An Imperfect Peace: Trends In Paramilitary Related Violence 20 Years After The Northern Ireland Ceasefires

BACKGROUND: The 1994 Northern Ireland ceasefire heralded a new beginning for the region after 30-years of violence. In the 20-years following the cessation of hostilities, paramilitary punishment attacks continue to occur in breach of the ceasefire. The aim of this study was to review trends in these attacks over the 20-years and their impact on orthopaedic services. METHODS: We conducted a retrospective review of patients admitted under orthopaedic services following paramilitary assault across Northern Ireland over the last 20-years. The frequency of assaults, demographics of the victim population, injury pattern and weapons used was determined. Data on the total number of attacks was obtained from the Police Service for Northern Ireland (PSNI). RESULTS: 3691 paramilitary style attacks occurred between 1994 and 2014 despite bilateral ceasefires. The overwhelming majority of attacks are on males, however females and children as young as 12 have been victims. Prior to 1994, penetrating trauma predominated (62% vs 38%), with blunt trauma more common post ceasefire (60% vs 40%). 33% of those injured required orthopaedic treatment. The type of weapon used in these assaults has changed primarily from ballistic to non-ballistic devices. CONCLUSIONS: We present data of paramilitary related trauma presenting to orthopaedic services across Northern Ireland in the 20-years since the conclusion of hostilities following the negotiated 1994 ceasefire. Many assaults continue to occur despite being in breach of the ceasefire. The frequency of these assaults is however, declining. The type of weapons used has changed resulting in less ballistic trauma and more blunt trauma. The injury pattern associated with blunt trauma has significant long-term morbidity and potentially a greater financial burden on the health service. IMPLICATIONS: 20-years of peace in Northern Ireland has had a hugely positive impact on the political and financial stability of the region. Unfortunately, continued violence represents a significant burden on the health service resources and causes potential long-term changes to victim’s lives.