Shot in the Head

While protests in the United States in June and July of 2020 were overwhelmingly peaceful and without incident, some devolved into violent confrontations between police and protestors, including widespread law enforcement use of  crowd-control weapons  (also known as “less-lethal” weapons).

Tear gas, pepper spray, stun grenades, and acoustic weapons have all been extensively employed, but the scale of the use of kinetic impact projectiles (KIPs) stands out in reports from protestors, journalists, and bystanders. KIPs include various bullets and baton rounds, as well as tear gas canisters, that are fired into crowds from a gun, rifle, or other launcher.

In an effort to record the scope of KIP use and the resulting injuries,  Physicians for Human Rights  (PHR) used open-source research methods to collect publicly available data.

Shooting civilians in the head with KIPs violates widely accepted use of force principles, which forbid targeting of the head and neck and  emphasize proportional response  to actual threats faced by  law enforcement . Furthermore, our past research has shown that severe injury, disability, and death are often consequences of being shot in the head with these weapons. Such excessive and indiscriminate police responses to protests have a  chilling effect  on the exercise of the fundamental First Amendment rights to freedom of assembly and expression (for more information, click "Legal Background" in the navigation bar).

Using cues from social media and legal claims, events in each city are reconstructed below to provide a better understanding of the context behind the dangerous use of KIPs in individual circumstances. These cities illustrate the range of KIPs used in the United States during the summer 2020 protests and the resulting injuries, although it should be noted that the use of crowd-control weapons was not restricted to these three cities.

PHR’s database contains only incidents documented in traditional and social media. The tally depends on individuals to self-report their experiences, on journalists to identify and document injuries, or on the legal system to present these instances in the course of litigation. For these reasons, this count of injuries is believed to be only a fraction of the total number of people shot in the head and neck by U.S. law enforcement during the protests since May 2020 (for more information, click "Methods and Limitations" in the navigation bar).

A kinetic impact projectile (KIP) functions by striking an individual with a blunt object shot from a firearm at a relatively low velocity, ostensibly incapacitating or discouraging the individual through the infliction of pain but not penetrating or causing severe injury. PHR uses the term “KIP” to include all projectiles used for crowd control worldwide, recognizing the wide variation in designs and names of these “impact munitions.” In this analysis, the term KIP includes tear gas canisters, that – although not designed to be used as projectiles – qualify for our criteria when they are fired directly at people.

According to the UN Guidance on Less Lethal Weapons in Law Enforcement ( 2020 ), known risks of KIPS include:

Targeting the face or head may result in skull fracture and brain injury, damage to the eyes, including permanent blindness, or even death. 

The firing of kinetic impact projectiles from the air or from an elevated position, such as during an assembly, increases the risk of striking protesters in the head. 

Targeting the torso may cause damage to vital organs, and there may be penetration of the body, especially when projectiles are fired at close range.

Three different cities shared similar cases of protestors, journalists, and bystanders shot in the head with KIPs. Their stories are detailed below. All quotes used are from the victims’ social media accounts.

Warning: these images may be disturbing for some viewers. 

PHR’s open-source review identified at least 12 people struck in the head with KIPs in Los Angeles on Saturday afternoon, May 30. Visual evidence, narratives, and court documents allow us to reconstruct the shootings.

Rubber bullets are KIPs that can be solid rubber, plastic, or PVC (or other nonmetallic materials) or composite projectiles that bear a nonmetallic outer shell. They are found in numerous forms and under various names. The LAPD's  published equipment list  shows at least two types of KIPs.

The LAPD’s  use of force guidelines  for sponge rounds state: 

Less-lethal force options are only permissible when: An officer reasonably believes that a suspect or subject is violently resisting arrest or poses an immediate threat of violence or physical harm. Less-lethal force options shall not be used for a suspect or subject who is passively resisting or merely failing to comply with commands [emphasis original]…. The 40mm [less-lethal launcher] shall not be used to target the head, neck, face, eyes, or spine unless lethal force is authorized. 

In response to incidents on May 30 and 31, the LAPD published  additional guidelines  on the use of 37-mm multiple foam baton rounds: 

The 37mm Less-Lethal Launcher disperses five foam baton rounds toward the ground in front of a hostile crowd once an unlawful assembly has been declared. It is not to be fired directly at individuals, and only authorized for use by specially trained personnel.

No evidence has been presented that any of the civilians who were shot in the head by the LAPD on May 30 were behaving in a manner that warranted the use of lethal force as outlined in these LAPD rules governing use of force.

As of August 31, more than 56 cases of possible misconduct related to the protests in Los Angeles are under investigation, and 10 officers have been assigned to non-field duties pending the results of the investigation. Additionally, the Los Angeles City Council has unanimously voted for an “after-action” investigation into incidents of the possible use of excessive force. The  report  will look at the LAPD actions between May 27 and June 7 and will be overseen by the Police Commission.

On Sunday, May 31, protestors gather near the headquarters of the Austin Police Department (APD) on the corner of East 8th Street and I-35. Officers respond with "bean bag" rounds, shooting six protestors in the head. 

A "bean bag" round, also known as a flexible baton round (or the genericized "Super-Sock"), consists of a synthetic bag encasing dozens of metal pellets. The bag is designed to expand upon being shot, distributing the impact force over a wider area than a single, rigid projectile.

The Austin Police Department's  use of force policy  states: 

The head and neck should not be intentionally targeted, however any target area or distance may be considered when it reasonably appears necessary to accomplish immediate incapacitation in order to prevent serious injury or death to officers or others.

No publicly available evidence has been presented that suggests any of the civilians shot in the head in Austin were engaged in conduct that presented a threat of serious injury or death to officers or others. In the case of teenager Brad Levi Ayala, video footage shows that, at the moment he was shot, he was not engaged in behavior that could be perceived as violent under the above policy.

It is recognized that the sometimes chaotic circumstances of crowded spaces may negatively affect the ability of officers to accurately employ certain weapons. The dynamic nature of crowds, where individuals are not static targets, may also cause shots to impact unintended targets. However, this raises the question of whether a weapon that cannot be used accurately and can cause serious injury should be used at all in these spaces.

In Austin, as of August 31, five APD officers are under investigation over their  use of “less-lethal” weapons  during the protests.

The ongoing protests in Portland, Oregon came to national attention as federal law enforcement agents were deployed there in early July 2020, leading to a dramatic increase in people joining the protests. The actions of federal agents against protestors added to a growing tally of protestors' head injuries from KIPs in Portland: at least 14 by the end of July.

The multitude of law enforcement agencies that responded to the Portland protests resulted in a wide variety of munitions being used, ranging from foam rounds seen elsewhere, to relatively novel munitions with little data on their health effects. Cases in Portland show that these, too, can cause severe injuries when they hit the head.

The sustained protests with small groups of protestors committing  violent acts  outside the Federal courthouse and the Justice Center posed a challenging task for law enforcement in Portland. In similar contexts, law enforcement officers have justified their use of force in response to direct threats to officers, property, or other civilians. However, the cases detailed in Portland suggest that nonviolent protestors and members of the media often fell victim to indiscriminate KIP use.

The abundance of head injuries raises a question regarding adherence to protocols. Moreover, uncertainty over the identity of departmental affiliations hinders understanding of the effective use of force policies. For instance, federal law enforcement officers  have often declined to identify themselves , posing an additional problem for civilians. Under these circumstances, it is not possible to understand fully the specific use of force guidelines at play.

The PPB's  use of force policy  states:

Members shall not deliberately target a subject’s head, neck, throat, or groin area, unless deadly force is authorized.

Similarly, the  Use of Force Policy Handbook  of U.S. Customs and Border Patrol, one of the federal agencies which deployed forces to Portland, states:

Authorized Officers/Agents shall not intentionally target the head, neck, groin or female breast. 

While a  flurry of lawsuits  have been  filed against  the City of Portland and the Department of Homeland Security, the difficulty in tracing munitions to specific agencies makes accountability for injuries more challenging in this situation. 

The 115 cases presented here reflect only cases fulfilling our documentation criteria. While many captured media attention, they form only a snapshot of the serious – often life-threatening – injuries that KIPs have caused in the United States since May 26. It seems clear that crowd-control projectiles are being used in cities across the country in violation of local, federal, and international guidelines. In using dangerous and often indiscriminate weaponry to disperse largely peaceful assemblies, such deployments of KIPs also violate  First Amendment protections  of free speech and assembly.

In the setting of the movement for racial justice in the United States and an end to the police violence that is behind these protests, freedom of speech and assembly must be safeguarded, not silenced. PHR condemns violence in protests that threatens health, lives, and livelihoods. As physicians and health workers, the fundamental principle of our professional lives rests on the value of human life and on promoting health and well-being. In these times, we specifically advocate for the protection of the lives of Black people who have been subjected to discrimination, targeting, and disproportionate violence by law enforcement.

The classification of KIPs as “less-lethal” contradicts extensive research illustrating that these weapons can cause serious injuries, permanent disabilities, and death. Severe injuries are more likely when KIPs are fired at close range, as some types of KIPs have the same ability to penetrate the skin as conventional live ammunition and can be just as lethal. When launched or fired from afar, these weapons are often inaccurate and can strike vulnerable body parts, causing unintended injuries to bystanders. Therefore, PHR considers that KIPs are not an appropriate weapon for crowd management and specifically for dispersal purposes. PHR thus recommends that localities move to ban their use altogether in crowd-control situations, due to the egregious and life-threatening injuries they can cause, particularly given their inherently indiscriminate nature in crowd-control situations. PHR further recommends that the use of KIPs in non-crowd-control situations be restricted to instances of last resort, and then used only in a manner that meets the international standards tests of necessity, proportionality, legality, and proper use, i.e. by properly trained police. 

Each incident recorded in this review represents a use of potentially lethal force, as defined by police departments’ own protocols. To date, these law enforcement agencies have not presented any evidence to justify their use of lethal force against the 115 victims detailed.

All three cities studied revealed particular problems with the use of KIPs. In Los Angeles, KIPs were misused as tools to disperse peaceful demonstrators who were attempting to leave a protest zone. The incidents in Austin demonstrate how the use of KIPs not appropriate for crowd control has life-altering consequences. In Portland, the maze of overlapping departments and jurisdictions hampered accountability for acts that clearly violated proper KIP use.

Piecemeal, post-hoc changes to individual law enforcement, while important, are inadequate to address what is clearly a national phenomenon regarding the misuse of crowd-control weapons. The incidents and injuries identified in this open-source review demand national action on regulation, education, and training on the use of force and accountability around all impact projectiles.

This open-source review suggests that so-called “less-lethal” crowd-control weapons escalate tensions, often violate constitutional rights, and can result in significant injuries, disability, and even death. Injuries such as those shown here, coupled with PHR’s in-depth documentation and research on the use and impact of these weapons, make clear that kinetic impact projectiles should not play any role in crowd control. 

• " Crowd-Control Weapons and Social Protest in the United States ," a primer (Physicians for Human Rights)
• " Lethal in Disguise: The Health Consequences of Less-Lethal Weapons " (Physicians for Human Rights)
•  United Nations Human Rights Guidance on Less-Lethal Weapons in Law Enforcement  (United Nations Office of the High Commissioner on Human Rights)
• " Preparing for, Protecting Against, and Treating Tear Gas and Other Chemical Irritant Exposure: A Protester’s Guide " (Physicians for Human Rights)
• Haar R.J., Iacopino V., Ranadive N., et al,  Death, injury and disability from kinetic impact projectiles in crowd-control settings: a systematic review , BMJ Open 2017;7:e018154. doi:10.1136/ bmjopen-2017-018154

Congress shall make no law … abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.

• First Amendment to the US Constitution ~ 1789 

The United States Constitution, along with the Universal Declaration of Human Rights ( 1948 ) and the International Covenant on Civil and Political Rights ( 1966 ), protect the right to freedom of assembly, including the right to hold peaceful public or private meetings, marches, processions, demonstrations, and sit-ins. These documents also note that life and liberty must only be deprived with due process of law. 

In the context of policing protests, the role of the police should be to facilitate freedom of assembly and freedom of expression, while ensuring public safety. The mere fact that an assembly may be considered unlawful under domestic law does not by itself justify the use of crowd-control weapons (CCWs) in dispersing the assembly. Circumscribed or sporadic incidents of violence, similarly, do not compel the declaration of an unlawful assembly and/or riot and do not by themselves justify the dispersal of an assembly ( United Nations ). Moreover, excessive and indiscriminate police responses to protests not only violate the rights of current peaceful protestors but have a well-studied  chilling effect  on the future exercise of the fundamental rights to freedom of assembly and expression.

The state has a duty to protect those exercising their right to peacefully assemble from any type of violence, including violence from law enforcement agents and any individuals who engage in acts of violence. However, any action taken involving the use of force to protect against violence  must be lawful and proportionate , and failure to follow these principles must be the subject of an independent, impartial, and effective investigation.

International legal principles help guide the determination of when the use of force is truly necessary and how to limit excessive use. The United Nations Office of the High Commissioner for Human Rights has established  a series of principles  guiding the proper use of all CCWs: 

• Necessity – Any use of force must be employed only when it is strictly necessary and to the extent required for the performance of law enforcement duties.
• Proportionality – Use of force must be proportionate to the lawful objective sought, and to the seriousness of the threat posed. 
• Precaution – Any use of force must be accompanied by reasonable precautions to prevent the loss of life and minimize the severity of any injury. 

Despite these protections of speech and assembly, international and national laws are underdeveloped and have not kept pace with the manufacture and deployment of modern CCWs. Case law, coupled with the UN Basic Principles on the Use of Force and Firearms ( 1990 ) and the UN Human Rights Guidance on Less-Lethal Weapons in Law Enforcement ( 2020 ), provide some additional guidance on the use of force and CCWs, specifically: 

• Legality – Actions must conform to national laws and regulations and international human rights standards. Law enforcement agencies must be accountable through adequate reporting and review procedures. 
• Proper use – Police must be trained on and adhere to protocols on the use of CCWs.
• Non-discrimination – Law enforcement officials must ensure non-discrimination and de facto equal treatment of persons subject to the use of force. They must exercise a heightened level of care and precaution toward individuals who are known or are likely to be especially vulnerable to the effects of a particular weapon.
• Accountability – States must hold law enforcement officials accountable for any decision to use force and ensure external oversight, monitoring, reporting, and transparency. In the event that law enforcement use of force causes death or injury, the state must ensure a prompt, impartial, and effective investigation.

In the United States, adjudication of excessive-force cases by law enforcement are governed by Fourth Amendment protections from unlawful searches and seizures, although the standard of “ objective reasonableness ” not only supports  qualified immunity  but also makes obtaining accountability for excessive force  near-impossible . The deployment of CCWs is also governed by individual state and local municipality departmental use of force policies ( example ). However, these are often opaque to the public and ill-defined, and when we have reviewed them,  they fall well below the standards established by international guidelines . This study has demonstrated that departments' own principles are often violated, leading to serious injuries to people and resulting in infringements of the right to free speech and assembly. U.S. legislation on restricting the right to peaceful assembly and on CCWS are dependent on city, state, and federal legislation, and varies greatly. This lack of legislative vision must remedied.

More information about initiatives aimed to stifle protest within the United States can be found  here . 

The full database of head injuries (based on web searches of publicly available media, including social media and news media, lawsuits, medical reports, and other audiovisual media) relied upon open-source investigation guidelines from the  forthcoming  Berkeley Protocol on Open-Source Investigations. We adopted this open-source approach as a method explicitly because no national data on the use of less-lethal weapons is available. Searches were conducted between May 31 and July 31, 2020, covering incidents from May 26 to July 27.

PHR included data on injuries visualized to the head, face, or neck (defined as any injuries above the clavicles) reported to have occurred in the setting of a protest. Keyword searches were conducted using phrases such as "shot in the head or face," "protest injury," and "rubber bullet," among other terms. PHR only included injuries that were reported to have occurred secondary to crowd-control projectiles, including, but not limited to, the following KIPs: rubber and plastic bullets, foam batons, "bean bag" rounds, and tear gas canisters when used as projectiles.

In this report, PHR did not include or analyze injuries that were reported to have occurred secondary to other potentially dangerous crowd-control weapons, such as non-fragmentary stun grenades, water cannons, batons, or any other use of force incidents. Chemical injuries from tear gas were also not included.

Potential entries were sorted using a tiered system that prioritized national media, local media, and then social media (Twitter, Facebook, Instagram) or other websites (GoFundMe, YouTube). Data from lawsuits, including medical reports, was used when available to supplement these reports. Cases were triple-checked by two investigators (Reynhout, Hsia) against other reports to ensure cases were not misattributed or double-counted, and to ensure that the included cases met the stated inclusion criteria. Social media records without corresponding visual documentation of injuries were excluded. News accounts without visual documentation of injuries were included only if the source was a major broadsheet newspaper or a local affiliate of a major news outlet. 

PHR utilized the guidelines in the  Istanbul Protocol  to make reasonable conclusions about the etiology of the injuries and excluded any injuries that were not reported to be from KIPs (cases were reviewed by a physician based on these guidelines). These restrictions were placed to ensure a conservative dataset. While this report attempted to identify injuries described in reports, PHR did not directly consult with and/or examine any of the victims.

PHR was unable to independently authenticate or verify the videos by looking at the original footage, or by using tools to show the videos have not been altered, or with metadata to confirm the time/date or geolocation of the images. Location data was approximated using information contained in legal documents and referencing of local features, such as street signs, buildings, businesses, architectural features, and other landmarks visible in photos and video. While this data was used to reconstruct events within the case studies, PHR’s national map generalizes the placement of individual events for legibility. 

This report highlights how much is still not known, not reported, and not being studied in the area of crowd-control weapons and the injuries they cause.

This study likely represents an undercount of the number of people who suffered head injuries from KIPs. Survivors who did not report their injuries to the press or social media were by default not counted in this study. Many reasons for non-reporting exist, including concerns about privacy, reprisal, or other repercussions, access to social media/technology, and non-recognition of the problem of misuse of “less-lethal” weapons. We observed that, in many cases, a delay of weeks exists between the date of incident and initial media coverage. Our sampling and searching methodology was done manually rather than with social media-mining methods or specially designed algorithms. The methodology may be affected by inherent cognitive biases, language, and terminology preferences.

Open-source investigations have several inherent weaknesses and biases. In general, photos and videos provided offer only a snapshot of events as they occurred. We can only construct narratives of what happened based on the materials we had access to, that at times others had edited, and by using clips and photos taken by others. Data is likely incomplete and the methodology may have missed events leading to the highlighted situations, thus affecting the chain of events as we understand them. There is also always a chance of manipulation of the evidence or manufactured disinformation and this analysis did not independently authenticate the videos used.

While this analysis focuses on head and neck injuries, we emphasize that these are not the only ways that KIPs can kill or maim. In the protests following George Floyd's death, at least two people were shot in the groin with KIPs, suffering potentially permanent injury, and there were many other reports of injuries to other parts of the body, which were not included, given the parameters of this investigation.

In our selection criteria, we have attempted to make choices that consistently generate conservative estimates of total cases. This allows us to qualify our count as a minimum estimate of the true scale of recent police violence through the use of KIPs in the United States.

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