Rubber bullets cause injury, disability, death

Reuters Health Information: Rubber bullets cause injury, disability, death

Rubber bullets cause injury, disability, death

Last Updated: 2017-12-22

By Will Boggs MD

NEW YORK (Reuters Health) - Rubber bullets and other kinetic impact projectiles (KIPs) used in crowd-control settings can cause serious injury, permanent disability, and death, according to a systematic review.

"We conclude by saying that there is likely no role for projectiles in crowd control, primarily because they are indiscriminate at long ranges (where they are supposed to be used) and similar to live ammunition at close ranges (where they are unfortunately often used)," Dr. Rohini J. Haar from University of California, Berkeley, told Reuters Health by email.

Manufacturers produce more than 75 different types of KIPs that are designed as crowd-control weapons to incapacitate individuals by inflicting pain or sublethal injury. KIPs can cause blunt and penetrative injuries, ranging from local contusions to severe organ damage and death. Injuries resulting from KIPs are not well documented.

Dr. Haar and colleagues systematically reviewed the literature on these weapons as part of a larger effort by Physicians for Human Rights and the International Network of Civil Liberties Organization to research their health effects and develop recommendations on avoiding preventable injury, disability, and death.

The 26 reviewed articles identified 1984 people with injuries, including 53 (3%) who died from their injuries and 300 (15%) who were permanently disabled, according to the December 18 BMJ Open online report.

Most of the deaths resulted from penetrative injuries (56%), with blunt injury accounting for 23%.

The majority of injuries resulting in permanent disability were secondary to vision loss and abdominal injuries resulting in splenectomy or colostomy. Two individuals required limb amputations.

Of the 2,135 injuries among the 1,931 survivors (including the 300 with permanent disabilities), 71% were severe. Of the head-and-neck, ocular, nervous, cardiovascular, pulmonary and thoracic, abdominal, and urogenital injuries, 91.5% were severe. Skin injuries were generally minor, whereas 87% of musculoskeletal injuries to the limbs were severe.

Most of the injuries and permanent disabilities were from bullets that had a metal core or were otherwise composed of metal, and the firing distance of the weapon was generally less than designated or directly related to the severity of the injury.

Several articles pointed out that KIPs are inherently inaccurate at longer distances, with some reporting instances in which these weapons unintentionally injured bystanders and nonviolent demonstrators instead of the targeted individuals.

Seven articles also indicated that delays to medical care contributed to morbidity from these injuries.

The researchers note, "While this article focuses on the injuries caused by KIPs, other crowd-control weapons (CCWs), such as tear gas, water cannons, acoustic weapons and electrical devices, have caused significant injury. This discussion does not in any way suggest that other weapons are safer but rather that appropriate use of force and alternatives to weapons must be considered in all contexts."

"The best alternative would be proportionate and community-based traditional policing strategies (arresting trouble makers and protecting peaceful protestors' safety and right to assembly and speech)," Dr. Haar said. "If things get violent and single arrests are not viable, there are other alternatives that can be used with caution - anything from clear communication, discussing with leaders, to kettling (confining demonstrators to a small area), to cautious use of other crowd-control weapons. Rubber bullets, however, represent some of the most dangerous and should not be used."

"There are countries (Ireland, for instance) that have made strong headway in collaborating with human rights organizations and really understanding the proportionate use principle and human rights foundations for policing," he added. "Many other countries, including the U.S., perhaps Egypt is an extreme example, have not taken any steps and have gotten worse. Most are somewhere in the middle. We hope, with this article, to shine a light on a global issue - all countries deal with it."

"More research is required to better understand regional differences in the usage, policy and accountability around the use of these weapons," the authors conclude. "There is an urgent need to establish international guidelines on the use of CCWs to prevent unnecessary injury, disability and death, particularly in the use of operational models that avoid the use of weapons."


BMJ Open 2017.

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