Editorial comment: soft tissue infection after missile injuries to the extremities--a non-randomized, prospective study in Gaza City.

In the last decade, hundreds of civilians and soldiers died, and thousands were wounded due to numerous terrorist attacks in Israel. 1–3 This conflict led to prolonged , low-intensity damage to people and property, which is different than a total war. In the military literature, this is called low-intensity conflict. Low-intensity conflict is not peace and it is not war—the severity and distribution of injuries and principles of the medical response are different. In some incidents, the principles resemble those during a wartime medical responses, and in some incidents, the principles resemble those of peacetime medical responses. In other incidents, the response is unique. Low-intensity conflict is different from war in several ways: (1) the force is localized; (2) the destructive energy of the weapons is lower; (3) the number of casualties per day is lower; (4) the frequency of major wounds is lower; (5) the availability of medical personnel and means of evacuation is higher; (6) the proximity to high-level trauma hospitals is closer; and (7) the transport time is shorter. There is not enough data concerning the best management of wounds during a low-intensity conflict. It is not clear whether the principles of wound care should be similar to those of wartime injuries or to peacetime injuries. In a recent study, the injury data regarding Israel Defense Forces (IDF) casualties during the first 19 weeks of the events was analyzed by the IDF Medical Corps. Ninety-six of the 356 IDF casualties during the first four months of the events were admitted or killed. Bullets were the most common cause of injury (63.5%). Fragments and explosives accounted for 14.6% of injuries, stones and sling-thrown marbles accounted for 9.4% of injuries, and 12.5% of injuries were due to miscellaneous causes. The most commonly injured body regions included the head, face, and neck (54.2%), and the limbs (50.0%). The trunk was injured in 25% of the cases, and 4.2% of the injuries were classified as external. A total of 83.8% of the casualties were evacuated by ambulances and the rest were evacuated by air. All casualties, except for one, arrived at the hospital within 1.5 hours after the injury. Seventy-five percent of the injured were evacuated to trauma centers, and the rest were evacuated to other hospitals. Most of the soldiers either were mildly injured or killed; few suffered severe injuries. 4 Hamouda et al suggest that missile wounds in this …