Abstract

Background: The atrocity of 9/11 exemplified ‘external’ caused civil violent deaths which have major policy implications for the countries contributing armed forces to the ‘Coalition-In-Iraq’ [C.I.I]. C.I.I Government’s resources for perennial ’internal’ violent deaths (suicide homicide and road) are likely to be threatened by alternative priorities. C.I.I ‘internal’ deaths are compared with those of 9/11 to provide information to determine relative risks. Material/Methods: To uniformly compare mortality between countries we utilise the most recent WHO mortality data taking the latest three years 1997–1999 and calculating an average annual number and rate of ‘internal’ deaths in each country these are compared with the 9/11 fatalities calculating a proportional ratio as an indicator of differential damage to families and society. Results: USA ‘external’ deaths were 3074 people and annual average suicides were 30966. Total ‘internal’ deaths exceeded ‘external’ more than 30 times. Every fortnight there are more USA ‘internal’ violent deaths than on 9/11. Except Australia and Bulgaria every country had more suicides than died on 9/11. Apart from Bulgaria total ‘internal’ deaths exceeded the ‘external’ toll in all other CAI countries- by 14 times in Japan; 6 in Republic of Korea 4 in Italy 3 in Spain and the UK twice in Canada and 1.5 times in Australia. Conclusions: The extent of ‘internal’ civil violent deaths such as suicide highlight the perennial pressures upon psychiatric services and the need to defend resources at a time of competing priorities.