Civilian pattern of injuries in armed conflicts - a systematic review.

Background: War causes severe suffering and harm to the civilian population. Knowledge about civilian injury patterns constitutes a part of the dimensioned planning and preparedness for medical care and civilian defence in times of war. This systematic review is conducted on request from The Swedish National Board of Health and Welfare and includes civilian injury patterns in modern war.

Methods: The aim of the study is to describe civilian injury patterns in war 1973-2023. We have conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The protocol has been registered 2023-05-06 in PROSPERO (CRD4202321483).

Results: The search resulted in 3455 identified articles. 1226 of those were duplicates. 2229 studies were assessed, and 1817 papers were excluded. 412 papers went through full text assessment resulting in 63 remaining papers. Injuries to the extremities constitutes 50%, followed by head injuries (26%) and injuries to the chest (18%). Notably, 23% of the wounded are children.

Discussion: There is no standardized classification or method to report and describe civilian war injuries and the injury panorama. Variations in how the injuries were reported made synthesis of the results difficult. In the present survey we haven't investigated mortalities and causes of death. Reliable data from recent wars, such as the ongoing war in Ukraine and Gaza, was missing from the open literature.

Conclusions: The distribution of injuries seems comparable with data from World War II and the conflict in Korea. There is no standardized simple protocol to report civilian injuries in war. Ideally, a protocol should include even the severity impact of the injuries. Knowledge of civilian injury pattern and estimate of the total number of wounded is important to plan the civilian health care capabilities in war time.