Pediatric injury during conflict and prolonged insecurity in Iraq from 2003–2014

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Injury disproportionately affects low- and middle-income countries, and in Iraq, this risk has been compounded by conflict and insecurity since the Coalition invasion in 2003. Children in such settings are particularly vulnerable; yet, the epidemiology of pediatric injury during conflict has not been previously described. This study aimed to characterize the pattern and outcomes of pediatric injury in Baghdad, Iraq from 2003–2014.


We conducted a cluster-randomized, cross-sectional, community-based survey in Baghdad in 2014 to determine the epidemiology and impact of injuries since 2003. This study details the injury patterns and outcomes among children (ie, <18 years of age) as well as care sought and provided.


A total of 900 households, which represented 5,148 persons, were surveyed. There were 152 pediatric injuries from 2003–2014 (28% of all injuries). The incidence of childhood injury during the study period was 6.5 per 1,000 life years. The most common cause of injury was fall (52 injuries; 34% of pediatric injuries) followed by road traffic crash (32; 22%). Fifteen percent of pediatric injuries were directly related to conflict (22 injuries). There were 10 reported deaths (7% of pediatric injuries).


Although falls and road traffic crashes were the most common causes of childhood injury, conflict was directly responsible for 1 in 6 injuries. The number of pediatric injuries that resulted in death far exceeded that of low- and middle-income countries unaffected by conflict. These findings reflect the importance of pediatric injury prevention, protection of vulnerable populations, and essential trauma care during conflict.

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