The medical consequences of incendiary weapon use in 21st-century armed conflict: A scoping review

Incendiary weapons (IW) have been used in 21st-century armed conflicts, causing severe burn injuries with lifelong physical and psychological consequences. Existing international law has shortcomings that have undermined its ability to adequately address the human cost of IW. While the harm from IW has been reported, limited standardized clinical data on their medical effects, in addition to high-quality evidence on treatment protocols, exist. No structured assessment of existing literature on this topic exists. This review seeks to address this gap.

A scoping review was conducted to evaluate existing literature and identify evidence gaps regarding the medical effects and management of IW injuries in 21st-century armed conflict. A systematic search strategy was performed using standardized inclusion criteria. A standardized extraction form was used to capture data elements for description in both peer-reviewed and grey literature.

Our search identified 14,050 records for screening across peer-reviewed and grey literature that were narrowed to 56 included reports. A total of 5565 patients were specifically reported to be affected by IW across 26 countries; however, there was a lack of homogeneous reporting across all categories of interest. Available reports described severe and multidimensional injuries with lack of consensus regarding both diagnosis and treatment of IW injuries.

Available data regarding IW use, injury, and treatment are heterogeneous, limiting epidemiological analysis to inform care and practice guidelines. The described injuries raise the need for standardized data collection and focused training on IW care in conflict settings. Global databases to strengthen the evidence base on IW casualties are needed to enhance policy efforts, diagnosis and treatment standards, and trainings, which will in turn improve clinical performance.