Civilians constitute a significant wartime target, and trauma accounts for most of their injuries. Air raid sirens have long been used to alert civilians of incoming attacks and have since expanded to warn of natural disasters. Sirens are known to cause significant emotional distress and physiological changes. Injuries inflicted from trauma during a run for shelter have yet to be described in the medical literature.

During the recent Israel-Gaza conflict of May 2021, most of Israel's population experienced rocket warning sirens. We collected all adult patients arriving at a major tertiary medical center emergency department (ED), attesting to having suffered their injury while running for shelter. Clinical and demographic data were retrieved and analyzed.

A total of 48 patients were identified, with a mean age of 59.6±20.0. Ten (21%) patients were admitted, and their mean length of stay was 4.4±3.7 days. Women had a higher probability of being hospitalized (42.9% vs. 5.9%, p=0.04), and those hospitalized tended to be older (68.8±16.4 vs. 54.8±20.8, p=0.06). Extremity injuries were most common (50%), before head trauma (29%), and torso injuries (25%). Most patients (38/48, 79.2%) were discharged from the ED, and the rest were hospitalized for observation or surgery. One patient died from a head injury.

This study implies that injuries while running for shelter were the most significant cause of physical injury to Israeli civilians during the Israel-Gaza 2021 conflict. Warning siren injuries should be given appropriate attention from prevention by directed media campaigns to post-conflict reimbursement.