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Epidemiology of Injuries and Deaths From Landmines and Unexploded Ordnance in Chechnya, 1994 Through 2005
To the Editor: Due to more than a decade of armed conflict and civil unrest, Chechnya is among the settings most affected by landmines and unexploded ordnance worldwide.1 We undertook this study to assess the magnitude and describe epidemiologic patterns of injuries and deaths due to landmines and unexploded ordnance in Chechnya.
Methods
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We obtained data on landmine and unexploded ordnance injuries in Chechnya from 1994 through 2005 from the United Nations Children's Fund and Voice of the Mountains, a Chechen nongovernmental organization.
In October of 2000, Voice of the Mountains in collaboration with the United Nations Children's Fund began collecting data on injuries that occurred since 1994 and on new injuries. Injury reports were obtained from a variety of sources, including the International Committee of the Red Cross, local nongovernmental organizations, district administrations, district health facilities, and local police stations. Deaths were attributed to injuries only if they occurred within 1 month of the event. Using the reported address, trained nongovernmental organization staff interviewed the injured person or the family of a person who had died, verifying the information obtained from reporting organizations. The Information Management System for Mine Action2 form, which conforms to the standard questionnaire of the World Health Organization,3 was used for data collection. Only data on civilian noncombatants were included in the database. We used results of the official population census conducted in Chechnya in October of 20024 (1.08 million inhabitants), which reportedly included refugees and internally displaced persons, as a denominator to calculate injury rates. Statistical analyses were performed using JMP software version 5.0 (SAS Institute Inc, Cary, NC). The Institutional Review Board of the Centers for Disease Control and Prevention exempted this study from review.
Results
The database included information on 3021 individuals injured or killed by landmines or unexploded ordnance. The largest number of injuries occurred during 2000 and 2001 (716 and 640, respectively), resulting in population injury rates of 6.6 per 10 000 per year in 2000 and 5.9 per 10 000 per year in 2001. Injury rates in 1999 and 2002 were also high, 3.4 and 4.0 per 10 000 per year, respectively. Injury rates in 2003, 2004, and 2005 were 1.9, 0.9, and 0.2 per 10 000 per year, respectively.
Overall, 81% of reported injuries were in males, and 26% were in children under 18 years of age. Of those injured, 23% died as a result of the accident. Children were more likely to be injured by unexploded ordnance and to sustain upper body injury and upper limb amputations compared with adults (Table). Most injuries that occurred while the person was traveling or performing activities of economic necessity (farming; tending animals; collecting wood, food, or water) were caused by landmines, while most injuries that occurred while the person was playing near an explosive device or tampering with it were caused by unexploded ordnance.
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Table. Distributions of Injuries and Deaths Due to Landmines and Unexploded Ordnance in Chechnya, 1994 Through 2005, by Age Group (N = 3021)*
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Comment
This study shows that over the past decade, the civilian population in Chechnya experienced rates of landmine and unexploded ordnance injuries several times higher than those reported for the same period from other highly affected regions. Rates of injury reported from Chechnya, Afghanistan, Angola, and Cambodia in 2000 were approximately 6.6, 0.5, 0.7 and 0.6 per 10 000 per year, respectively.1
A higher proportion of children in Chechnya were injured by unexploded ordnance compared with adults, as in Afghanistan,5 Bosnia, and Herzegovina.6 Because unexploded ordnance are usually more visible than landmines, these injuries may be more amenable to prevention through targeted educational messages.
Although injury rates in Chechnya have been decreasing since 2002,the threat may rise as the security situation improves and population movement and economic activity increases. Therefore, identification and marking of dangerous areas followed by substantial mine clearance efforts are urgently needed. If troops are withdrawn, it will be critical to clear minefields that were originally laid to protect military encampments, checkpoints, and other military objects.
Author Contributions: Dr Bilukha had full access to all of the data and takes responsibility for the integrity and accuracy of the data analysis.
Study concept and design: Bilukha, Anderson, Brennan.
Acquisition of data: Tsitsaev, Ibragimov, Murtazaeva.
Analysis and interpretation of data: Bilukha, Tsitsaev, Anderson, Brennan.
Drafting the manuscript: Bilukha, Anderson, Brennan.
Critical revision of the manuscript for important intellectual content: Bilukha, Tsitsaev, Ibragimov, Anderson, Brennan, Murtazaeva.
Statistical analysis: Bilukha, Anderson, Brennan.
Administrative, technical or material support: Bilukha, Tsitsaev, Ibragimov, Anderson, Murtazaeva.
Study supervision: Bilukha.
Financial Disclosures: None reported.
Funding/Support: No additional funding was reported.
Acknowledgement: We thank the United Nations Children's Fund for providing the data on individuals who were injured or killed by landmines and unexploded ordnance in Chechnya.
Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention and the United Nations Children's Fund.
Oleg O. Bilukha, MD, PhD
obilukha1{at}cdc.gov
International Emergency and Refugee Health Branch
Division of Emergency and Environmental Health Services
National Center for Environmental Health
Centers for Disease Control and Prevention
Atlanta, Ga
Zaur Tsitsaev, BS
United Nations Children's Fund
Nazran, Republic of Ingushetia, Russian Federation
Ramzan Ibragimov, BS
Voice of the Mountains Non-Governmental Organization
Grozny, Republic of Chechnya, Russian Federation
Mark Anderson, MD, MPH;
Muireann Brennan, MD, MPH
International Emergency and Refugee Health Branch
Division of Emergency and Environmental Health Services
National Center for Environmental Health
Centers for Disease Control and Prevention
Eliza Murtazaeva, BS
United Nations Children's Fund
1. International Campaign to Ban Landmines. Landmine Monitor Report 2002: Toward a Mine-Free World. New York, NY: Human Rights Watch; 2002.
2. Geneva International Centre for Humanitarian Demining. Information Management System for Mine Action. http://www.gichd.ch/1225.0.html. Accessed June 17, 2006.3. World Health Organization. Guidance for Surveillance of Injuries Due to Landmines and Unexploded Ordnance. Geneva, Switzerland: World Health Organization; 2000.4. Aliev T. Census shows rise in Chechnya inhabitants. The St. Petersburg Times. October 22, 2002. http://www.sptimes.ru/index.php?action_id=2&story_id=8427. Accessed May 17, 2006.5. Bilukha OO, Brennan M, Woodruff B. Death and injury from landmines and unexploded ordnance in Afghanistan. JAMA. 2003;290:650-653.
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6. Kinra S, Black ME. Landmine related injuries in children of Bosnia and Herzegovina 1991-2000: comparison with adults. J Epidemiol Community Health. 2003;57:264-265.
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Letters Section Editor: Robert M. Golub, MD, Senior Editor.
JAMA. 2006;296:516-518.
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