Traumatic injuries and outcomes during the Libyan Civil War: a systematic review

Introduction The Libyan Civil War (LCW) is an ongoing internal armed conflict that started as a peaceful protest in February 2011, resulting in a power vacuum after the regime collapsed and an uncontrolled spread of arms, which caused a significant increase in violence and trauma. Our review aims to investigate the war-related epidemiology and mortality in patients who have been injured during this conflict.

Methods A systematic review was undertaken according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Medline, Embase, Web of Science and Cochrane Library databases were searched for studies published between February 2011 and May 2024. Studies were included if they involved patients with trauma during the LCW and outcomes of interest were type and anatomical distribution of injuries and mortality. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation.

Results Thirteen studies met the eligibility criteria, with a total sample size of 4665 patients. There were seven studies (n=4378 patients) that reported mortality rate, with 438 (10%) who died. 13 out of the 14 studies documented the mechanism of injury of their participants with a total number of 4543 injuries, most commonly from firearm-related trauma (60.3%). 12 studies recorded the anatomical distribution of their sample of 4123 anatomical sites, with extremities being the most affected part, accounting for 54.5% of injuries.

Conclusion The LCW has caused a high burden of morbidity and mortality among the Libyan population. This review provides an insight into the adverse health consequences of this active war and highlights the difficulties in collecting reliable information on the wounded during conflicts.

PROSPERO registration number

CRD42024527289.