The Beirut Pager Explosions of 2024: A Systematic Review of an Unprecedented Mass Casualty Event

In September 2024, Lebanon experienced an unprecedented mass casualty incident involving the simultaneous detonation of thousands of weaponized pager devices. This systematic review characterizes the resulting injury patterns, surgical burden, and disaster-response lessons to help inform future preparedness and response strategies.

PubMed, Embase, Scopus, and Web of Science were searched for studies on casualties from the pager explosions. A random-effects meta-analysis estimated pooled prevalence of injuries by body region.

Sixteen articles met inclusion criteria overall, comprising seven studies in the clinical synthesis and nine articles in the qualitative disaster-response synthesis. A consistent injury pattern predominantly affected the hands, face, and eyes. Specialty-specific cohorts demonstrated severe ocular destruction, frequent hand amputation, and a substantial operative burden. In the two comparable hospital-based cohorts eligible for meta-analysis, upper extremity injuries were most common (pooled prevalence 84%; 95% CI: 73-91%; I² = 0%). The incident exposed critical weaknesses in triage, communication, and specialty surge capacity.

The 2024 pager explosions produced a novel injury signature distinct from conventional blast trauma. These findings, while based on limited case series, underscore the urgent need for health care systems to develop flexible, adaptive disaster plans that can respond to the unique threats of unconventional warfare.