literature on CM as compared to research on landmine injuries.
Methods: Data on CM injuries were obtained from the Cluster Munition Monitor database. Health care per capita data were obtained from the World Bank. Development and gender indices were obtained from the United Nations Human Development Reports. Two reviews of PubMed were conducted in August 2015, one using the search terms ‘cluster munitions’ and the other ‘landmines.’
Results:Although global casualty estimates are as high as 55,000 for CM, from the 1960s through 2013, only a total of 19,419 CM casualties were documented. Approximately, 94% were civilian victims. In 2013, casualties from CM remnants were reported in ten countries: Cambodia, Croatia, Iraq, Lao PDR, Lebanon, South Sudan, Sudan, Syria and Vietnam, and Western Sahara. A majority of the victims have been documented in four countries (Table 1). The literature review revealed only 10 papers on CM with the first written in 2003. Only 5 were research papers, the others were commentaries. For landmines, there were a total of 106 papers of which 38 were research papers dating back to the 1980s.
Conclusion:Despite an international treaty banning the use of CM, injuries to civilians commonly occur. The countries with the highest numbers of casualties have few health resources to care for their population and thus would benefit from improved surgical capacity. Unlike landmines, little research on CM injuries is described in the literature. Academic surgeons can contribute by: 1) joining with colleagues in affected countries to undertake research, and 2) raise awareness on the need to improve surgical and rehabilitation capabilities for injured victims located mostly in low-resource countries.
