24.Mahajna, A., Aboud, N., Harbaji, I., Agbaria, A., Lankovsky, Z., Michaelson, M., Fisher, D., and Krausz, M. Blunt and penetrating injuries caused by rubber bullets during the Israeli-Arab conflict in October, 2000: a retrospective study. The Lancet 2002; 359,9320:1795-1800

Low-velocity rubber bullets were used by Israeli police to control riots by Israeli-Arabs in early October 2000. This study aims to establish the factors that contribute to severity of blunt and penetrating injuries caused by these missiles. Medical records of 595 casualties admitted were analyzed. Relation of severity of injury to type of bullet, anatomical region of injury, and final outcome were assessed. One female and 151 males (age range 11–59 years) were included in the study, in which 201 proven injuries by rubber bullets were detected. Injuries were distributed randomly over the body surface and were mostly located in the limbs (n=73), but those to the head, neck, and face (61), chest (39), back (16), and abdomen (12) were also frequently noted. 93 (61%) patients had blunt injuries and 59 (39%) penetrating ones. Severity of injury was dependent on ballistic features of the bullet, firing range, and anatomic site of impact. Two casualties died after a penetrating ocular injury into the brain and one died as a result of postoperative aspiration after a knee injury. Interpretation Resistance of the body surface at the site of impact (elastic limit) is the important factor that ascertains whether a blunt or penetrating injury is inflicted and its severity. Inaccuracy of rubber bullets and improper aiming and range of use resulted in severe injury and death in a substantial number of people.