By James Batchelor, Associate Dean International Research & Enterprise
The ongoing conflict in Ukraine continues to cause significant harm to civilians, with towns and villages across the country being devastated by bombing and shelling. In light of this, I would like to share a program of work that I have been involved with over the last five years.
As a group of researchers within the University, we began discussing the levels of conflict and terrorism around the world and the lack of research being done in this area.
The Situation
This led to the adaptation of the RESiN study, where a multidisciplinary team of researchers reviewed over 1.2 billion pounds of funding to gain an understanding of the portfolio of research related to conflict. The results showed that the most significant funder was the US Department of Defense, focusing on traumatic brain injury in early laboratory research, specifically the biological effects of blast on the brain. However, there was little to no research or funding in other areas and, particularly, regarding civilians.
Given that the data indicates that conflict disproportionately affects civilians, and particularly females and children, it is crucial that efforts are made to mitigate harm and understand the epidemiology of blast injury, define best practices in treating patients in conflict, and undertake new research for treatments. Organisations such as Every Casualty, which promotes the documentation and recording of injury and deaths, also underscore the importance of this issue.
Conflict
Modern conflict is increasingly urban, protracted, and complex. From the Boston Marathon bombings to Sri Lanka’s Easter Suicide Attacks to the devastation of Homs and Ukraine, explosive violence causes catastrophic harm to civilians, with a disproportionate impact on women and children. This threat is growing – the use of explosive weapons in populated areas (EWIPA) has become the defining feature of 21st-century armed conflict, where improvised explosive devices (IEDs), car and suicide bombings, indiscriminate airstrikes, and shellings in populated areas are commonplace. Over the last decade, civilians made up more than 90% of those killed or injured by EWIPA. Civilian infrastructure is destroyed by improvised and factory-made munitions alike, impacting, amongst others, the essential services of healthcare, sanitation, transportation, and education. These threats occur in tandem with those of prior fields of battle that are littered with explosive remnants of war and landmines disrupting civilian livelihoods for years to come.
Clinical Challenges
The clinical challenges associated with blast events are innumerable. Civilian blast injury patterns are diverse and devastating, exacerbated by a broad demographic, none of whom are protected by body armour. Many patients with severe wounds die before reaching a health facility. Blast, fragmentation (e.g., shrapnel), and burns that do not kill immediately cause severe injuries that result in life-long reliance on healthcare. Such events overwhelm stressed healthcare systems; especially fragile facilities that lack the resources, capacity, or capability to cope. Furthermore, the sequelae of blast injury, including long-term functional disability and psychological trauma (e.g. PTSD), impedes victims’ ability to return to normal life, generating a life-long need for rehabilitative services that are often misunderstood or absent.
Data
Data collection on the harm caused by explosive violence has been constantly raised as a critical issue. Specifically, data disaggregated by gender, disability, age, and weapon type. Data collection needs to improve to better support health systems in their preparedness and response.
A Global Priority
EWIPA is a priority issue for the United Nations (UN), where the Irish Government is championing a Political Declaration to protect civilians from EWIPA. The IBRN is informing this consultation process. The UN Institute for Disarmament Research (UNIDIR) has produced a framework for analysing the immediate and long-term impacts of EWIPA, aligned with the UN Sustainable Development Goals, and the International Committee of the Red Cross (ICRC) has designated EWIPA as a key priority and is currently advocating for avoidance policies. These efforts are designed to raise awareness and recommendations for monitoring EWIPA. While such advocacy is critical, it must be substantiated by methodologically rigorous research to inform practical solutions that mitigate harm and nurture sustainable health system improvements.
The Response
In order to address these gaps, we established the International Blast Injury Research Network (IBRN) in 2019, a collaboration between researchers from diverse backgrounds, including medicine, engineering, journalism, data science, humanitarian aid, and the military. The network is based at the University of Southampton and the University of Cape Town. Our vision is to improve the impact, effectiveness, and relevance of blast injury and protection research to address the global challenges of explosive violence, landmines, and explosive remnants of war.
Our research aims to build a novel evidence-base surrounding blast injury and protection research and develop global networks to facilitate effective trans-disciplinary collaborations. To achieve this, we are: mapping global research investment into blast injury research, undertaking scientific reviews of blast injury research, organising international workshops and forums, and taking an applied multidisciplinary approach. We are also facilitating ongoing research cooperation between the fields of engineering and medicine and promoting more comprehensive collaboration between academia, industry, clinicians, defence, and humanitarian organisations.
Practical Research and Priority Setting
Since launch in 2019, we have run two international workshops and have a growing commitment from other organisations to participate, including the Universities of Sheffield, Washington, Beirut, and Armed Action on Violence, as well as individuals from other research institutions, NGOs, and, more recently, a researcher from the BBC World Service.
This year, the International Blast Injury Research Network (IBRN) will organise two events to further our understanding of the medical and engineering challenges of blast injury.
Our first event, set to take place in March, is funded by a University Multidisciplinary Award between engineering medicine and the business school’s operation research group and will be held in Beirut. The workshop will focus on the health consequences of the 2020 Beirut blast and mass-casualty explosive events and will bring clinical teams from Lebanon together to help understand the response and injuries sustained mapped against the engineering models of the blast loading across the city. The agenda includes presentations, interactive activities, and discussions on topics such as blast injuries, treatments, health system responses, disaster responses, and long-term health consequences. We will be welcoming experts from multiple disciplines to participate, and the event aims to bring together those who were involved or have conducted research specifically on the impacts, responses, and aftermath of the 2020 Beirut Blast and other mass-casualty explosive events. Additionally, we are currently undertaking a large-scale study, collecting information from people injured on that day with the support of the American University of Beirut.
Later in the year, our next meeting will be hosted by the University of Cape Town and will focus more specifically on the blast modelling from an engineering perspective. This event is funded by the World Universities Network and will feature engineers from the Universities of Southampton, Sheffield, Cape Town, and Sydney. The event aims to generate new ideas and partnerships in the field of engineering and blast modelling and will provide a platform for exchanging knowledge and expertise among the attendees.
The Result
I believe that through the International Blast Injury Research Network, Southampton and its partners can make a meaningful contribution towards understanding and addressing the complex issue of harm caused by explosive weapons in conflict, and ultimately improving the protection and health outcomes for civilians affected by such violence. Southampton is a place where building networks of researchers with partners can take on complex challenges, and we can bring people together.
This is not the only network in the University, there are lots, but promoting them can bring new collaborators together.