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Benjamin Seet, FRCS, MPH; Gilbert M. Burnham, MD, PhD

JAMA. 2000;284:598-603.

Context  The rising number of deaths among United Nations (UN) peacekeeping forces after the Cold War has made some troop-contributing countries hesitant to participate in peacekeeping operations. While the number and scale of missions have increased, no data have demonstrated a parallel increase in risks to peacekeepers.

Objective  To determine the association of characteristics of UN peacekeeping operations with risks and mortality rates among UN peacekeeping forces in both the Cold War and post-Cold War periods.

Design, Setting, and Participants  Descriptive analysis of 1559 personnel deaths during 49 UN peacekeeping missions from 1948-1998 based on the casualty database maintained by Department of Peacekeeping Operations, UN Headquarters.

Main Outcome Measures  Number and percentage of deaths by circumstance, total crude death rate, and crude death rate and relative risk of death by circumstance (hostile acts, unintentional violence, and illness or other causes) and time period (Cold War vs post–Cold War), geographic region, and nature of peacekeeping response; and regression analysis of mission variables (strength, duration, and humanitarian mandate) associated with total number of deaths.

Results  More deaths have occurred among UN peacekeeping forces in the past decade alone than in the previous 40 years of UN peacekeeping (807 vs 752), but crude death rates did not differ significantly by time period (Cold War vs post–Cold War, 21.8 vs 21.2 deaths per 10,000 person-years; P = .58), level of peacekeeping response, or for geographic regions other than East Europe and Central America, where rates were lower (P<.001 for both regions). Unintentional violence accounted for 41.2% of deaths, followed by hostile acts (36.1%), and illness or other causes (22.7%). Deaths from hostile acts increased after the Cold War (relative risk [RR] 1.51; 95% confidence interval [CI], 1.22-1.88), while rates for deaths caused by unintentional violence decreased (RR, 0.79; 95% CI, 0.67-0.94) but remain high, particularly in the Middle East and Asia (RR, 1.39; 95% CI, 1.15-1.69). Regression analysis showed a significant association between number of deaths and the strength (P<.001) and duration (P<.001) of a peacekeeping mission.

Conclusion  The increase in number of deaths among UN peacekeeping personnel since 1990 can be attributed to the increased number and scale of missions after the Cold War rather than increased RR of death. Post–Cold War peacekeeping personnel have a higher risk of dying from hostile acts in missions where more force is required. In missions providing or facilitating humanitarian assistance, both the RR of deaths from all causes and deaths from hostile acts are increased.

Author Affiliations: Center for Refugee and Disaster Studies, Johns Hopkins School of Hygiene and Public Health, Baltimore, Md (Drs Seet and Burnham); Dr Seet was formerly with the Medical Support Unit, Department of Peacekeeping Operations, United Nations.

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