Are there lessons for Baghdad in the Boston bombings?

Amid the bleak news of the Boston Marathon bombing and its dramatic aftermath, one silver lining has been the success of the first responders in preventing a far more horrific outcome after the explosions. And people are citing an unlikely reason why: the war in Iraq.

In recent days, several articles have pointed to just how instrumental the lessons learned on the battlefield in Iraq and Afghanistan were to mitigating the damage in Boston. Scientific American notes that experiences with IEDs taught medics the importance of responding quickly, since bleeding out was identified as the most common cause of death in these explosions. In an article in Mother Jones, Tim Murphy echoes this idea, explaining the importance in Boston of applying tourniquets -- a lesson learned in Baghdad.

But the spate of deadly bombings from Somalia to Iraq in the days since the Boston bombings made us wonder if the reverse could be true: Could the lessons of Boston apply to bombings in Iraq?

In fact, this debate took place in the pages of the Lancet in 2011. After the medical journal published a statistical analysis of suicide bombings in Iraq that highlighted their disproportionate effect on civilians, Pierre Pasquier and two fellow French scientists wrote the authors a letter suggesting the application of basic care techniques could mitigate these effects, substantially decreasing fatalities.

They pointed to studies showing that in the early years of the war, "around 90% of military combat-related deaths occurred before the casualty reached a medical treatment facility," and went on to say that medics in the military subsequently focused on preventing exsanguination, or blood loss, through the applications of tourniquets in pre-surgical settings, which drastically reduced casualties -- the very lesson that was applied in Boston. They conclude:

Hence, focusing on civilians after bombing, we wonder whether simple tools such as the tourniquet, applied by the man in the street, could be a more efficient approach to improving survival than the hypothetical deployment of "high-quality treatment" facilities.

The study's authors, however, issued an obvious but important reply -- one that offers insight into why the lessons of Boston unfortunately may not be entirely applicable to Iraq:

It is essential to point out that, to whatever degree civilian-administered tourniquets might improve immediate rates of survival from extremity wounds caused by suicide bombs, a tourniquet is a temporary measure that does not replace the adequate health care required by victims for their continued survival. If a civilian-applied tourniquet is required temporarily to stanch severe bleeding from an extremity, to survive in the long term, that civilian will require effective emergency and surgical treatment to the limb once arriving at hospital.

They went on to cite studies about Israeli bombings to explain the complexity of injuries sustained in suicide attacks, pointing out that research shows the "substantial proportions of victims arrive not only with extremity injuries (44%), but also with internal injuries (32%), head injuries (22%), chest injuries (21%), abdominal injuries (16%), and burns (17%). Survival of these wounds would not be affected by tourniquets." Many of these injuries would require surgical and intense post-operation therapy, for which the Iraqi healthcare system does not have adequate capacity.

It's a frustrating reminder of the public health and infrastructural problems that need to be addressed if pre-surgical care in Iraq is to make a significant difference in saving civilian lives, as it did in Boston.

STR/AFP/Getty Images


Brothers in arms: A brief history of sibling terror plots

News that the two suspects in the Boston Marathon bombings are brothers has sparked a great deal of interest in their family history and the relationship between the two siblings. But if they were indeed behind the assault, they wouldn't be the first brothers to plot or carry out such an attack. Here is a look at some of their predecessors in recent years:

Duka brothers

In 2009, three brothers --ethnic Albanians from the former Yugoslavia -- were convicted of plotting to murder military personnel at Fort Dix, a base south of Trenton, N.J, along with two other men. Dritan Duka and Shain Duka received life in prison plus thirty years, while Eljvir received life imprisonment. The brothers claim they're innocent.

Merah brothers

Last March, Mohammed Merah fatally shot a rabbi, three Jewish schoolchildren, and three French paratroopers in an attack in Toulouse, France before he himself was gunned down in a shootout with police. Merah, who claimed he was trained by al Qaeda, said the attack stemmed from France's ban on the full Muslim veil, the country's presence in Afghanistan, and his disgust over the treatment of Palestinians. His brother Abdelkader is being held in France on charges of complicity.

Qazi brothers

Late last year, Sheheryar Alam Qazi and Raees Alam Qazi were charged with aiding terrorists and planning to detonate a weapon of mass destruction in the United States (U.S. prosecutors say Raees wanted to retaliate against U.S. drone strikes in Afghanistan by blowing up a New York City landmark). The Florida-based brothers are both naturalized U.S. citizens from Pakistan.

Warsame brothers

In March, a Danish court convicted two Danish brothers from Somalia of planning a terror attack with Somalia's al-Shabab militants, and sentenced each to three and a half years in prison. Guleed Mohamed Warsame and Nuur Mohamed Warsame were found guilty of conspiring to send Guleed to a Shabab-run training camp in Somalia.

Quider brothers

In January, two Bedouin brothers from the Negev confessed to a plot to fire rockets at Israel and stage a suicide bombing at a bus station in Beersheba. Mahmoud Abu Quider reportedly scouted the attack sites, while his brother, Samah, was to help carry out the assaults.

Handout/Getty Images