Technological Sabotage and Its Medical Fallout: Lessons from Lebanon’s Pager Explosions

Summary: On September 17, 2024, a coordinated series of pager and walkie-talkie explosions targeted thousands of members affiliated with a prominent political party across Lebanon. The blasts resulted in 2,800 injuries and 12 fatalities, with nearly two-thirds of the injuries affecting the face, eyes, or hands. The Lebanese American University Medical Center (LAUMC) treated 38 injured individuals, of whom 36 were admitted as inpatients, and 13 of them required care in the Intensive care unit. Surgical intervention was needed for 33 patients, with 32 suffering finger amputations, 31 presenting with eviscerated eyes, and 17 experiencing combined eye and hand injuries. This intentional mass casualty event overwhelmed healthcare infrastructure, as the unprecedented pattern and severity of injuries created an urgent demand for ophthalmological and orthopedic expertise. The incident highlights the growing need to understand and prepare for the medical impacts of hybrid warfare, where non-traditional and unconventional tactics, such as technological sabotage, can generate large-scale civilian casualties. It also exposed critical gaps in disaster preparedness, underscoring the need for hospitals to reassess their mass casualty protocols, establish targeted training programs, and conduct regular preparedness drills. Lessons from this event emphasize the importance of maintaining robust emergency response systems capable of addressing large-scale, unconventional threats and injury patterns.