Knife Crime in the UK: Everyone's Problem

Edna Astbury-Ward

September 27, 2019

There isn't a city in the UK that is not affected by knife crime; "It's not just a London problem, its everyone's problem" says Ms Nabeela Malik trauma and general surgeon from Queen Elizabeth Hospital Birmingham. In fact, knife crime is on the rise in all parts of the UK.

So much so that even the sparsely populated and quiet rural village of Llanwrst in North Wales has recently experienced a knife crime incident. Other villages in Wales have also experienced knife crime, which has risen 23% in Wales since 2018. There have been a total of 47,136 offences involving knives in England and Wales since 2018, a 17% increase and the highest number since the Home Office Homicide Index began in 1946.

According to the Home Office, the most common method of killing, for both male and female victims, was by a knife or other sharp instrument. There were 285 such homicides recorded in the year ending March 2018. Sixty-nine percent of victims were male and 31% female. Just under two-thirds of sharp instrument homicide victims were white (63%, 179 homicides), while a further quarter (25%; 70 victims) were black.

What Circumstances Lead to Knife Crime?

There are multiple, important socio-economic risk-factors that contribute to knife crime, ethnicity being just one. In 2018, figures from the Mayor of London Policing and Crime Office (MOPAC) showed that young black and minority ethnic teenage boys and men were disproportionately affected, as both victims and perpetrators. However, neighbourhood influences and local culture may be equally important.

What we do know on a human level, is that just over half (51%, 373 offences) of all UK homicide cases resulted from a quarrel, a revenge attack or a loss of temper. Perhaps this is the reason West Midlands Police have chosen to use convicted murderer Sadam Essakhil as part of their knife crime campaign. Essakhil says: "The reason I carried a knife that evening was for my own protection, there was no intention on that day to go out and hurt anyone." What leads young people to the belief that they need to arm themselves with knives for protection is not clearly understood, but it is thought to also relate to issues of gang territory as well as deprivation and disenfranchisement.  

Gang Culture and Knife Crime

David Jamieson, the West Midlands Police and Crime Commissioner, told delegates at a knife crime conference organised by the Royal College of Surgeons in Birmingham last week, "We actually don't really know the causes of knife crime" but he added that the city of Birmingham (where he is based) had specific demographics that may lead to increased gang related knife crimes. Birmingham has the highest young population in Western Europe, 50% of inhabitants are under 25 years old and 50% are Black/ Asian ethnicity.

Ninety percent of victims in Birmingham are male, with peak assault age 16-25 years. The majority of victims and perpetrators originate from areas with a score of less than three on the Index of Multiple Deprivation. Jamieson added, “The numbers of children excluded from school, increase in children in care, and cuts in law enforcement meant knife crime was likely to increase.” He conceded that 50% or more knife injuries may not be reported to police, which is why the Government's initiative to get doctors to report knife crime is important.

Doctors are legally obliged to report to police all knife crime injury due to interpersonal violence.

Why Do So Few Knife Crime Victims Die?

The difference in number of knife crime incidents (47,136) compared to deaths (285) resulting from knife crime is equivalent to 0.6% mortality. The reasons for the discrepancy are multiple and profound but can be simply categorised into perpetrators criminal intent and surgical excellence. Mortality studies show that chest, abdominal, and head & neck injuries are the cause of most knife crime deaths, yet the majority of knife crime victims have penetrating limb injuries.

According to the Trauma, Audit & Research Network (TARN) chest injury accounts for more than 50% of deaths but only 12% of admissions to the emergency department (ED) and conversely limb injury accounts for 64% ED attendance but considerably less mortality. However, extremity injury, most commonly upper limb injury is by no means a minor injury, as force of up to 100kg/1000 newtons can be exerted in a savage attack and can cause severe vascular, soft tissue and bony injury requiring expert surgical input from a number of specialist trauma teams.

Plastic surgery is required in almost 78% of limb injuries. Overall plastic surgery is required for 35% of all knife injured patients, general surgery in 23%, and cardiothoracic in 22% of knife crime victims. However, not all these services are located in all major trauma centres, which means that once the patient is stabilised they may have to be transferred elsewhere for specialist surgery.

Gang Related Wounding Messages

A new type of horrific knife injury now being reported is that of buttock injury, commonly called 'bagging' or 'dinking'. Bagging is intended to debilitate and is inflicted as a warning to the victim. 'Bagging' victims are frequently treated with a colostomy bag and catheter for an extended period as a result of the attack.

However, depending on the length of the knife and the severity of the stab wound, it often leaves victims with complex long-term health problems including perforation of the rectal cavity and damage to internal muscles and organs. Unfortunately, 'bagging' victims may present to the ED with what appears to be a small laceration and large heamatoma. In some instances lack of understanding of the implications of buttock injury may mean that the patient is sent home and will slowly and silently bleed to death. It is estimated that without blood replacement, bleeding from this type of wound at 20ml per minute will be lethal in 2 hours.

Penetrating buttock injury should be regarded as a life-threatening injury with long-term implications beyond damage to the pelvis.

Choice of weapon is also changing, although there is very little data publicly available on the breakdown of actual weapons used in up to 36% of knife crime attacks. Evidence from the West Midlands shows that the use of machetes has increased nearly 14% in that area. Clearly in a country that has no agricultural use for a machete in urban areas, one can only conclude that the perpetrator has deliberately gone out armed with a weapon with the intention to maim or kill. There are calls for more severe sentencing in these cases. A surgeon at

The Royal College of Surgeons Conference on knife crime said last week: "Anything we do is probably 20 years too late, as many of their problems began earlier."

Gender Differences in Knife Crime

A third of women were more likely to be attacked by a partner or ex-partner, whereas men are more likely to be attacked by a stranger.

The type and behaviour of knife crime towards female victims is also gender specific - 65% of women are more likely to be assaulted in a domestic setting whereas stranger violence towards men more often occurs in the street. Upper limb wounds are more prevalent in women as a result of defence. Women are also more likely to suffer multiple wounds and a number of women attacked with knives have also been pregnant - it is well documented that domestic violence increases during pregnancy. Where females are the perpetrator of knife attacks, they tend to be older.

What is Being Done About Knife Crime?

There are a number of multi-agency initiatives running in the UK to help tackle knife crime, including the Home Secretary's Serious Violence Strategy 2018 . However, currently, agencies do not co-ordinate their work with each other and there has been a call for a multi-agency register to be created in order to assess the effect of individual injury prevention strategies.

RedThread is one such agency. RedThread is a youth work charity whose Youth Violence Intervention Programme runs in hospital emergency departments in partnership with the major trauma networks. Currently RedThread is a pan London organisation and has pilot sites in Nottingham and Birmingham. The aim of their work is to reduce serious youth violence. RedThread youth workers utilise their unique position as part of the emergency department alongside clinical staff to engage young victims. They recognise that at the point of entry into the ED the victims are particularly vulnerable - a moment they refer to as the 'Teachable Moment' - so they encourage and support young people at that time to make positive change to disrupt the cycle of violence.

Mr Ewen Griffiths, a consultant upper gastro-intestinal and general surgeon at Queen Elizabeth Hospital (QEH), Birmingham has referred to knife crime as a "public health emergency". Therefore it stands to reason to adopt a public health approach to violence reduction, which is exactly what the Centre for Trauma Sciences at Barts and The London have done. Their public health approach to preventing knife violence is a multilevel framework that addresses the root causes of violence as well as those already involved or at risk.

Royal College of Surgeons Response to Knife Crime

Professor Derek Alderson, president of the Royal College of Surgeons (RCS), emeritus professor of surgery at the University of Birmingham and visiting professor at University of Newcastle, says that the RCS can raise awareness by political lobbying and engaging with the media.

The RCS intends to promote the development of trauma surgery and has already established regional trauma networks with a new trauma centre to be opened in Cardiff in 2020. Professor Alderson notes that there is no point in having major trauma centres without trauma surgeons. In particular, he told delegates that surgeons will be trained to perform surgery in all adverse environments including terrorist attacks.

Clearly the increase in knife crime means that the trauma surgeons and their team's workload will be increased, but the RCS is confident that it is prepared and is doing everything possible to work with other agencies to prevent knife crime and save lives.

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