Paramilitary punishment in Northern Ireland: a macabre irony.

The various types of paramilitary "punishments" occurring during civil disturbances in Northern Ireland are described along with a retrospective analysis of 100 victims of low-velocity punishment gunshot wounds admitted to the Royal Victoria Hospital, Belfast, between July 1, 1986, and December 31, 1989. While "kneecapping" remains the most common form of punishment, an alteration in the character and pattern of injury has resulted in an increase in the incidence of ankle and elbow gunshot wounds. The possibility of a complicated injury involving bone, blood vessel, or nerve (either alone or in combination) occurred in approximately 40% of knee injuries, 70% of ankle injuries, and 30% of elbow injuries. The implications of these alterations in character with respect to provision of hospital care and social morbidity are described. A macabre irony exists in that the punishment policy is dictated by the paramilitary organizations who themselves are the perpetrators of major terrorist crimes.