• Kyle Shaak, Riyadh Lafta, Barclay T Stewart, Thomas R Fowler, Sahar A Esa Al-Shatari, Gilbert Burnham, Megan Cherewick, Sherry M Wren, Reinou S Groen, and Adam L Kushner.
• *Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA †Department of Community Medicine, Al Munstansiriya University, Baghdad, Iraq ‡Department of Surgery, University of Washington, Seattle, WA §School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa ¶Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA ||Human Resources Development and Training Center, Iraq Ministry of Health, Baghdad, Iraq **Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD ††Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD ‡‡Department of Surgery, Stanford School of Medicine, Palo Alto, CA §§Surgeons OverSeas (SOS), New York, NY ¶¶Alaska Native Medical Center, Department of Obstetrics and Gynecology, Anchorage, AK; Surgeons OverSeas (SOS), New York, NY; and Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD ||||Surgeons OverSeas (SOS), New York, NY, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD ***Department of Surgery, Columbia University, New York, NY.
• Ann. Surg. 2017 Feb 1.

ObjectiveTo examine sex differences in injury mechanisms, injury-related death, injury-related disability, and associated financial consequences in Baghdad since the 2003 invasion of Iraq to inform prevention initiatives, health policy, and relief planning.BackgroundReliable estimates of injury burden among civilians during conflict are lacking, particularly among vulnerable subpopulations, such as women.MethodsA 2-stage, cluster randomized, community-based household survey was conducted in May 2014 to determine the civilian burden of injury in Baghdad since 2003. Households were surveyed regarding injury mechanisms, healthcare required, disability, deaths, connection to conflict, and resultant financial hardship.ResultsWe surveyed 900 households (5148 individuals), reporting 553 injuries, 162 (29%) of which were injuries among women. The mean age of injury was higher among women compared with men (34 ± 21.3 vs 27 ± 16.5 years; P < 0.001). More women than men were injured while in the home [104 (64%) vs 82 (21%); P < 0.001]. Fewer women than men died from injuries [11 (6.8%) vs 77 (20%); P < 0.001]; however, women were more likely than men to live with reduced function [101 (63%) vs 192 (49%); P = 0.005]. Of intentional injuries, women had higher rates of injury by shell fragments (41% vs 26%); more men were injured by gunshots [76 (41%) vs 6 (17.6%); P = .011).ConclusionsWomen experienced fewer injuries than men in postinvasion Baghdad, but were more likely to suffer disability after injury. Efforts to improve conditions for injured women should focus on mitigating financial and provisional hardships, providing counseling services, and ensuring access to rehabilitation services.

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