Date Published: May 10, 2019
Publisher: Public Library of Science
Author(s): Mohamed A. Daw, Abdallah H. El-Bouzedi, Aghnyia A. Dau, Florian Fischer.
The consequences of armed conflicts impose considerable burdens on the economy and health care services, particularly in countries that are not equipped to deal with them, such as in the Middle-East, and North African countries. Little is known about the burden of mortality and injury resulting from the Libyan armed conflict. This study aimed to determine the trends and patterns of mortality, injury and disabilities directly associated with the Libyan armed conflict and analyze the geographic variation within the country during 2012–2107.
Data on conflict-related deaths, injuries, and disabilities were obtained from the national registry offices. The information included date, place, and demographic information. A questionnaire was also used to obtain information from the affected individuals and their families. National and regional trends of mortality, injury and disabilities were calculated. Spatial analysis was performed using geographic data available on all documented cases to analyze clustering of mortality and injury.
A total of 16,126 deaths and 42,633 injuries were recorded with complete information during the Libyan conflict from 2012 till 2017. The overall mortality rate was 2.7/1000 population and injury rate was 7.1/1000. The overall male-to-female ratio of mortality and injury was 4.4:1; 42.3% were single and aged 20–30 years old, and 26.4% were aged 31–40 years. Moreover, injuries resulted in death in 20.1% of cases and disability in 33.5% of the cases. Most of the disabilities were caused by blasts, while gun shots resulted in more deaths. The overall mortality and injury rates were highest during 2015–2017. These rates were highest in the eastern region. Injuries were most concentrated in Benghazi and Derna in the east, followed by Sert and Musrata in the central region.
Conflict-related mortality, injury and disability has inflicted a heavy burden on the Libyan society that may persist for a long time. The rates of these casualties varied in time and place. National, well-planned efforts are needed to address this serious situation and its consequences.
Many parts of the world are involved in armed conflicts, the most prominent of which are in Arab countries, including Syria, Iraq, Yemen and Libya. Armed conflicts always impose heavy burdens of death, injury and disability . Globally, it has been estimated that in 2013, 800,000 people sustained war-related injuries that warranted hospital admission, and approximately 310,000 people died as a consequence of collective violence [2,3]. This however resulted in over 9% of deaths worldwide with over five million deaths annually . It has been projected that armed conflict will become the eighth most important cause of death by 2020 .
Armed conflicts have heavy, direct and long-lasting impacts, particularly in developing countries, which are ill-equipped to deal with the consequences, and where most wars occur. Armed conflicts are a major cause of mortality, injury and disability, imposing heavy burdens on populations, governments, economies, and health care systems worldwide [23,24]. Documentation of the impact of armed conflict on health is one of the most difficult and most important public health challenges . Injuries and fatalities related directly to the Libyan conflict pose a major challenge to the health care services of the country, in which the already fragile infrastructure has been largely disrupted. Reliable data on the extent, types and geographic distribution of casualties are needed in order to develop rational, targeted health care strategies [26,27].
Though this study attempted to be comprehensive and was based on documented registry data, it might not fully represent the actual situation. First, many cases might not have been reported because of the vast area of the country and the lack of security . Second, as the study lasted for six years, the registration cannot be easily sustained particularly for minor and short cases of injury and disability. Moreover, the study did not highlight the severity of injuries, degrees and duration of disabilities, and whether injured victims had recovered. This may have affected the accuracy of the number of deaths and injuries reported. Fourth, locations were frequently estimated, which could have led to imprecision. Fifth, civilian deaths and injuries are not well illustrated because the use of heavy weapons blocked roads and turned certain urban areas into no-go zones . “We are pursuing this line of research by investigating civilian casualties, and particularly children.”
The Libyan war has inflicted a grave toll on the country’s population and public health system. The overall fatality and injury rates increased from 2012 to 2017, with a peak in 2016. Young men comprised more than 80% of the dead and injured. Analyzing mortality and injury burdens on even narrower geographic scales is important for guiding public health responses and allowing more effective targeting.
The Libyan armed conflict has and will continue to impose heavy burdens on the demography and quality of life of Libyan society. The country faces serious and unprecedented challenges. No single policy can be addressed in a complex and relapsing conflict environment such as Libya [43,44]. Hence, the country should be alerted to deal with such ongoing consequences particularly within the health care settings. The Libyan health care system has to be re-organized to deal with these consequences by adopting short-term and long-term strategies . These may include the following: