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2005
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20 Nov 2005
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WARFARE
Spiegel PB, Salama P. War and mortality in Kosovo, 1998-99: an epidemiological
testimony. Lancet 355(9222):2204-9, 2000.
BACKGROUND: The total number, rates, and causes of
mortality in Kosovo during the last war remain unclear despite intense
international attention. Understanding mortality that results from modern
warfare, in which 90% of casualties are civilian, and identifying vulnerable
civilian groups, are of critical public-health importance. METHODS: In September
1999 we conducted a two-stage cluster survey among the Kosovar Albanian
population in Kosovo. We collected retrospective mortality data, including cause
of death, for the period of the conflict. FINDINGS: The survey included 1197
households comprising 8605 people. From February, 1998, through June, 1999, 67
(64%) of 105 deaths in the sample population were attributed to war-related
trauma, corresponding to 12,000 (95% CI 5500-18,300) deaths in the total
population. The crude mortality rate increased 2.3 times from the pre-conflict
level to 0.72 per 1000 a month. Mortality rates peaked in April 1999 at 3.25 per
1000 a month, coinciding with an intensification of the Serbian campaign of
"ethnic cleansing". Men of military age (15-49 years) and men 50 years and older
had the highest age-specific mortality rates from war-related trauma. However,
the latter group were more than three times as likely to die of war-related
trauma than were men of military age (relative risk 3.2). INTERPRETATION:
Raising awareness among the international humanitarian community of the
increased risk of mortality from war-related trauma among men of 50 years and
older in some settings is an urgent priority. Establishing evacuation programmes
to assist older people to find refuge may prevent loss of life. Such mortality
data could be used as evidence that governments and military groups have
violated international standards of conduct during warfare.
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