American Univesity of Beirut

Study led by AUB professor documents ammonium nitrate impact in The Lancet

​Safa Jafari Safa, Office of Communications,​​​​​​

A study of the pattern of injuries caused by the Beirut Port explosion of August 4, 2020, led by AUB Professor Ahmad Mansour, has been published in the world leading medical journal, The Lancet. The study is based on a mass survey and is considered the most scientific documentation to date of an ammonium nitrate disaster.

This is the first report to document the trends and injuries from the Beirut Port ammonium nitrate explosion (BPANE) and documents around 14,000 persons injured by the blast, while local media have reported 4,000. The report was featured in the high impact international journal, The Lancet, which publishes papers that have made a crucial contribution to science and human health.

Titled “The Beirut Port explosion: injury trends from a mass survey of emergency admissions," the study was conducted by a research team composed of AUB post doc research fellow, Dr. Hana Mansour; resident in training, post graduate year 4, at Hotel Dieu de France emergency department, Dr. Eugenie Bitar; and 38 additional collaborators who worked under the guidance and supervision of three AUB professors: Dr. Ahmad Mansour, clinical professor in the department of ophthalmology; Dr. Eveline Hitti, chairperson of emergency medicine; and Dr. Fadlo Khuri, AUB president and professor of medicine (hematology and medical oncology). 

Over the days that followed the ignition of 2,700 tons of stored ammonium nitrate in the Beirut Port in what became one of the largest nonnuclear explosions in the last 100 years, the team conducted a mass survey of emergency department (ED) admissions to document and analyze the injury trends and patterns of victimized civilians. Over a diameter of 90 kilometers from the site of this highly rare event, emergency room admissions of 42 hospitals were surveyed.

Dr. Ahmad Mansour spoke to us about the study which documents 8,643 casualties while the estimated number exceeded 14,000, incompletely counted due to overcrowding and failure of registration in hospitals closely affected by the blast. The vast majority of emergency admissions had superficial lacerations from glass shards due to shattered windows or doors.

Only 12 percent were admitted for observation, for monitoring in intensive care unit or for surgical repair of fractures, tendon repairs, or reconstruction of eyes. Fatalities, which were estimated at 200 people, were seen to be low. This was related in part to the long experience of medical personnel in dealing with major explosions during the civil war, and also to the considerable number of hospitals and allied medical personnel.  

The study documents 8,643 ED utilizations within 52 hours post blast. Hospitals within five kilometers of the BPANE could not register all the patients due to unprecedented overcrowding. The number of such nonregistered casualties may have well exceeded 3,000 patients. Minor injuries (or first aid) were treated within health facilities related to the Red Cross, Civil Defense, nongovernmental organizations or private clinics and this category is estimated to count around 3,000 injured. 

According to the study, the large number of casualties resulted in a large number of operations including tendon laceration and fractures or eye lacerations. Besides the bodily injuries, psychological trauma showed up few days after the blast and were not studied in the current survey.

Dr. Mansour also spoke about the impact of ammonium nitrate as a high-order explosive that upon ignition can produce an over-pressurization shock wave with the shock front being a moving wall of highly compressed air travelling to great distances. “This can lead to shattering of glass doors and windows for dozens of kilometers, as well as collapse of nearby old buildings," he added.

Ammonium nitrate has been involved in dozens of major explosions in the last century, in cities like Texas City, USA; Brest, France; and Tianjin, China—also with suboptimal documentation and with fewer casualties.

“The study is the most scientifically documented ammonium nitrate disaster in history with previous incidents mentioned in a journalistic way," said Mansour. “The documentation also adds weight to the level of negligence that led to the disaster and the need for judiciary action flagrant shortcomings."

“Ammonium nitrate trade needs to be under the supervision of the United Nations in a way similar to the supervision of nuclear energy," he concluded.


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