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Cited by 26Health and Conflict StudiesEnvironmental and Biological Research in Conflict ZonesDisaster Response and Management

Civilian Population Victimization: A Systematic Review Comparing Humanitarian and Health Outcomes in Conventional and Hybrid Warfare

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Khorram-Manesh, Amir, Burkle, Frederick M·2023·Disaster Medicine and Public Health Preparedness
DOI 10.1017/dmp.2022.96
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Abstract

Objective: The main objective of this study was to summarize the Hybrid War’s core characteristics and humanitarian and medical impacts. Method: A Systematic Literature Review according to PRISMA guidelines, using the following keywords, ‘Hybrid War,’ ‘Humanitarian Law,’ ‘Human Rights,’ ‘Lawfare,’ and search engines PubMed, Scopus, Web of Science, and Gothenburg University’s database to collect literature from 2000 to 2022 in English was conducted. The eligibility of qualified articles was assessed, an inductive qualitative thematic analysis was applied, and the scientific evidence of each selected piece was evaluated. Results: The objectives of a Hybrid War are to achieve the tactical and strategic goals in a battle rather than to save civilian lives. It involves networks of state and non-state actors with various means of military and militia influences and strategies, creating difficulties in implementing, controlling, and evaluating the International Humanitarian Law’s “A State responsibility” principle, to gain insight into an armed conflict. It targets populated civilian areas and raises ethical and moral concerns by using Lawfare. Conclusions: Hybrid War’s multi-domain action should be met with multi-dimensional approaches and a doctrine of ‘acceptable losses.’ Its characteristics and consequences should be learned and taught. Several measures need to be implemented to counteract its impacts, and a flexible surge capacity should be designed, planned, and executed.

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  • This prioritization results in substantial humanitarian and medical consequences, encompassing direct civilian casualties, destruction of medical infrastructure, and long-term population health implications.

    “This prioritization results in substantial humanitarian and medical consequences, encompassing direct civilian casualties, destruction of medical infrastructure, and long-term population health implications (Khorram-Manesh and Burkle, 2022).”

    From Hybrid Warfare and Customs Security: Strengthening Resilience for Sustainable Development (2025) · cites this paper as Khorram-Manesh and Burkle, 2022

  • In hybrid warfare, tactical and strategic goals often take precedence over civilian protection.

    “In hybrid warfare, tactical and strategic goals often take precedence over civilian protection.”

    From Hybrid Warfare and Customs Security: Strengthening Resilience for Sustainable Development (2025) · cites this paper as Khorram-Manesh and Burkle, 2022

  • Hybrid warfare involves the deployment of both state and non-state actors utilizing diverse military and militarized strategies, which significantly complicates adherence to and assessment of international humanitarian law, particularly regarding the principle of state responsibility.

    “Hybrid warfare involves the deployment of both state and non-state actors utilizing diverse military and militarized strategies, which significantly complicates adherence to and assessment of international humanitarian law, particularly regarding the principle of state responsibility.”

    From Hybrid Warfare and Customs Security: Strengthening Resilience for Sustainable Development (2025) · cites this paper as Khorram-Manesh and Burkle, 2022

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Cited by

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Authors
Khorram-Manesh, A., & Burkle, F. M.
Affiliations
National Academy of Medicine (US)
ORCID
Venue
Disaster Medicine and Public Health Preparedness
Publisher
Cambridge University Press (CUP)
Published
2022-04-11
Volume
17
Pages
e192-e192
ISSN
  • 1935-7893 (ISSN-L)
  • 1938-744X
DOI
10.1017/dmp.2022.96
OpenAlex
W4223466960
Cited by
26
References
4
Citations by year
2026: 4 · 2025: 1 · 2024: 7 · 2023: 10 · 2022: 4
FWCI
1.06
Type
journal article
Language
en
Open access
Licence
Locations
  • Disaster Medicine and Public Health Preparedness (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Health and Conflict Studies
  • Physical Sciences › Environmental Science › Management, Monitoring, Policy and Law › Environmental and Biological Research in Conflict Zones
  • Health Sciences › Health Professions › Emergency Medical Services › Disaster Response and Management
Keywords
hybrid warfare, civilian victimization, international humanitarian law, lawfare, state responsibility, non-state actors, civilian protection, armed conflict, military doctrine, surge capacity
MeSH terms
Humans, Warfare, Outcome Assessment, Health Care, Crime Victims

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