Casualty care in a low-resource conflict setting: injury epidemiology and management among military personnel in Burkina Faso from 2020 to 2024.

Introduction: The Sahel region of Africa has been increasingly affected by terrorist groups; however, little international attention has been received. To address the lack of data on local casualty care in the Sahel, we conducted an analysis of casualties treated at a military hospital in Burkina Faso.

Methods: A retrospective analysis of casualties treated at the largest military hospital in Burkina Faso between 1 January 2020 and 31 December 2024 was conducted. Study participants included military personnel and 'country defence volunteers' with injuries sustained during military and antiterrorism operations. Data were obtained from paper records, including patient charts, hospital registration, anaesthesia logs and operative reports. We analysed injury epidemiology, care processes and early outcomes, then compared these to findings from US casualties during operation enduring freedom (OEF) in Afghanistan.

Results: Of 1392 casualties with conflict-related injuries managed during the study period, the majority (99.7%) were male with a mean age of 29.0 years. Less than 1% (0.2%) arrived within 1-hour postinjury, compared with 65.8% of OEF casualties. The majority (62.8%, n=874) arrived between 12 and 24 hours postinjury. Injury mechanisms included gunshot wound (67.9%, n=945), improvised explosive devices (20.9%, n=291), other explosives (5.0%, n=69) and transport incidents (5.9%, n=82). Extremities were the most common anatomical region of injury. The most common procedure was irrigation and debridement (78.7%, n=1096). Inpatient mortality was 1.9% (n=27).

Conclusions: In this analysis of casualties from a low-resource conflict setting (LRCS) in Burkina Faso, we observed prolonged prehospital times, predominantly isolated soft tissue and extremity injuries, low inpatient mortality and gaps in data availability. Coordinated efforts to standardise casualty data collection in LRCS may hold the potential to improve insight into injury patterns and outcomes in similar environments as well as yield evidence-based opportunities to reduce preventable death.