Neurological Sciences

, Volume 34, Issue 11, pp 1971–1976 | Cite as

Pain and neurological sequelae of cluster munitions on children and adolescents in South Lebanon

  • Youssef FaresEmail author
  • Fouad Ayoub
  • Jawad Fares
  • Rabi Khazim
  • Mahmoud Khazim
  • Souheil Gebeily
Original Article


This paper aims at evaluating the neurological repercussions arising from injuries sustained due to cluster munitions in children up to 18 years in South Lebanon following the 2006 conflict. Data on neurological and pain symptoms suffered during and after treatment because of sub-munitions in South Lebanon from August 2006 till late 2011 were prospectively recorded. Patients were divided into subcategories; children aged 12 and under and adolescents aged between 13 and 18. During the study period, there were 407 casualties, 122 (30 %) of which were aged 18 years or younger. There were 116 (95 %) males and six (5 %) females. Average age was 14 years. 10 (8.2 %), all males, died as a result of their injuries. 42 (34.4 %) were children and 80 (65.6 %) were adolescents. 112 had surgical treatments for their injuries. 83 out of 112 patients (74 %) with non-lethal injuries had amputations, 67 % children and 78 % adolescents. Among those who had amputations, 31 (37.4 %) suffered from phantom limb pain and 71 % suffered from stump/residual limb pain. 88 % of patients were diagnosed with post-traumatic stress disorder (44 % children and 77 % adolescents) and 41 % were diagnosed with post-concussion syndrome. Four patients (3.6 %) suffered from traumatic brain injuries, both penetrating and closed. Pain syndromes were found in all patients who had amputation. The injury related comorbidities together with many post-concussion syndrome cases, and fewer traumatic brain injuries lead into a high level of physical, psychosocial and economic burdens on the community.


Cluster bombs Cluster munitions Neurological effects Psychological effects Pain 


  1. 1.
    Beehner L (2006) The campaign to ban cluster bombs. Backgrounder. Accessed 21 April 2012
  2. 2.
    Jaber H (2009) Cluster bombs leave ‘toys’ that kill children. Accessed 24 November 2012
  3. 3.
    (2010) International Campaign to Ban Landmines. Landmine Monitor. Accessed 24 May 2012
  4. 4.
    (2011) Children and Landmines: A Deadly Legacy. Unicef. Accessed 23 June 2012
  5. 5.
    Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, Cunin G, Fermanian J, Ginies P, Grun-Overdyking A, Jafari-Schluep H, Lantéri-Minet M, Laurent B, Mick G, Serrie A, Valade D, Vicaut E (2005) Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 114:29–36PubMedCrossRefGoogle Scholar
  6. 6.
    Nixon R (2007) Of landmines and cluster bombs. Cult Crit 67:160–174CrossRefGoogle Scholar
  7. 7.
    Walsh NE, Walsh WS (2003) Rehabilitation of landmine victims—the ultimate challenge. Bull World Health Organ 81:665–670PubMedGoogle Scholar
  8. 8.
    Watts HG (2009) The consequences for children of explosive remnants of war: land mines, unexploded ordnance, improvised explosive devices and cluster bombs. J Pediatr Rehabil Med 2:217–227PubMedGoogle Scholar
  9. 9.
    Williamson B (2011) The impact of ERW on children. J ERW Mine Action 15:29–32Google Scholar
  10. 10.
    Fares Y, Fares J (2013) Anatomical and neuropsychological effects of cluster munitions. Neurol Sci. doi: 10.1007/s10072-013-1343-7 Google Scholar
  11. 11.
    Borrie J, Cave R (2006) The humanitarian effects of cluster munitions: why should we worry. Clust Munitions 4:5–13Google Scholar
  12. 12.
    Bendinelli C (2009) Effects of land mines and unexploded ordnance on the pediatric population and comparison with adults in rural Cambodia. World J Surg 33:1070–1074PubMedCrossRefGoogle Scholar
  13. 13.
    Kalauokalani DAK, Loeser JD (1999) Phantom limb pain. In: Crombie IK (ed) Epidemiology of Pain. IASP Press, Seattle, pp 143–153Google Scholar
  14. 14.
    Kooijman CM, Dijkstra PU, Geertzen JHB, Elzinga A, Van der Schans CP (2000) Phantom pain and phantom sensations in upper limb amputees: an epidemiological study. Pain 87:33–41PubMedCrossRefGoogle Scholar
  15. 15.
    Flor H, Elbert T, Muhlnickel W, Pantev C, Wienbruch C, Taub E (1998) Cortical reorganization and phantom phenomena in congenital and traumatic upper-extremity amputees. Brain Res 119:205–212CrossRefGoogle Scholar
  16. 16.
    Sherman RA, Sherman CJ, Parker L (1984) A survey of current phantom limb treatment in the United States. Pain 8:85–99CrossRefGoogle Scholar
  17. 17.
    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders: DSM-IV. American Psychiatric Association, Washington, DCGoogle Scholar
  18. 18.
    Roth W, Briar-Lawson K (2011) Globalizations. State University of New York Press, New York, Social Justice and the Helping ProfessionsGoogle Scholar
  19. 19.
    Ling G, Bandak F, Armonda R, Grant G, Ecklund J (2009) Explosive blast neurotrauma. J Neurotrauma 26:815–825PubMedCrossRefGoogle Scholar
  20. 20.
    Bandak FA, Eppinger R, Ommaya A (1996) Traumatic brain injury: bioscience and mechanics. Mary Ann Liebert Publishers, New York, pp 167–172Google Scholar

Copyright information

© Springer-Verlag Italia 2013

Authors and Affiliations

  • Youssef Fares
    • 1
    Email author
  • Fouad Ayoub
    • 2
  • Jawad Fares
    • 3
  • Rabi Khazim
    • 4
  • Mahmoud Khazim
    • 5
  • Souheil Gebeily
    • 6
  1. 1.Neurosurgery Division, Faculty of Medical SciencesLebanese UniversityBeirutLebanon
  2. 2.Department of Basic Sciences, Faculty of Dental MedicineLebanese UniversityBeirutLebanon
  3. 3.Faculty of MedicineAmerican University of BeirutBeirutLebanon
  4. 4.Orthopaedics, Southend University HospitalEssexUK
  5. 5.Institute of Human GeneticsNewcastle UniversityNewcastleUK
  6. 6.Neurology Division, Faculty of Medical SciencesLebanese UniversityBeirutLebanon

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