Objective: To determine the pattern of causalities of Iraqi ballistic missile attacks on Tehran,the capital of Iran,during Iraq-Iran war.Methods: Data were extracted from the Army Staff Headquarters based on daily reports of Iranian army units during the war.Results: During 52 days,Tehran was stroked by 118 Al-Hussein missiles (a modified version of Scud missile).Eighty-six missiles landed in populated areas.During Iraqi missile attacks,422 civilians died and 1579 injured (4.9 deaths and 18.3 injuries per missile).During 52 days,8.1 of the civilians died and 30.4 injured daily.Of the cases that died,101 persons (24％) were excluded due to the lack of information.Among the remainders,179 (55.8％) were male and 142 (44.2％) were female.The mean age of the victims was 25.3 years±19.9 years.Our results show that the high accuracy of modified Scud missiles landed in crowded areas is the major cause of high mortality in Tehran.The presence of suitable warning system and shelters could reduce civilian casualties.Conclusion: The awareness and readiness of civilian defense forces,rescue services and all medical facilities for dealing with mass casualties caused by ballistic missile attacks are necessary.