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dc.contributor.authorHeszlein-Lossius, Hanne Edøy
dc.contributor.authorAl-Borno, Yahya
dc.contributor.authorShaqqoura, Samar
dc.contributor.authorSkaik, Nashwa
dc.contributor.authorMelvær, Giil Lasse
dc.contributor.authorGilbert, Mads
dc.date.accessioned2019-08-29T08:05:20Z
dc.date.available2019-08-29T08:05:20Z
dc.date.issued2019-01-14
dc.description.abstract<i>Background</i> - Little data exist to describe the use and medical consequences of drone strikes on civilian populations in war and conflict zones. Gaza is a landstrip within the Palestinian territories and the home of 2 million people. The median age in Gaza is 17·2 years and almost half of the population is below the age of 14 years. We studied the prevalence and severity of extremity amputation injuries caused by drone strikes compared with those caused by other explosive weapons among patients with amputations attending the main physical prosthesis and rehabilitation centre in Gaza.<p> <p><i>Methods</i> - In this retrospective cross-sectional study, we recruited patients from the Artificial Limb and Polio Centre (ALPC) in Gaza city in the Gaza strip with conflict-related traumatic extremity amputations. Patients were eligible if they had one or more amputations sustained during a military incursion in Gaza during 2006–16 and had an available patient record. Each patient completed a self-reporting questionnaire of the time and mechanism of injury, subsequent surgeries, comorbidities, and their socioeconomic status, and we collected each patient's medical history, recorded the anatomical location of their amputation or amputations, and interviewed each patient to obtain a detailed description of the incursion or incursions that led to their amputation injury. We classified the severity of amputations and number of subsequent surgeries on ordinal scales and then we determined the associations between these outcomes and the mechanism of explosive weapon delivery (drone strike vs other) using ordinal logistical regression.<p> <p><i>Findings</i> - We collected data on 254 patients from APLC who had sustained an amputation injury. Of these patients, 234 (92%) were male and 43 (17%) were aged 18 years or younger at the time of injury. The age of participants was representative of the Gaza population, with a median age at inclusion was 28 years (IQR 23–33), and the median age at the time of injury was 23 years (IQR 20–29). 136 (54%) amputation injuries were caused by explosive weapons delivered by drone strikes, with explosives delivered by tanks being the next most common source of amputation injury (28 [11%]). Adjusted for age and sex, drone-delivered weapons caused significantly more severe injuries than explosives delivered by other mechanisms (eg, military jet airplanes, helicopters, tank shelling, and naval artillery; odds ratio [OR] 2·50, 95% CI 1·52–4·11; p=0·0003). Compared with all other types of weapons, the patients whose injuries were caused by drone strikes needed significantly more subsequent surgical operations to treat their amputation injuries than those injured by other weapons (OR 1·93, 1·19–3·14; p=0·008).<p> <p><i>Interpretation</i> - Drone strikes were the most commonly reported cause of amputation injury in our study population and were associated with more severe injuries and more additional surgeries than injuries caused by other explosive weapons. Limitations of our study include the self-reported nature of the mechanism of injury and number of subsequent surgeries and selection bias from not incorporating amputation injuries from individuals who died immediately or due to complications. The increasing use of drones needs to be addressed, rather than passively accepted, by the international community. This study fills a gap in our knowledge of the civilian consequences of modern warfare and we believe it is also relevant to the growing populations that are being exposed to drone warfare and for health-care personnel treating these people.en_US
dc.descriptionSource at <a href=https://doi.org/10.1016/S2542-5196(18)30265-1>https://doi.org/10.1016/S2542-5196(18)30265-1. </a>en_US
dc.identifier.citationHeszlein-Lossius, H.E., Al-Borno, Y., Shaqqoura, S., Skaik, N., Giil, L.M. & Gilbert, M. (2019). Traumatic amputations caused by drone attacks in the local population in Gaza: a retrospective cross-sectional study. <i>The Lancet Planetary Health, 3</i>(1), e40-e47. https://doi.org/10.1016/S2542-5196(18)30265-1en_US
dc.identifier.cristinIDFRIDAID 1691379
dc.identifier.doi10.1016/S2542-5196(18)30265-1
dc.identifier.issn2542-5196
dc.identifier.urihttps://hdl.handle.net/10037/16030
dc.language.isoengen_US
dc.publisherElsevieren_US
dc.relation.ispartofHeszlein-Lossius, H.E. (2019). Life after war-related extremity amputations. A retrospective, descriptive clinical follow-up study from Gaza, occupied Palestine. (Doctoral thesis). <a href=https://hdl.handle.net/10037/16053>https://hdl.handle.net/10037/16053. </a>
dc.relation.journalThe Lancet Planetary Health
dc.rights.accessRightsopenAccessen_US
dc.subjectVDP::Medical disciplines: 700::Clinical medical disciplines: 750::Traumatology: 783en_US
dc.subjectVDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Traumatologi: 783en_US
dc.titleTraumatic amputations caused by drone attacks in the local population in Gaza: a retrospective cross-sectional studyen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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