Creative Destruction

September 16, 2006

What the ICRC really tells us about War Casualties

Filed under: Feminist Issues,Statistical Method,War — Daran @ 8:43 pm

In recent posts, I’ve been debunking the myth – mistakenly attributed to the ICRC – that women and children are 80% of war casualties. Here I summarise and discuss the findings of four papers from the peer reviewed British Medical Journal, all of which which were based on patient data from Red Cross and Red Crescent Hospitals. (See also my Analaysis of the figures given in the Lancet study on the war in Iraq.)


The data are consistent with the hypotheses that upwards of 75% of war casualties are adult men, and that upwards of 90% of war casualties are male. See below for detailed findings and discussion.


Robin M Coupland, surgeon, Hans O Samnegaard: “Effect of type and transfer of conventional weapons on civilian injuries: retrospective analysis of prospective data from Red Cross hospitals”

Subjects: 18 877 people wounded by bullets, fragmentation munitions, or mines treated in Red Cross/Crescent Hospitals in multiple conflict zones on two continents.

Relevant findings: 26.4% of all casualties (and 18.7% of bullet casualties) are “Women and girls, boys (under 16), [and] men over 50”. If the unstated (but presumably non-zero) number of men over the age of 50 are excluded, then the figures for “women and children” must be lower. See Table 1.

Markus Michael et al.: “Incidence of weapon injuries not related to interfactional combat in Afghanistan in 1996: prospective cohort study”

Subjects: 608 people admitted to Jalalabad hospital because of weapon injuries.

Relevant findings: 90% of all casualties (95% of combat casualties and 85% of non-combat casualties) are male. If we add the number of female casualties to the number of child casualties we obtain the figure 25%, which is an upper limit to the number of “women and children” casualties. (The actual figure will be lower because there were presumably a number of girls who are double-counted in this sum.) See Table 1.

David R Meddings, Stephanie M O’Connor: “Circumstances around weapon injury in Cambodia after departure of a peacekeeping force: prospective cohort study”

Subjects: 863 people admitted to hospital for weapon injuries over 12 months.

Relevant findings: 85% of casualties were male, and 51% “civilian”. See Table 1. It is not clear how “civilian” is defined in this study.

David R Meddings: “Weapons injuries during and after periods of conflict: retrospective analysis”

Subjects: 2332 people who received weapons injuries during the conflict or post-conflict periods and were admitted to hospital within 24 hours of injury.

Relevant findings: 94% (during the conflict period) and 97% (during the non-conflict period) of casualties were male. See Table 1.


It’s important to realise that these studies do not represent independent data. As far as I can tell, all three other papers used subsets of the Coupland data. However, while none of these papers provide quite the information I’m interested in, Coupland and Michaels allow me to calculate upper limits to the proportion of “women and children” casualties in two different way, (remarkably agreeing to within 1%), while Michael and the two papers by Meddings give the proportion of male casualties, which cannot be determined from Coupland. All in all, the four papers present a remarkably consistent picture of an overwhelmingly high male casualty rate, born largely by adult men, despite diverse geographical, political, and military circumstances.

A number of possible confounding factors are discussed by the authors. These can be divided into three categories – sample bias, misclassification of “civilian” status, and misclassification of wound type. The latter issue is marginal to my enquiry, and I devote no further discussion to it; I discuss the other two issues below:

Sample Bias

If the relevant population is “all those killed or injured by weapons of war”, then a sample drawn solely from Red Cross/Crescent hospitals is clearly not random. The unsampled population can be divided into several subpopulations each of which may present quite different casualty profiles:

  • Casualties treated in military hospitals. (May include more combatants).
  • Casualties treated in hospitals run by the civil authorities. (One might expect the profile of casualties to differ between areas where an effective civil health service continues to function, and areas where it has collapsed, or where none has ever existed.)
  • Casualties treated by other humanitarian organisations. (May reflect the differing priorities of these organisations.
  • Casualties who are killed in the attack, or who die before reaching hospital.
  • Casualties who are captured and treated (or not) by the capturing force. (More likely to be men, whether combatant or no.)
  • Other casualties who are not treated in hospital.

The effect of excluding fatalities is that groups of casualties with a high wound to kill ratio are overrepresented. In general this means combattents who were actively defending themselves, and non-combattents who were “collateral damage”, i.e., “caught in the crossfire” but not specifically targeted. By contrast attacks on groups who are able neither to hide, nor escape, nor defend, often have very low wound to kill ratios, sometimes nil. (Cite) Such massacres, under- or unrepresented in the ICRC data, are usually perpetrated against men (Cite).

Taking all these factors into consideration, it would appear that sample bias is more likely to lead to an underestimate than overestimate of the proportion of male casualties.


Coupland designates as “civilian” casualties who are women, children under 16 and men over 50. I find this problematic for several reasons. Firstly he doesn’t seem to distinguish between “civilian” and “non-combatant”. These are essentially different concepts. A person is a civilian if they are not currently enlisted into a military unit. A person’s status as a (non-)combatant depends upon their posture with respect to the ongoing conflict. Non-civilians (i.e., soldiers) are non-combatant if they are hors-de-combat by reason of injury or because they have been taken prisoner or disarmed. Civilians can be combatants if they attack others, or provide support to military or paramilitary units.

It’s important to observe that Coupland does not regard adult men within the age range necessarily to be combattents, nor does he classify them as such. Rather he takes the view that there are likely to be more non-combatants among the adult men, than combattents among the “civilians”. Although I do not disagree with this conclusion, I find the labelling prejudicial in that it reinforces the prevailing cultural view that men are less worthy of concern as victims of war than “innocent” women and children, regardless of whether they are combatants, or whether they have any choice to be in the position they’re in.

(Edited for spelling)


  1. […] large one in terms of the numbers affected. The median figures for war casualties based on empirical research (as distinct from being plucked out of the air) is about 90% male. The number of male dead denied […]

    Pingback by Feminist Critics — March 23, 2007 @ 5:38 pm | Reply

  2. […] follows a third: my focus upon the victimisation of men and boys rather than women and girls. The casualties of war are overwhelmingly male. In particular far more men are killed than women. But that implies that the survivors of war are […]

    Pingback by Feminist Critics — January 12, 2008 @ 3:16 am | Reply

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