Injuries from explosives, firearms in Gaza surpass those in previous conflicts

International healthcare workers deployed to Gaza, Palestine, report experiencing extensive polytrauma (≥2 anatomical regions), complex blast injuries from high yield explosives, firearm-related injuries to upper and lower limbs, and severe disruption to primary care and the treatment of chronic diseases during the ongoing conflict, results of a recent survey have shown.

“The volume, distribution, and military grade severity of injuries, indicate patterns of harm that exceed those reported in previous modern-day conflicts,” the authors said.

“These findings highlight the urgent need for resilient, context-specific surveillance systems, designed to function amid sustained hostilities, resource scarcity, and intermittent telecommunications, to inform tailored surgical, medical, psychological, and rehabilitation interventions,” they added.

This survey study was conducted between August 2024 and February 2025 in 78 international healthcare workers deployed to Gaza to systematically document the patterns of war-related injuries. The authors distributed a Delphi informed survey through nongovernmental organizations and secure WhatsApp and email groups. Respondents completed the survey using contemporaneous logbooks and shift records.

Through the survey, the authors obtained data on 12 anatomical regions, mechanisms of trauma, and general medical conditions. The 78 healthcare workers reported a total of 23,726 trauma-related injuries and 6,960 injuries related to the use of weapons. [BMJ 2025;390:e087524]

Among traumatic injuries, the most common was burns (n=4,348, 18.3 percent), followed by lower limb (n=4,258, 17.9 percent) and upper limb injuries (n=3,534, 14.9 percent). For weapon-related trauma, the most common was explosive injuries (n=4,635, 66.6 percent), mainly affecting the head (n=1,289, 27.8 percent), while firearm injuries extremely affected the lower limbs (n=526, 22.6 percent).

In addition, the healthcare workers reported 4,188 people with chronic disease across 11 domains who required long-term treatment.

“The results provide actionable insights to tailor humanitarian response and highlight the urgent need for structured, resilient clinical surveillance systems,” the authors said.

Record loss

The recording of injury data for this study is marked by attacks on hospital infrastructure, where the loss of paper records and disruption to digital connectivity have led to the obscurity of the true clinical situation. [https://www.un.org/unispal/document/thematic-report-attacks-on-hospitals-31dec24/]

These data focus on survivors who reached healthcare facilities and were clinically evaluated instead of reflecting a complete census of all people affected in Gaza.

“These findings provide critical insights into the injuries and conditions most relevant to immediate management, rehabilitation, and long-term health planning,” the authors said.

Conflicts

Explosive injuries accounted for 67 percent of the cases in this report compared with previous conflicts. This aligned with US military data from Iraq and Afghanistan and was double the 31 percent of explosive injuries seen among civilian populations in contemporary conflicts. [PLoS One 2022;17:e0266588; BMJ Mil Health 2020;166:261-265; US Dept of Veterans Affairs 2016;PMID:28813129]

“The resulting injury profiles resembled those reported in combat settings among trained military personnel, highlighting the burden of trauma among civilians in Gaza,” the authors said.

“Explosive weapons, designed for open battlefields, are increasingly being deployed in densely populated urban areas,” they added. [https://reliefweb.int/report/world/how-can-healthcare-access-be-strengthened-settings-where-explosive-weapons-are-being-used-understanding-challenges-and-gaps-and-exploring-practical-measures-approaches-and-opportunities]

Recording these injury patterns adds to the evidence base for humanitarian analysis of the health consequences of modern urban conflict. [https://www.ohchr.org/en/instruments-mechanisms/instruments/protocol-additional-geneva-conventions-12-august-1949-and]