Revisiting the Battle of Solferino: The Worsening Plight of Civilian Casualties in War and Conflict

Frederick M. Burkle

Research output: Contribution to journalReview articlepeer-review


The toll of civilian deaths in current wars and conflicts has been building for decades. Civilian populations, particularly since WWII, have suffered most of the consequences of armed violence and today represent the most at-risk population. This is attributed to the rise of religious and ethnic hatreds, the collapse of State structures, the battle for control of natural resources, the vast availability of weapons, the proliferation of acts of terrorism, and the spread of so-called asymmetric conflicts. Protections provided to innocent civilians under International Humanitarian Law and the Geneva Conventions have been ignored. This commentary captures the experience of the immediate care and transportation provided to military casualties of the Battle of Solferino in 1859 with civilian casualties recently documented in a Stanford-led study during the "golden hour" after injury in 13 conflicts from 1990 to 2017. Despite many advances in triage and management of war injuries over the intervening decades, the common thread of these 2 scenarios is that transport times and early resuscitation capacity and capabilities, first recognized in the 19th century wars and now accepted as global norms and markers for survival from trauma, are as unavailable today to civilians caught up in war and conflict as they were to soldiers in the 19th century.

Original languageEnglish (US)
JournalDisaster medicine and public health preparedness
StateAccepted/In press - Jan 1 2019
Externally publishedYes


  • Geneva Convention
  • civilian casualties
  • international humanitarian law
  • trauma
  • war and conflict

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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