Blast and fragmentation injuries associated with cluster munitions in modern warfare: a narrative review

Cluster munitions remain a significant source of blast and fragmentation injuries in modern armed conflicts owing to their wide-area effects, high fragment density, and the persistence of unexploded submunitions. These weapons generate complex injury patterns involving blast overpressure, high-velocity fragment penetration, thermal effects, and multi-system trauma, posing substantial clinical, forensic, and humanitarian challenges. This narrative review synthesizes current evidence on injury mechanisms associated with cluster munitions, with particular emphasis on fragment-induced penetrating trauma, wound morphology, injury biomechanics, and forensic interpretation. Relevant literature was identified through searches of major scientific databases and supplemented by forensic and conflict-related reports. The reviewed evidence indicates that secondary blast injuries caused by high-velocity fragments represent the predominant mechanism of injury associated with cluster munitions, frequently affecting the extremities, head, neck, thorax, and abdomen. Fragment characteristics, including velocity, mass, geometry, and impact angle, strongly influence penetration behaviour, tissue disruption, and wound patterns. Recent advances in ballistic gelatin testing, tissue simulants, post-mortem investigations, medical imaging, and computational modeling have improved understanding of fragment-tissue interactions and injury prediction. From a forensic perspective, irregular wound morphology, retained metallic fragments, complex injury trajectories, and multisystem trauma present significant challenges for injury reconstruction, weapon attribution, and cause-of-death determination. In addition to immediate casualties, unexploded ordnance (UXO) associated with cluster munitions continues to cause injuries and fatalities long after hostilities have ceased. Despite advances in injury biomechanics and forensic investigation, significant gaps remain in the quantitative characterization of fragment injuries and standardization of medico-legal assessment protocols. Improved integration of forensic pathology, biomechanics, trauma medicine, and computational modeling is essential for advancing injury reconstruction, forensic investigation, protective strategies, and civilian protection in conflict-affected environments.