Patterns of injury in war surgery - update 2006

According to studies by the Hamburg Working Group on Research into the Causes of War (AKUF), 39 wars and arm conflicts took place worldwide in 2005. Wars reached a peak in 1992 with 55 wars (for comparison, there were 4 wars in 1945). Well over 90 per cent of all wars since 1945 have taken place in the so-called “Third World”. The struggle for power in the state and attempts at secession were and are the most important reasons. These intra-state wars dominate warfare today. They are no longer characterized by positional warfare lasting for months (“trench warfare”) or area bombardments. Small arms (pistols, [machine] guns) are an important element in modern conflicts – globally, they cause 60 to 90 per cent of all direct war victims – along with explosive munitions such as grenades, landmines and improvised explosive devices (IEDs). According to data from media reports and targeted case studies, the number of direct victims of war globally is calculated to be approx. 80,000 to 110,000 per annum since 2003. However, reports from conflict zones often contain only estimates of the dead and wounded and of their patterns of injury that are caused by direct combat actions. From the military and operational surgical aspect, exact epidemiological analyses of these data are of particular interest. Information can be obtained from them of the specialist demands that will be made on the surgical team or individual surgeon and from this the required continuing education concept and the necessary personnel and material infrastructure can be derived.