Mortality from Landmines and Explosive Hazards: Findings from a Global Epidemiological Analysis

Introduction: Explosive hazards like landmines are known to contaminate over sixty countries and continue to threaten the health of affected communities across generations. The current study is the first to consider the impact of landmines and explosive remnants of war by drawing on global casualty data to determine mortality patterns. Method: This study is a retrospective analysis of secondary multi-source data on over 100,000 explosive hazard casualties from 17 low and middle income conflict-affected countries. This data was collected from mine action centers, international non-governmental organizations, and international bodies (e.g., United Nations), and include surveillance data, retrospective and prospective survey, and data collected through organizational operations. Results: The global case fatality rate was 38.8 deaths per 100 casualties. Males represented 87.4% (n = 34,642) of those killed, however females had higher odds of death when involved in an explosive incident (OR = 1.29, 95% CI: 1.24 – 1.34, p < 0.01). Adults experienced higher odds of death compared to children (OR = 1.60 95% CI: 1.55 – 1.64, p < 0.01). Case fatality ranged between countries with Lao PDR, Angola and Ukraine the countries with the highest proportion of deaths. Improvised explosive devices (IEDs) and ERW had higher odds of death compared to antipersonnel landmines (OR = 1.78, 95% CI: 1.67 – 1.91, p < 0.01; OR = 1.55, 95% CI: 1.50 – 1.60, p < 0.01). Conclusion: Mortality from landmines and other explosive hazards remains a public health issue in conflict impacted countries. This study addresses the lacunae of global data for explosive hazard casualties and provides an understanding of how fatal injury is endured. Adult males represent the most deaths globally, however case fatality ranges across conflicts. ERW and IED had the highest risk of death. These findings underscore the need for a global health response and strengthen advocacy measures for conflict affected communities as well as weapons prohibition campaigns.