Introduction: Gunshot injuries are one of the leading causes of fatal and non fatal injury in many countries (1) .All over the world, injury studies show an increasing preference for the gun as the weapon of choice for homicides and suicides (2).Firearms are more lethal compared to other portable and concealable weapons (2). Gunshot injuries impact severely on the criminal justice as well as health care systems (3, 4). There is no available published statistics on fatal gunshot injuries inKenya. Some basic statistics are important in understanding the magnitude and severity of the socio-economic burden caused by gunshot injuries. Objective: To determine the patterns of fatal gunshot injuries inNairobi. Methods: A cross sectional prospective autopsy based study carried out between 1st June 2009 and 30th November 2009 at theNairobi city mortuary and at the medico legal unit, Ministry of Health – Government of Kenya. Consecutive postmortems were conducted to determine the patterns of fatal gunshot injuries on all victims of fatal gunshot injuries seen withinNairobi. Data was entered into SPSS database and analyzed using SPSS version 15. Results: One hundred and ninety four (194) fatal gun shot cases were consecutively sampled over a period of 6 months. Majority of the victims (65%) were in the 21 – 30 years age bracket with the youngest victim being 16 years old and the oldest victim being 75 years old. Males were the main victims comprising 99% of the fatalities. Criminals constituted 75.2% of the victims while Civilians constituted 17% and police officers 3.1 %.Most of the victims were shot by police officers (76.8%) while criminals executed 14.4% of the victims. Most of the bodies (63.4%) had more than 1 gunshot entry wound with one of the bodies having 14 gunshot entry wounds. Majority (51%) of the bodies had gunshot entry wounds over multiple anatomic sites with the head and chest as the main targets. 80.4% of the gunshot entry wounds were estimated to have been of medium range of firing. The reconstructed direction of firing showed that 36.1% of the bodies had a front to back direction of firing. 47.4% of the bodies had multiple vital organ injuries with the brain the single most injured organ (31.4%). The manner of death was mainly homicidal (99.0%) while suicidal and accidental each constituted 0.5% of the cases. Head and chest injury were the major causes of death constituting 54.6 %. Conclusion: There was a