Dr. Mohsen Rezaeian

Correspondence to:
Dr. Mohsen Rezaeian (PhD, Epidemiologist, Associate Professor)
Social Medicine Department,
Rafsanjan Medical School,
Rafsanjan, Iran.
Tel: +98 391 5234003
Fax: +98 391 5225209
Email: moeygmr2@yahoo.co.uk

 

ABSTRACT According to the statistics in the year 2000, mortality caused by war-related injuries has been estimated to be the 18th leading cause of death in Eastern Mediterranean Region (EMR) of the World Health Organization (WHO), which justifies paying more attention to it. Therefore, this report tries to disclose the different patterns of age and sex groups' mortality rates caused by war-related injuries in the year 2000 within EMR. It also discusses the health impacts of the most recent war within region i.e. the war in Iraq on the above patterns in order to highlights that this war is enormously deteriorated the fragile situations within region. Key words: War, Eastern Mediterranean Region (EMR), Iraq.

The Eastern Mediterranean Region (EMR) is one of the six World Health Organization's (WHO) Regions that in the year 2000, consists of 22 countries including Afghanistan, Bahrain, Cyprus, Djibouti, Egypt, Iraq, Islamic Republic of Iran, Jordan, Kuwait, Lebanon, Libyan Arab Jamahiriya, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, Somalia, Sudan, Syrian Arab Republic, Tunisia, United Arab Emirates and Yemen⁽¹⁾. The region is the cradle of many religions including Islam (that is the faith of the 90% of the people within region), Christianity, Judaism and Zoroastrianism⁽²⁾. For its geopolitical situation and enormous natural resources including oil enormous reservoirs, the region has endured a great deal of wars and armed conflict throughout human history.

As the statistics show, in the year 2000 mortality caused by war-related injuries has been estimated to be the 18th leading cause of death in this region whilst it has been estimated to be the 11th cause of death in African Region (AFR), the 34th in both the European Region (EUR) and South-East Asia Region (SEAR), the 62nd in the American Region (AMR) and the 66th in the Western Pacific Region (WPR) (1). Therefore, on the face of these figures, mortality caused by war-related injuries should be considered as one the most urgent public health problems only within the AFR and EMR.

Since, these aggregate figures may hide dissimilarities that have happened among sexes and age groups, the chief aim of this report is two-fold. The first aim is to disclose the different patterns of age and sex groups' mortality rates caused by war-related injuries in the year 2000 within EMR. It should be noted that such a basic understanding could help to assess the true magnitude of the war problem within the region and to apply efficient measures to prevent, reduce or control it. The second aim of this report is to discuss the health impacts of the most recent war within the region i.e. the war in Iraq, on the above patterns in order to highlight that this war has enormously deteriorated the fragile situations within the region.

I have obtained, plotted and compared different age and sex groups (0-4, 5-14, 15-29, 30-44, 45-59, 60 and above) estimated mortality rates caused by war-related injuries (ICD9 codes E990-E999)⁽³⁾, which have been estimated by the WHO Global Burden of Disease project (GBD) for 2000, version 1⁽⁴⁾ and its aggregated results for WHO regions has been published in the world report on violence and health⁽¹⁾. This version of the GBD has been applied to the statistical modeling, systematic reviews of health service data and epidemiological studies plus extensive analyses of mortality data to produce as fair as possible estimates of mortality caused by war-related injuries⁽⁴⁾.

The resulting plot shows that in all age groups the rates of mortality caused by war-related injuries are higher in males in comparison to females. In both genders the first and the last age groups have higher rates than the other groups. Furthermore, the most high-risk age group among males is the first one (0-4 years) (34.6 per 100,000), which also has the highest rate among all other age and sex groups, and among females is the last one (60 and over) (13.7 per 100000). The least high-risk age group among males is the second one (5-14 years) (4.1 per 100000) and among females is the fourth one (30-44 years) (2 per 100000) (Diagram 1), which also has the lowest rate among all other age and sex groups.

Based on these patterns it seems that within the region, mortality caused by war-related injuries in the year 2000 affected the most vulnerable groups i.e. children and elderly more than the other groups. Although the increased mortality rates among these high risk groups especially infants during armed conflicts have been well documented⁽⁵⁾ in what follows I will try to briefly draw the attention of the readers to the most recent war within the region i.e. the war in Iraq, which has begun in March 2003, mainly by the US and UK led coalition forces. Although this war has happened after the year 2000, its nature and its consequences could help to not only better understand the above observed patterns but also to emphasize on this fact that the vulnerable groups within the region are still dying from war related injuries even in a greater extent compared to the year 2000.

During the past 20 years, the people of Iraq have been caught up in three wars i.e. war with Iran in the 1980s, the Gulf War in 1991 and the US and UK led coalition invasion of Iraq in 2003⁽⁶⁾. Just a year before the third war was started, a report from Medact i.e. a UK based organization of health professionals had warned that a new war on Iraq could produce a humanitarian disaster (7 & 8). Despite this warning, the war begins and we have now realized that the impacts of this recent war on the health situations of Iraqi people are devastating.

In terms of health systems, the quality of state services is poor due to persistent under-funding, poor physical infrastructure, scarcity and mismanagement of supplies, lack of up to date skills and knowledge and staff shortages⁽⁹⁾. For instance, it has been documented that in 2006, of 34,000 physicians registered in Iraq before the 2003 invasion, almost 2000 had been murdered, 250 had been kidnapped and 12,000 had left Iraq⁽¹⁰⁾.

In terms of mortality, the situation is even worth. A survey, which compares mortality in Iraq during the period of 14.6 months before war with 17.8 months after war reveals that more than 100,000 excess deaths have happened in the second period. Air strikes from invaded forces accounted for most of these extra death, which mostly happened among women and children⁽¹¹⁾. Unfortunately, the subsequent survey conducted recently by the same team concluded that the mortality figure has risen to almost 655,000, most of them happen in males due to violence⁽¹²⁾.

Let us compare these extra deaths in Iraq with this estimation by the WHO that globally in the year 2000 nearly 310,000 people died from war related injuries⁽¹⁾. By making this comparison or realizing this fact that these extra deaths are high above the death toll of Hiroshima one comes to this conclusion that this rings a very strong alarm⁽¹³⁾ that this war has turned into a human unjustifiable disaster that has made the already frail situation in EMR even more fragile.

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