UMass Chan Medical School Faculty Publications

UMMS Affiliation

Department of Psychiatry

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Document Type



Adolescent; Adult; Cause of Death; Child; Child, Preschool; Delivery of Health Care; Female; Humans; Infant; Male; *Public Health; Quality of Health Care; Syria; Vulnerable Populations; *Warfare; Weapons; Wounds and Injuries


Epidemiology | Human Rights Law | International Humanitarian Law | International Public Health | Maternal and Child Health | Psychiatry and Psychology | Public Health | Social Control, Law, Crime, and Deviance


Article introduction:

What started as a peaceful uprising in Syria in March 2011 escalated quickly to an armed conflict. By 2012 conflict had become the leading cause of death of Syrians. Health systems have been reshaped, now being separated into areas controlled by the government, the opposition, or self proclaimed Islamic State factions—we group the last two as non-state armed groups (NSAG; fig 1). These areas differ vastly in terms of service delivery capacity, number of trained staff, and accessto essential medicines.

Indirect conflict related deaths have arisen from poor sanitation and severe disruption to Syria’s healthcare system. In December 2014, 20% of Syria’s public hospitals were completely non-functional, and another 35% provided only partial services. Direct conflict related deaths are those that are caused by weapons and other violent methods used in warfare.

In this article we assess the direct conflict related deaths (hereafter termed violent deaths) of women and children among civilians killed in the Syrian conflict, because they are identified as vulnerable populations in public health and under specific laws of war such as the Geneva Conventions.


Syria, Syrian conflict, civilian deaths, violent deaths, weapons, warfare

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© BMJ Publishing Group Ltd 2015. Open access copy retrieved from with license at

DOI of Published Version



BMJ. 2015 Sep 29;351:h4736. doi: 10.1136/bmj.h4736. Link to article on publisher's website

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

BMJ (Clinical research ed.)

PubMed ID