Reverberating effects of explosive violenceExplosive violence and victim rights

An overview of the long-term harm resulting from the use of explosive weapons in populated areas: an analysis of the ten worst-impacted countries

Explosive weapons directly and indirectly impact civilian populations during times of conflict. Since 2011, Action on Armed Violence (AOAV) has recorded 276,921 deaths and injuries from explosive weapons around the world. Of these, 76% (209,557) have been civilians. When such violence occurs in populated areas, the casualty rate is much higher. AOAV has consistently found that when explosive weapons are used in populated areas, more than nine out of every ten casualties are civilians.

State use of such weapons has increasingly caused civilian harm in recent years. In 2017, civilian casualties from state use of explosive weapons accounted for at least 51% of all civilian casualties – for the first time outstripping the harm inflicted upon civilian populations by non-state actors. Furthermore, civilian casualties resulting from state use of explosive weapons increased 44% in 2017 compared to the previous year – or by almost 250% since 2011. In 2017, when state actors used explosive weapons in populated areas, 93% of the casualties were civilians.

The use of explosive weapons with wide area effects in populated areas has other far-reaching and often devastating consequences that go beyond the immediate deaths and injuries. Such weapons are responsible for destroying key infrastructure; for depriving communities of water, sanitation, electricity or medical care. Many civilians will suffer psychologically, while the interruption to education and employment can stunt development.

Worst impacted countries and territories

The countries and territories worst impacted by manufactured explosive weapons, as opposed to improvised explosive devices (IEDs), between 2011 and 2017 include: Syria, Yemen, Iraq, Gaza, Pakistan, Libya, Ukraine, Afghanistan, Somalia and India. In order to better understand the reverberating impacts from the use of explosive weapons, this report will focus on some key, impacted areas, including health, economies, the environment and society as a whole.


Beyond the death and injury caused by explosive weapons, health can suffer in other ways, particularly due to damage caused to health infrastructure and access to medical care. In recent years, the targeting of hospitals has tragically become ‘the new normal’, according to Michiel Hofman, a senior humanitarian specialist at Médecins Sans Frontières (MSF). The destruction of just one hospital can deny care to hundreds of thousands of people. When the MSF hospital in Saada, Yemen, was hit in an airstrike in October 2015, it was reported that up to 200,000 people lost access to medical care. In Yemen, with 274 health facilities damaged in the conflict and only 45% of national facilities fully functional, on February 23, 2017, Dr. Nevio Zagaria, the World Health Organisation’s (WHO) Acting Representative in Yemen, stated that the Yemeni health system had collapsed, leaving 14.8 million people — more than half the population — lacking access to basic health care.

In other countries and territories amongst the most impacted, similar damage to healthcare infrastructure has been seen. In Syria, explosive violence has rendered health facilities almost completely non-functional, with 60% of health-care facilities in Syria damaged or destroyed. In Gaza in 2014, 15 out of 32 hospitals were damaged by explosive weapons. The economic losses for the health sector were estimated to stand at over 380 million USD. Over a year later, at least 80,000 people in Gaza still had only limited access to health services due to the destruction of health facilities. In 2011, during the fighting between government forces, supported by AMISOM (the African Union Mission in Somalia), and militant Islamists in Mogadishu, hospitals here too were targeted and either damaged or destroyed, further impacting the civilian population.[i]

Illness and disease

Alongside the destruction of healthcare and direct injury, there are other indirect impacts of explosive violence. Vaccination programmes, for instance, may become disrupted by bombing. Destruction of water treatment plants, distribution networks, or sewer systems, create challenges for communities and authorities alike. Diseases can spread rapidly in conflict and post-conflict conditions, exacerbated both by such destruction and by the lack of healthcare accessibility. Recent outbreaks of disease in areas beset by explosive violence, for instance, include cholera in Yemen and polio in Syria. In Yemen, according to WHO, about 5,000 people fall sick every day from cholera and a further 500,000 are suspected of having contracted the disease. Such health impacts can continue for years after conflicts end, despite healthcare and reconstruction efforts.

Since the onset of conflict in Syria in 2011, the percentage of children under the age of one lacking immunisation for measles increased from 20% in 2011 to 46% by 2014. Similar results are seen for immunisations for DTP (a combination of vaccines against three infectious diseases –  diphtheria, pertussis and tetanus). However, as complete data is only available until 2014, many of the other most impacted countries and territories cannot be fully analysed. Nevertheless, due to the long-term presence of explosive violence in Iraq between 2011 and 2014, this country too can be used as an example – similar correlations between explosive violence and immunisations can be seen. The charts for DTP immunisations also suggest a correlation between explosive violence and access to immunisations. Of course, other factors, including the use of small arms by non-state actors, may also come into play – some groups may even target medical workers providing vaccinations, as is seen in Pakistan.

Other health-related harm caused by the use of explosive weapons frequently includes disruption to medical and food supplies due to damage caused to roads and other transport infrastructure, and which may have lasting impacts of nutrition and healthcare. The Food and Agriculture Organization (FAO) found that 60% of the 815 million chronically food-insecure and malnourished people in the world and 75% of stunted children age under 5, live in conflict affected countries.

Many of the most food insecure people are from war-zones such as those in Yemen, Syria, Afghanistan and Ukraine. This demonstrates the impact of regional violence too on local populations. For example, 1.2million people in Ukraine face acute food insecurity due to the violence in Donbas. Whilst in Iraq the bombardment of roads, bridges and other trade routes left Mosul under siege in November 2016. 750,000 civilian residents of western Mosul were trapped and many were on the brink of starvation, with all food supplies running low after four months of siege.

Medicins Sans Frontieres, reported treating over 450 cases of severe malnourishment in children between March and July 2017. Of these cases, most were babies – 60% were less than six-months old. As the explosive violence continued, the number of civilians suffering malnutrition did also.

This harm in Yemen is well-reported, with a quarter of the 28 million-strong population reported to be starving and more than 1.8 million children under the age of 5 acutely malnourished, including 500,000 children suffering from severe acute malnutrition. The humanitarian crisis has been brutally impacted by the explosive violence, both by Houthi shelling and Saudi-led coalition airstrikes. Even after conflict ends the effects of malnutrition such as stunted growth and delayed cognitive development are likely to continue.

Psychological health

It is difficult to compare data on mental health indicators and explosive violence, particularly given the stigma associated with mental health in the countries most impacted. However, where studies have been conducted they indicate a high correlation between explosive violence and psychological trauma.

The impact of explosive violence on mental health is well documented. Muteness, rage attacks, bed-wetting, insomnia and persistent nightmares were witnessed by social workers in 2017 at the Iraqi refugee camp of Hasansham, a camp that housed those fleeing, among other things, explosive violence in western Mosul. Over half of the 1,500 children registered there were severely traumatised, needing urgent psychological support – a generation of children may be permanently damaged.[ii]

In Syria, one study found that, among Syrian refugees interviewed, almost all children and 84% of adults reported that bombing and shelling was the number one cause of psychological stress. 71% of interviewees said children were increasingly suffering from symptoms of toxic stress and PTSD. These psychological conditions are likely to have lasting consequences on the children impacted. Save the Children, who carried out the aforementioned study, added that: “Daily exposure to the kind of traumatic events that Syria’s children endure… will likely lead to a rise in long-term mental health disorders”.

Whilst there has been relatively little data collected on the psychological impact of the conflict on civilians in Yemen, suicide rates were said to have risen by 40.5% between 2014 and 2015. Another study found a dramatic rise in feelings of fear, insecurity, anxiety and anger in children in Sana’a, Aen, Taiz and Abyan.

In all the top 10 worst impacted countries, psychological harm has resulted from the use of explosive weapons. After the violence in 2014, 20% of the population of Gaza were estimated to have suffered from related mental health problems, for which they would need short- to long-term support to recover. In Donetsk and Luhansk, the conflict-impacted areas of eastern Ukraine, it is estimated that more than 200,000 children, or one in four, needs urgent psychological care due to the violence in the region. The shelling in both Indian- and Pakistan-administered areas of Kashmir is reported to have had a significant impact on the mental health of those in these areas, including PTSD in children.[iii]

Explosive violence severely affects those in the areas impacted, both physically and mentally. Additionally, other consequences, discussed below, can exacerbate the impact on people’s health.


Whilst GDP can be affected by multiple factors, AOAV’s findings suggest that high levels of explosive violence almost always accompany a decline in GDP levels. For example, as explosive violence has increased in Syria, real GDP growth has gone down. Between 2011 and 2016, the cumulative loss in GDP is estimated to be $226 billion (USD) – four times Syria’s GDP in 2010.

In Yemen, since the onset of explosive violence in 2015, evidence suggests GDP has contracted by 37.5% – with the largest components of GDP – agriculture and oil and gas production – seeing limited activity due to the violence.

Whilst for some countries, such as Syria, Libya, Somalia and Gaza, data is unavailable, statistical analysis shows that for those where data was available, there is a correlation between the levels of explosive violence and GDP.[iv] Where explosive violence increases this is often mirrored or followed by a decrease in GDP, whilst when violence begins to lessen, GDP begins to rise.

Other economic impacts can be witnessed, such as on poverty and employment. Whilst comparative data on poverty in those most impacted countries is rarely available, often due to such violence and instability itself, studies show such violence exacerbates poverty. Poverty is often a reported consequence of the violence in these countries and territories. In Syria, poverty levels have escalated dramatically; today two out of every three civilians are said to live in extreme poverty. In Yemen, whilst there was already severe poverty across the country prior to the war, the violence has greatly exacerbated this – 80% of the population now require humanitarian assistance. Additionally, 40% of households have been reported to have lost their primary income source, while the import of key commodities has been limited by the involvement of key ports in the conflict.

In Syria, since the beginning of conflict, jobs have been destroyed at an approximate rate of 538,000 per year on average, whilst the overall unemployment rate increased from 8.6% in 2010 to 52.9% by 2015. Youth unemployment reached 78% during the same period. With many displaced, and businesses and factories destroyed or damaged in bombardments, post-conflict reconstruction will undoubtedly represent a perpetual challenge.


In many cases, there is little research on the environmental harm from explosive violence and it is unlikely we will understand the extent of the environmental harm in the countries that are currently most impacted for some years. But, it remains the case that such violence causes serious harm to land and wildlife, as it frequently exacerbates or contributes to ground, air, water pollution and marine pollution. These also give rise to additional human health concerns, particularly when access to clean, safe water is affected. Agriculture particularly is often highly affected.

It might be assumed that increasingly urbanised conflicts cause less long-term environmental harm. However, vital infrastructure is more frequently damaged, detrimental to both humans and the environment itself. According to one World Bank study, in Syria an estimated 27% of homes across the cities studied have been destroyed or damaged, and over half of all medical and education facilities damaged. The rubble from such bombardment alone can cause harmful pollution. Such infrastructural destruction has also had a disastrous impact in Yemen. In Yemen, by July 2017, over 14.5 million people lacked access to safe drinking water, 14.8 million people lacked access to basic health care and 4.5 million people needed emergency shelter.

Such damage is predictably costly to rectify and leaves many displaced – unable to return until such areas are rebuilt. A further complication is the presence of unexploded ordinance (UXO).


In Syria, removing UXO contamination alone could take 50 years, preventing rebuilding and civilians returning to homes. It also leaves millions of civilians in danger from such explosives. 8.2 million civilians worldwide are reported to be living in communities with explosive hazards and many have become casualties already.

In Iraq, the case is similar. As more land is declared liberated from ISIS, people have begun returning home, putting them at huge risk from UXO. In 2017 alone, UNMAS (the United Nations Mine Action Service) rendered safe 44,376 explosive hazards, 748 of which were categorised as improvised explosive devices (IEDs).

Saudi cluster munitions, as well as other UXO, also litter areas in Yemen and have caused multiple casualties to date. In 2016, the Yemen Executive Mine Action Centre (YEMAC) cleared over 264,000 pieces of UXO, as well as 250,000 in the first nine months of 2017. This decontamination also comes at significant cost to the international community.

Ukraine too has recently been reported to have become one of he most mine-contaminated places on Earth, endangering 220,000 children living in the contaminated areas. UXO was the leading cause of child casualties in the area between January and November 2017.

Beyond further death and injury, such contamination prevents civilians returning to normal lives, preventing access to schools and livelihoods, exacerbating poverty and perpetuating human displacement. It also adds to the psychological suffering of the communities, through the heightened fear and anxiety of living in proximity to explosive hazards.

In many countries, including Syria and Iraq, the ongoing deployment of improvised explosive devices by non-state groups presents similar challenges and prolongs insecurity, even after militants have been defeated or forced elsewhere by state or international forces.


Whilst explosive violence impacts many areas of society, including gender-based violence and increases in crime[v], the effect of displacement communities on education is particularly pronounced.


An average of 5.3 million people a year are newly displaced due to conflict, with up to 15,000 people forced to flee their homes every day. Many are fleeing the devastation wrought by explosive weapons.

Conflict is the main cause of displacement, and when explosive weapons are used, the need to flee is even greater and the length of displacement even longer. Areas of Harm, a report by the civil society organisations PAX and Article 36, found that, when explosive weapons were used in populated areas, civilians were not only killed or injured, but entire populations were repeatedly displaced.

Whilst there are multiple factors that influence levels of displacement, there is a strong correlation between the levels of casualties explosive violence in a country and the number of displaced persons. The graphs show the levels of explosive violence casualties recorded, compared to the numbers of those internally displaced – civilian harm mirrors displacement.[vi]

All show a strong correlation between explosive violence and internal displacement, particularly the levels of new displacements. This is especially evident in countries where seeking refuge abroad is a less likely option, such as Yemen and Gaza.

As can be seen from the graphs, the shelling in Kashmir is typically the main driver of displacement in India. A similar picture may be seen in Ukraine’s Donbas region.

Depending on the scale and location of the violence, many may also seek refuge abroad. This is often dependent on additional political and economic factors. However, similar results and reasoning is found for those who seek refuge abroad. In Escaping the Bombing, Humanity and Inclusion found that among the Syrian refugees interviewed in Jordan, the threat of explosive weapons was the primary, overriding factor influencing their decision to flee the country.

AOAV’s report The Refugee Explosion also found a high correlation between the rise in casualties from explosive violence and the numbers seeking refuge abroad. Syria alone has seen approximately 5.6 million refugees flee to try and escape the bombing.


Education is also commonly impacted. This, alongside displacement, has prevented many from accessing education. In Syria, for instance, the on-going violence has left a quarter of schools unusable, while repairing Syria’s broken education sector is estimated to cost £2billion. Furthermore, the lost years of schooling at all educational levels by the end of 2015 was estimated by the Syrian Center for Policy Research to represent in Syria “a human capital debit of 24.5 million lost years, which represents a deficit of 16.5 billion USD in human capital investment”.

Predictably, education is most affected where the bombs are dropping. For example, in Kashmir, in both India-administered and Pakistan-administered areas, education has been severely impacted by cross-border shelling. Year-on-year hundreds of schools are forced to close due to shelling – leaving children without access to education. In recent years, the impact has meant that often much of the curriculum remains untaught – up to 50% in some years.

In Ukraine’s Donbas region, at least 45 schools have been damaged or destroyed since the violence began and more than 700 schools have been affected. UNICEF has appealed for 23 million USD to provide urgent humanitarian assistance to children and families affected by the conflict.

In Yemen, at least half a million children have dropped out of school since the escalation of explosive violence in 2015. The total number of out-of-school children stands at 2 million and the education of 4.5 million children is at risk. 2,500 schools are out of use, with two thirds damaged by attacks, 27% closed and 7% used by the military or internally displaced people (IDPs).

Explosive violence not only seriously harms access to education, but also children’s well-being in general – denying them safety, stability and support at a time when it is most critical.


The destructive impacts of explosive weapons, particularly when used in populated areas, have long-lasting consequences. AOAV’s recent research on the long-term harm from the use of explosive weapons demonstrates that such impacts are lasting – spanning years or decades after the conflict ends. The devastation to the communities is seen physically, to human beings and to infrastructure, as well as psychologically, with many suffering from the trauma of the explosive violence itself as well as the ongoing challenges presented by poverty and displacement.

Entire societies suffer, while healing and rebuilding is frequently stunted until the violence permanently ceases. Such recovery takes considerable time and funding, and is also dependent upon a resilient peace. Even so, years after such violence, instability and other consequences remain – depression, poverty, unexploded ordnance.

All the top ten worst impacted countries continue to feel the effects from the use of explosive weapons. The harm of explosive violence can last decades and is unfortunately wholly predictable when explosive weapons are used in populated areas.

This article is part of AOAV’s research on the reverberating effects of explosive weapons. For the main report, ‘When the bombs fall silent’, see here. For an overview and some key findings, see here. Or, to reach other articles as part of this research, please see here.

[i] and and

[ii] Anthony Lloyd, ‘My four-year-old son just wants to behead people’, The Times, Saturday December 10, 2106, p.42

[iii] and

[iv] India is not included as it would be unlikely to reflect any impact on GDP, given the explosive violence occurs in a relatively small area of the country.

[v] See:, and

[vi] According to AOAV data for explosive violence and the Internal Displacement Monitoring Centre.