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Iraqi civilians hit hard by suicide bombs

Suicide bombs in Iraq have killed over 12,000 civilians and 200 coalition soldiers between March 2003 and December 2010. The devastating impact of suicide bombs on both Iraqi civilians and coalition troops is detailed in an article by Dr Madelyn Hsiao-Rei Hicks at the Institute of Psychiatry (IoP) at King's College London and colleagues from the Iraq Body Count. 

Documented suicide bomb events caused 19% (42,928 of 225,789) of overall civilian casualties, 26% (30,644 of 117,165) of injured civilians, and 11% (12,284 of 108,624) of civilian deaths. The injured-to-killed ratio for civilians was 2.5 people injured to one person killed from suicide bombs. Suicide bombers on foot caused 43% of documented suicide bomb deaths, while suicide bombers using cars caused 36%. Suicide bombers who used cars caused 40% of civilian injuries.

Dr Hicks, lead author of the study published in the 9/11 special issue of The Lancet says: ‘The over 12,000 deaths that we describe from suicide bombings are sudden, tragic losses to Iraqi families of children, parents and siblings. This leaves families and friends to cope with bereavement, traumatic loss, and perhaps severe social and economic hardship if the family wage-earner is killed, adding to a family's burden of grief.
‘PTSD, other anxiety disorders, and depression are clearly of concern in the survivors and witnesses of these suicide bombings.  However, additional important psychological considerations include bereavement, damage to the social fabric, and the issue of how individuals cope with their vulnerability to being attacked as they go about their necessary day-to-day activities. Suicide bombings also add to the detrimental psychological and educational environment of children living in settings of armed conflict and insecurity.'
Of 3,963 demographically identifiable suicide bomb fatalities, 75% were men, 11% were women, and 14% were children. Children made up a higher proportion of demographically identifiable deaths from suicide bombings than from general armed violence (9%).  The injured-to-killed ratio for all suicide bombings was slightly higher for women than it was for men, but the ratio for children was lower than it was for both women and men, indicating lower survival of children than adults from suicide bombings.

Dr Hicks continues: ‘In addition to those who were killed, we found that over 30,000 Iraqi civilians were physically injured by these suicide bombings.  It has been shown in other research outside of Iraq that traumatic physical injury increases the risk for an individual developing PTSD or depression.  Injured survivors in Iraq are often unable to obtain physical rehabilitation and reconstructive treatment, which further increases their risk for psychiatric disorders and decreases their chances of regaining social function.  The availability of psychiatric treatment in Iraq to address these problems is currently very limited due to the overall shortage of Iraqi physicians, including psychiatrists.’

The authors note that rapid access to adequate hospital treatment is crucial for survival of blast injuries, but such access can be difficult for civilians in Iraq. Survival and recovery of Iraqis injured by suicide bombs could possibly have been worsened by Iraq's severe shortage of adequate emergency rooms, diagnostic equipment, trained paramedics and doctors, senior and specialty surgeons, all needed for complex blast injuries, intensive care units, rehabilitation, and supplies.

The Iraqi civilian population suffers a substantial public health burden because it is a primary chosen target of suicide bombers and those who deploy them. The findings about the likelihood of surviving injuries, which was particularly low for children, will require further study and, according to the authors, draw attention to the need for improved monitoring, prevention, and interventions to reduce mortality from suicide bombs in Iraq.

The Sigrid Rausing Trust and the Joseph Rowntree Charitable Trust supported the expansion of the overall Iraq Body Count (IBC) database. The authors would like to thank IBC volunteers Joshua Dougherty and Kay Williams for their help. 

Full paper: Hicks et al. ‘Casualties in civilians and coalition soldiers from suicide bombings in Iraq, 2003-2010: a descriptive study’, The Lancet, Vol 378 (September 3, 2011) doi:10.1016/S0140-6736(11)61023-4

For more information, please contact Seil Collins, Press Officer at the Institute of Psychiatry, King’s College London, email: tel: 0207 848 5377
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