up a newspaper and look at the international section. Most of
it will refer to acts of armed violence, to agreements that restrain
the capacity for armed violence, new means of inflicting armed
violence or just plain threats of armed violence. It takes little
to convince that armed violence is very much in our collective
conscience; furthermore, many historians argue that our world
as we know it, built on the notion of the nation state, is a world
born of armed violence, the capacity to inflict it and the restraint
of this capacity. Furthermore, the enforceability of our domestic
laws by which we abide ultimately depends upon threat of or actual
armed violence by legitimate carriers of weapons.
analysis of any war, rebellion or massacre tends to focus on political
motives, who is the guilty party or on the kinds of weapons used.
However, when the story extends to the victims, somehow rational
argument gets lost to sentiment. If we witness directly acts of
armed violence and their effects, logic deserts us; there is something
about armed violence that is so profoundly shocking, or dare I
say exciting, that it defies objective analysis. Perhaps this
is as it should be but if we can look past what shocks us, there
sits a health issue like all others - for it is undoubtedly a
health issue for the victims - and this invites a preventive approach.
pursuit of the means to find a way of talking objectively and
rationally about armed violence and its effects began during my
work as a field surgeon with the International Committee of the
Red Cross. It has continued during the work with the ICRC on a
variety of weaponry issues. Our antagonists would say "What's
the difference between blowing somebody's leg off with an antipersonnel
mine and blowing somebody's leg off with an artillery shell?"
(A buried antipersonnel mine results in a foot or leg amputation
in 100% cases because of its design; an artillery shell produces
the same effect in about 4% of its victims.) or "So you think
it's better to kill someone with a rifle than to blind them with
a laser?" or "You can kill someone with a toothpick if you really
want to!" or "Why bother with limiting small arms to the developing
world, they'll kill each other with machetes if they want to!"
or, more confusingly, "We know that non-lethal weapons might kill
some people - it just depends on how they're used." And these
were the experts speaking, often at conferences attempting to
bring rational argument to legal restraints about the design,
production, transfer and use of weapons.
can be analysed from a health perspective because, ultimately,
it affects people's physical, psychological or social well-being.1
Analysing armed violence in health terms carries the advantage
that it permits generic and objective consideration of sensitive,
shocking or emotional matters before entering into discussions
of the legal, political or "humanitarian" issues of a particular
analytic framework is a tool for sorting and prioritising a variety
of information about any given context. Incoming information is
appropriately categorised and the relationship between the categories
is established. Obviously, in an analytical framework of armed
violence, the effects of an act of armed violence make up one
of the categories; the other categories are made up of the determinants
of these effects.
can we categorise the determinants of the effects of armed violence?
When people suffer the effects of use of a particular weapon,
at some previous time, the weapon has to be transferred into the
hands of the user; before this, it has to be produced and before
production, it has to be designed and developed.3
Thus, important potential determinants of the effects of armed
violence are found in the continuum of "design - to - production
- to - transfer - to - use." The vulnerability of the victim or
potential victim is also important.
the nature of armed violence, the key determinants of the effects
the potential of the weapon to cause the effect (corresponding
the number of potential users armed (corresponding to
production and transfer);
the vulnerability of the victim (the potential to suffer
the potential for violence (intentional use of physical
essential part of this analytical framework is understanding the
interaction of these determinants; there are two core concepts:
first, effects of armed violence are only produced as long as
the potential of each determinant is above zero - each is a necessary
but not sufficient cause of the effects in question; second, the
potential for violence using weapons must be influenced by the
user's perceptions of the other three determinants - the complex
relationship between weapons and violence is played out in the
psychology of the user or users. By extrapolation, the nature
of the weapons themselves and their availability are major determinants
of the nature, timing and extent of armed violence.
analysing any act of armed violence the first step is to identify
the effects of concern. The next step is to identify the determinants
of these effects. Although one of the determinants may weigh more
heavily in the interaction than others, no single determinant
stands alone; the other three determinants must also come into
play. Addressing only one determinant may be ineffective in preventing
or limiting any given effect of armed violence unless that determinant
is eliminated completely.
or reporting any act of armed violence involves asking
1. What is the effect or effects that could be reduced
or eliminated? Bearing in mind that all four determinants must
be present in some way, four other questions follow:
2. What was the potential of the weapon or weapons to cause the
effect or effects?
3. How many potential users of the weapon or weapons were so armed?
4. In what way were the victims vulnerable? Given the answers
to questions 1 to 4:
5. What conclusions can be drawn or further questions asked about:
preventing or limiting the effects?
the context in which the weapon or weapons are, were
or would be used?
the intent of the user or users of the weapon?
of the framework to using explosive weapons in a populated area
injuries in a populated area under bombardment always generates
headline news. The hospital images are usually heart-rending.
Analysis revolves around whether the act of bombardment intentionally
targeted civilians or whether the target was a legitimate military
objective. If we apply the analytical framework of armed violence,
the effect we are concerned about (and should not lose sight of)
is the number of civilians killed or injured. The presented framework,
by placing reduction or prevention of a particular effect foremost,
forces us to think beyond the political situation and beyond whether
the combatants have broken law or whether the wounded receive
adequate surgical care in hospital.
contributes to the civilians vulnerability? Are they injured by
flying glass as the windows in their homes are shattered? If so,
distribution of adhesive plastic sheeting may reduce injuries
while resolution of the conflict is negotiated. Are they injured
in bread queues or at water distribution points? If so, the distribution
of these vital commodities could be changed in time or space so
as to reduce the number people waiting in an exposed location.
Alternatively, the bombarding party may agree to withdraw their
weapons to a greater distance. However, if the bombardment then
continues, any inaccuracies are likely to be multiplied and, in
addition, the users are unable to see or verify the damage produced;
the number of civilian deaths and injuries may increase. A defending
commander might place military objects in a populated area with
a view to protecting a town. But does this not also increase the
vulnerability of the inhabitants? Commanders on both sides have
a legal obligation to ensure the protection of civilians on whichever
side; this approach may help to frame dialogue between for example,
a commander working under a United Nations mandate and two belligerent
parties. These are just some of the approaches that may be generated
by bearing the analytical framework in mind. In brief, considering
the determinants of "collateral damage" permits its prediction;
prediction is the first step in prevention.
of the framework to use of biological weapons against civilians
effects of concern in this example are disease or diseases intentionally
inflicted on civilians. This phrase distinguishes the effect from
"bioterrorism" which refers to the weapon and the motivation behind
its use. The framework encourages systematic consideration of
preventive strategies from public health preparedness to criminalization
of the transfer of pathogens.
is generally held that biological weapons are easy to produce.
The reason that they have been infrequently used in warfare is
the difficulty of finding a safe and efficient delivery system.
The analytical framework explains how a small group or even one
person can deliver an agent in such a way as to terrorise a population
given selection of the right agent. To maximise the delivery for
this effect, one or a small number of people must use a simple
system or an existing system that would achieve the intended effect,
i.e., the postal service.
to October 2001, an assumption was made that the objective of
an act of terrorism using anthrax spores would be to kill many
people, i.e., the starting point for consideration was the intent.
This generated predictions of means of delivery (e.g. a crop sprayer)
and how the target population would be vulnerable (e.g. a dense
population or football crowd). The analytical framework shows
that the only effect that was considered was "number of deaths."
If the effect under concern was thought of as "number of people
suffering fear of intentional infection" or "extent of breakdown
of civil services" it would be clear that other possibilities
could have been considered regarding the intended target, the
agent and, in turn, the delivery system. We should not have been
so surprised that anthrax spores were delivered via a postal service
even though, at the time of writing, the intent was unknown.
use of biological agents, especially against a civilian population
is very much in the minds of policy makers. If thought is given
to reducing effects such as the chances of suffering a particular
and intentionally inflicted disease or the psychological effects
brought by use of a biological agent, the analytical framework
forces consideration of who is vulnerable and how, the likely
agent and the likely means to deliver the agent. Together these
may indicate the human resource or technology needed to carry
out the attack and in turn may even provide pointers to potential
world has been shaped by armed violence, the capacity for it and
the means to restrain it. It seems likely that our future will
continue to be likewise influenced. Is it not time to take a multidisciplinary,
coherent, and objective look at armed violence and not let logic
desert us? The first step is to consider the effects of armed
violence for what they are: a health issue.
Definition of violence - the intentional use of physical force
or power, threatened or actual, against oneself, another person,
or against a group or community, that either results in or has
a likelihood to result in injury, death, psychological harm, maldevelopment
or deprivation (World Health Organisation); Definition of health
- a state of complete physical, mental and social well-being and
not merely the absence of disease (World Health Organisation);
Definition of Weapon - material thing designed or used or usable
as an instrument for inflicting bodily harm.
2. R. Coupland Armed Violence, Medicine and Global Survival, 2001,
vol. 7, pp. 33-37.
3. R. Coupland, The Effects of Weapons on Health, Lancet, 1996,
Vol. 347, pp.450-451.
Robin M. Coupland is the adviser on armed violence and the effects
of weapons for the International Committee of the Red Cross. He
joined the ICRC in 1987 and worked as a field surgeon in Thailand,
Cambodia, Pakistan, Afghanistan, Yemen, Angola, Somalia, Kenya
and Sudan. As part of his current position he has focused on the
effects of conventional and anti-personnel weapons. He has paid
particular attention to the effects of antipersonnel mines and,
by using the Red Cross wound classification, fragment injuries
and the disruption of bullets. In promoting the concept of weapons
as a health issue, his work led to the organisation in 1996 of
the Montreux Symposium and initiated the "SIrUS Project" which,
in turn, has led to an examination of international legal responsibility
of governments to review new weapons and weaponsÕ systems. He
has developed and published an analytical framework of armed violence
as a tool for reporting and communication.