ORIGINAL ARTICLE ISRA MEDICAL JOURNAL | Volume 8 - Issue 1 | Jan - Mar 2016

FREQUENCY AND PRESENTATION OF FIREARM DEATHS IN ISLAMABAD DURING 2014 BASED ON AUTOPSY REPORTS

MUHAMMAD ARSHAD1 , HUMAIRA ZAFAR2

ABSTRACT

OBJECTIVES: To determine the frequency and presentations of firearm mortalities in Islamabad during 2014 and to find out the prevailing age, gender. To correlate frequency of gun shot injuries in relation to body region targeted. STUDY DESIGN: A Retrospective Descriptive PLACE AND DURATION: The study was conducted in the Federal Government Polyclinic Islamabad and Institute of Medical Science Islamabad From 1st January 2014 to 31st December 2014. METHODOLOGY: All cases of firearm mortality were recorded irrespective of age, sex, location of injuries, number of firearm injuries & type of firearm weapons used were amongst the inclusion criteria. All cases of putrefied dead bodies with firearm injuries and dead bodies with surgically altered wounds were amongst the exclusion criteria RESULTS: A total of 117 Cases of firearm related deaths were recorded from autopsy reports composing of 96 (82%) Male and 21(18%) Female. The victim ages ranged from 13 years to 63 years. Location of injuries on the body were highest on Head 29.9% ,Head & Chest 36.68%,Chest 19.70% , Chest + Abdomen 14.53% , Abdomen 17.95% and 4.3%.There were 71 dead bodies having two or more than two wounds of firearm entries and 46dead bodies having single firearm entry wound. CONCLUSION: Most of the firearm victims were male particularly male youth. Rifled firearms injuries on the head and chest were cause of death in rural community. KEY WORDS: Firearms, Death, Male Youth, Gun Violence. INTRODUCTION homicide rate is 91.4 % in Peshawar10 , 98.2 % in Karachi11, 12 , 77 %in Multan13 , 77.7 % in Dera Ismail Khan14 and 60% in Mirpur Violent injuries have become more prevalent in the recent Khas in AJK. Data collected from Department of Forensic years. More than 1.6 million people die as result of violent Medicine & Toxicology, Khyber Medical College show injuries Worldwide 1 . Violent traumatic injuries are the eighth about 3227 people died as result firearm injuries during 2000 to leading cause of death2 .Globally more than 5.8 millions people 2006 (Deaths reported for autopsy). are killed every year as result of violent injuries and road traffic The gun violence varies from country to country & even varies crashes3.4 . The violence and particularly the gun violence have from city to city within a country16 . This all depend upon the spread at terrific speed by the use of small arms – mostly availability of firearm in the region17-19 , as there is strong handguns (pistols, revolvers, rifles). More than 31000 people relationship between the availability of firearms leading to die as result of firearm injuries in United States of America shooting on minor disputes. Japan has the world's lowest gun yearly5,6 . More than 313045 Americans were killed due to shot mortality24 because there is strict control over firearms. gunshot injuries during 2003 to 2012 and Gunshot homicide Violent firearm injuries are common in the low and middle rate was 67%7 during 2013. Much higher than rest of the income countries twice of high-income countries in 200016 . developed world like France, United Kingdom, Germany and Male youths are much more vulnerable to gunshot homicides Canada. Thailand has a record firearm homicide (20032) during and suicides than extreme age groups20.21 . The studies 20028 . A study indicate the grave situation in India gun shot conducted in Pakistan indicate the second and third decade's killing about 32000 – 38000 people each year9 . age groups are frequent victims of firearm injuries and deaths Pakistan has no national data on gunshot injuries morbidity and (Multan 21-30 years (31.42%), 21-30 and 31-40 years (51.3%) mortality, some regional studies has seen carried out like in age group in Lahore, Dera Ismail khan, Peshawar and Turkey. Peshawar10 , Karachi 11, 12 Multan13 , Dera Ismail Khan14 , Lahore 15 Youth involvement in interpersonal conflicts is common and and Larkana indicating high rate of gun mortality. As firearm due to anger, intolerance, poverty, unemployment, family and neighborhood environment, access to weapon and substance 1.Assistant Professor of Forensic Medicine, abuse22 . Most common body part targeted are head, chest 2.Assistant Professor of Microbiology followed by abdomen and pelvis 23 .Vast numbers of local and modern sophisticated weapons are freely available in the Al-Nafees Medical College & Hospital, , Islamabad Campus, Pakistan. Pakistan. The largest influx is from Peshawar, as the country largest illegal firearm production and sale market (Darra Adam Correspondence to: Khel). There is public as well as media outcry on this issue. It is Muhammad Arshad important to curb the high rate of Gun crime. There are number Assistant Professor of Forensic Medicine of weapons which are used to commit homicide or suicides are Al-Nafees Medical College & Hospital blunt and sharp edge weapons. The current study was carried Isra University, Islamabad Campus, Pakistan. to observe the law and order situation in our country. Email: [email protected]

52 Wasif Farman et al. ISRA MEDICAL JOURNAL | Volume 8 - Issue 1 | Jan - Mar 2016

METHODOLOGY RESULTS

The study was conducted in the Federal Government Polyclinic A total of 117 Cases of firearm related deaths were recorded in Islamabad and Pakistan Institute of Medical Science Islamabad this study from autopsy reports composing of 96 (82%) Male From 1st January 2014 to 31st December 2014 maintaining the and 21(18%) Female giving female male ration is 1: 4.58. The inclusion criteria based on autopsy reports. The study design victim ages ranged from 13 years to 63 years with the mean ages Descriptive cross sectional and convenient sampling was most of the victims were 21 – 40 Years – 64.95% and 41 – followed. All cases of firearm mortality were recorded Onward 31.30%. irrespective of age, sex, location of injuries, number of firearm The location of injuries on the body regions were Head 35 injuries and type of firearm weapons used were amongst the (29.9%), Head & Chest 16(36.68%), Chest 23(19.70%),Chest & inclusion criteria. All cases of putrefied dead bodies with Abdomen 17(14.53%), Abdomen 21(17.95%) and Limbs firearm injuries and dead bodies with surgically altered wounds 5(4.3%). There were 71 dead bodies having two or more than were amongst the exclusion criteria. which data recorded on two wounds of firearm entries and 46dead bodies having single the proforma. The data was analyzed using SPSS version 17. A firearm entry wound. Rifled firearms were used in all cases i.e. descriptive analysis of variables was calculated in terms of 117(100%). percentages and ratio. TABLE: I: LOCATION OF FIREARM INJURIES (n=117) TABLE: II: AGE OF VICTIMS (n=117) Head Chest 13 - 20 21 - 40 41 - onward Head Chest Abdomen Limbs Chest Abdomen years years years 35 16 23 17 21 5 5 76 36

TABLE: III: GENDER OF VICTIMS (n=117) TABLE: IV: NUMBER OF FIREARM ENTRY WOUNDS (n=117) MULTIPLE Male Female SINGLE ENTRY WOUND ENTRY WOUNDS 96 21 46 71

DISCUSSION female are less exposed to violence because of cultural & religious reason unless domestic violence male female ratio In this study 117 cases of firearm mortality were recorded and 1: 78.8.consistent with studies conducted in national and this figure show high rate of firearm mortality. The total international studies.17, 21, 26. The most common body targeted Islamabad population is 1.9 million much lesser than Lahore, regions are head & chest25, 27 . These regions are mostly involved Peshawar and Rawalpindi. Most of the cases were from the rural as these regions have the vital organs of body, these finding are area of Islamabad which is 40%of Islamabad population. Here consistent to number of studies conducted in Pakistan & interpersonal conflicts are mostly due to land disputes leading abroad. There were 71 dead bodies having two or more than to the chain of enmity. This chain of enmity goes on generation two wounds of firearm entries and 46dead bodies having single to generation. Additionally the familial /domestic violence firearm entry wound. There were dead bodies with 10-15 (Marriage, in-laws dispute, unfaithfulness, poverty and gunshot entries. These findings demonstrate the illiteracy) are one of the contributing issues. This study is not aggressiveness, hostility, abhorrence, and wrath in our culture. consistent with studies conducted in the West3, 5, 7 where gun There is a strong relationship between firearm availability and violence is more common in urban cities. Some of Firearm gun violence as minor disputes lead to shooting. Greater risk of injuries cases did happen in urban area of Islamabad and few of violent deaths when unlocked loaded firearms are kept at them resulted in deaths. Gunshot deaths in Islamabad is more home, increasing three folds risk of homicide and 20times than what is on record as some cases of suicidal deaths are not more risk of suicide when previously domestic violence reported, even homicidal deaths are not reported because existed20,22,23 . Not only is the registered firearm available in deceased relatives have lack of trust in the country judicial Islamabad but there considerable number of illegal firearms. system. The victims of firearm mortality were grouped into 13– The state of affairs became worse as Pakistan being the 20 years, 21 years – 40 years and 41 years onward. Victim's developing country where poverty, inequality, injustice and mean age was ranged from 13 years - 63 years and these unemployment exsists29. It has been reported that about 20 findings are consistent with number of studies9-11 . million firearms are in civilian possession (both legal and illegal) Majority of the victims were between 16-40 years (78.90%), in Pakistan.30 these findings are consistent with number of international & national studies, coding the 2nd & 3rd decade of life is most CONCLUSION vulnerable9-11 . The study showed that male youth is more vulnerable to firearm High incidence of firearm mortality in the Pakistan capital and injuries as they are aggressive, intolerant ready to fight, violent, increased Male youths vulnerability to gun shot deaths. Chest poverty drug addiction & access to firearm weapon. and head are the most targeted regions of the body. Rifled The number of gun shoot victim were 102 male & female 13, firearms were weapon of choice for homicides and suicides.

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RECOMMENDATIONS 14. Haneef S, Iqbal P, Hussain T, Abbasi MH, Tariq A, Barkat H. Spectrum of Firearm Autopsy Cases Brought To Autopsy Lab 1. Establishment of more trauma centers and pre-hospital of Allama Iqbal Medical College Lahore. PJMHS 2014; 8(2): emergency services 365-68. 2. Sensitize and create awareness about dangers of firearm in 15. Maqsood M, Mughal MI,Chaudhary MK, Khokhar JI, Raza A. civilian hands Fatal Firearm Wounds-A Retrospective Study in Lahore. 3. Sensitize the law enforcement agencies to control spread of Pakistan Postgrad Med J 2011;22(2):45-52. firearm weapons 16. Hussain Z, Shah MM, Afridi HK, Arif M. Homicidal deaths by firearms in Peshawar: an autopsy study. J Ayub Med Coll REFERENCES Abbottabad 2006;18(1):44-47. 17. Marri MZ, Bashir MZ. An Epidemiology of Homicidal Deaths 1. Murray CJ, Lopez AD. Mortality by cause for eight regions of Due to Rifled Firearms in Peshawar Pakistan. JCPSP 2010; the world: Global Burden of Disease Study. Lancet. 20 (2): 87-89. 1997;349(9061):1269-76. www.who.int/iris/ 18. World Health Organization, World report on violence and bitstream/.../1/a77019.pdf. health: summary. Geneva: World Health Organization, 2. World Health Organization (WHO). Injuries and violence: 2002. Website: [www.who.int/violence.../violence/world the facts. Geneva, Switzerland: WHO; 2010. Website: report/en/summary_en.pdf]. [whqlibdoc.who.int/publications/2010/ 19. David H, Matthew M. Firearm availability and homicide 9789241599375_eng.pdf]. rates across 26 high income countries. J Trauma. 2000; 3. Krug, Etienne G. World Report on Violence and Health. 49:985-88. Geneva: World Health Organization, 2002. Website: 20. Matthew M, Deborah A, David H. State-level homicide [whqlibdoc.who.int/publications/2002/ victimization rates in the U.S. in relation to survey measures 9241545615_eng.pdf]. of household firearm ownership, 2001-2003. Social Sci 4. Injuries and violence: the facts. Geneva, World Health Med. 2007; 64 (2):656-64 Organization, 2010. Website: [www.who.int/violence_ 21. Humayun M, Khan D, Zaman F, Khan J, Khan O, Parveen Z. injury_prevention/key_facts/en/]. Analysis of homicidal deaths in district Di Khan: an autopsy 5. Charles F, John PV, Carol PV. Executive summary. Firearms study. J Ayub Med Coll Abbottabad.2009;21(1). 454-56. and Violence: A Critical Review. Washington, DC: National 22. Beth B, Lizotte AJ. Gun Ownership and Gang Membership". Academies Press. National Research Council 2004. J Crim Law & Criminology. 1973; 86(1): 37-58. Website: [http://www.apa.org/pubs/info/reports/gun- 23. James WD, Joseph F, Smith D. Kids, Guns, and Killing Fields". violence-prevention.aspx]. Society .1993; 30 (1). 1402-11. 6. Hassan Q, Shah MM, Bashir MZ. Homicide in Abbottabad. J 24. Perkins C, BJS Statistician Bureau of Justice Statistics Special Ayub Med Coll Abbottabad. 2005;17(1):78-80. Report National Crime Victimization Survey, 1993- 7. Seventh United Nations Survey of Crime Trends and 2001Weapon Use and Violent Crime September 2003. NCJ Operations of Criminal Justice Systems 1998-2000. WEB SITE, [http://www.bjs.gov/content/ Website: [www.unodc.org/pdf/crime/seventh_survey/ pub/pdf/wuvc01.pdf]. 7sc.pdf]. 25. Molina DK, Maio DV, Cave R. Gunshot wounds: a review of 8. Marwah S. Mapping Murder: Homicide Patterns And firearm type, range, and location as pertaining to manner of Trends In India An Analysis From 2000-2010 J. S. Asian Stud. death. Am J Forensic Med Pathol. 2013; 34(4):366-71. 2014; 2(2): 145-63. 26. Homicide. Website: www.undc.org/document/data/-and- 9. Afridi H, Zaman FU, Yousaf1M J. Pattern Of Injury To Internal analysis/statistics/GSH2013/2014-GLOBAL-Book] Organs In Firearm Homicidal Cases - On Autopsy Med. Sci. Retrieved on 17th Dec 2015 2014; 22(4): 177-81. 27. Mandal AK, Sanusi M. Penetrating chest wounds: 24 years' 10. Nasrullah M, Razzak JA. Firearm Injuries Presenting to a experience. World J Surg 2001; 25(2): 1145-49. Tertiary Care Hospital of Karachi, Pakistan. Inj Violence Res. 28. Miller T. The cost of firearm violence. Children's Safety 2009; 1(1): 27-31. Network Econ. and Data Anal. Resour Cent Pac Inst Res 11. Chotani HA, Razzak JA, Luby SP. Patterns of violence in Eval. 2013. Website: [http://www.childrenssafetynetwork. Karachi, Pakistan. Inj Prev. 2002;8(1):57-59. org/sites/ children safety network]. 12. Arif A, Ahmad M. Profile of Firearm Autopsies in Multan- A 29. http://tribune.com.pk/story/380032/the-weapons-trai- Five Year Study. Website: [pjmhsonline.com/ part-1-where-do-20m-illegal-arms-come-from/ apriltojune2015/profile_of_firearm_autopsies.htmby]. 30. Hougen HP 1, Rogde S, Poulsen K. Homicide by firearms in 13. Humayun M, Khan D, Zaman F, Khan J, Khan O, Parveen Z. two Scandinavian capitals. Am J Forensic Med Pathol. 2000 Analysis of homicidal deaths in district Di Khan: an autopsy Sep; 21(3):281-86. study. J Ayub Med Coll Abbottabad. 2009;21(1). 22-25.

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