The Beirut Pager Explosions of 2024: A Systematic Review of an Unprecedented Mass Casualty Event
Clinical Snapshot
PICO Framework
| P — Population | Casualties from the September 2024 pager explosions in Lebanon |
| I — Intervention | Not applicable (observational systematic review) |
| C — Comparator | Not applicable (descriptive analysis of injury patterns) |
| O — Outcomes | Injury patterns by body region, surgical burden, disaster response effectiveness |
Bottom Line
This systematic review of the 2024 Lebanese pager explosions reveals a distinctive injury pattern with 84% of casualties sustaining upper extremity trauma, predominantly affecting hands, face, and eyes. The event exposed critical gaps in healthcare surge capacity for specialty services, particularly ophthalmology and plastic surgery. While based on limited case series from a unique incident, these findings highlight the need for adaptive disaster preparedness that accounts for unconventional warfare tactics. Healthcare systems should consider developing flexible surge protocols for hand and eye trauma, enhanced triage systems for complex injury patterns, and improved communication networks for coordinated specialty response. The consistency of injury patterns across studies (I² = 0%) suggests reliable clinical findings, though generalizability remains limited given the unprecedented nature of this mass casualty event.
Key Findings
P Value: Not reported
Effect Size: 84% pooled prevalence
Primary Outcome: Upper extremity injury prevalence
Nnt Or Sensitivity: I² = 0% indicating no heterogeneity between studies
Confidence Interval: 73-91%
Clinical Application
Findings applicable to emergency preparedness planning, particularly for hand/eye trauma surge capacity Relevant for Australian emergency management planning, particularly given potential for similar unconventional threats. May inform TGA device security considerations and RACGP emergency preparedness guidelines Healthcare systems preparing for unconventional mass casualty events involving explosive devices
Abstract
OBJECTIVE: In September 2024, Lebanon experienced an unprecedented mass casualty incident involving the simultaneous detonation of thousands of weaponized pager devices. This systematic review characterizes the resulting injury patterns, surgical burden, and disaster-response lessons to help inform future preparedness and response strategies. METHODS: PubMed, Embase, Scopus, and Web of Science were searched for studies on casualties from the pager explosions. A random-effects meta-analysis estimated pooled prevalence of injuries by body region. RESULTS: Sixteen articles met inclusion criteria overall, comprising seven studies in the clinical synthesis and nine articles in the qualitative disaster-response synthesis. A consistent injury pattern predominantly affected the hands, face, and eyes. Specialty-specific cohorts demonstrated severe ocular destruction, frequent hand amputation, and a substantial operative burden. In the two comparable hospital-based cohorts eligible for meta-analysis, upper extremity injuries were most common (pooled prevalence 84%; 95% CI: 73-91%; I2 = 0%). The incident exposed critical weaknesses in triage, communication, and specialty surge capacity. CONCLUSION: The 2024 pager explosions produced a novel injury signature distinct from conventional blast trauma. These findings, while based on limited case series, underscore the urgent need for health care systems to develop flexible, adaptive disaster plans that can respond to the unique threats of unconventional warfare.
References
- 1.Saad, C., Slaiby, N., Chalhoub, G., Mina, C., & Helou, M. C. (2026). The Beirut Pager Explosions of 2024: A Systematic Review of an Unprecedented Mass Casualty Event. Disaster Medicine and Public Health Preparedness. https://doi.org/10.1017/dmp.2026.10357
Related Research
Journal of critical care
Artificial intelligence and computerized decision support in adult intensive care: A systematic review of randomized controlled trials
3 Aug 2026
Journal of pediatric surgery
Interpretable deep learning model for pediatric strangulated small bowel obstruction on CT: A multicenter study
3 Aug 2026
Telemedicine journal and e-health : the official journal of the American Telemedicine Association
Application of Telehealth and Artificial Intelligence in Military Health Care: A Promising Combination for the Future
3 Aug 2026
This content is for educational purposes for healthcare professionals only and does not constitute clinical advice. Clinical decisions should be based on individual patient assessment, current guidelines, and appropriate specialist consultation. Editorial Standards · Privacy Policy · Terms of Service