First aid and hospital care
The ICRC treats the wounded when war conditions prevent public medical facilities from doing so. It helps in their evacuation to first aid posts and with subsequent care, either in independent ICRC hospitals or by supporting existing health facilities with medicines, equipment, training and additional staff. In recent decades, the ICRC has assisted hundreds of hospitals and its medical teams have operated on more than 100,000 people in war zones in Asia, Africa and the Caucasus.
As a neutral and independent humanitarian organisation, the ICRC’s main concern is to promote respect for the rules of international humanitarian law which protect the wounded and sick as well as humanitarian workers. It seeks to ensure this through ongoing dialogue with all parties to the conflict and through its impartial assistance – with its partners – to all wounded and sick, whichever group they belong to. A priority here is trying to ensure that victims have access to the care they need.
The ICRC’s hospital services policy has gradually shifted from taking over from local authorities to providing support for existing local structures. Its support includes training and capacity building in most aspects of hospital management, ranging from provision of quality patient care to human resources, infrastructure maintenance, finance, logistics and administration.
In areas of conflict, health care professionals are often in short supply. Successful surgery – a key part of ICRC's activities – is critically dependent on competent nursing care. The training of nursing personnel is therefore a priority and covers all areas, from the operating theatre to the recovery wards.
The ICRC’s first aid and emergency transport activities provide treatment of casualties, from the point of injury until their transfer to appropriate medical facilities.
The ICRC works with National Red Cross and Red Crescent Societies and other local partners to establish vital first aid and emergency transport capacities.
Its priorities include assessment and evaluation of the situation, helping to develop the operational capabilities of local Movement partners, skills training and diverse logistical, material and financial support.
When the situation demands, the ICRC deploys its own specialist teams to work in hospitals and to provide training to local staff.
In the 1980s, the ICRC established its own hospitals in conflict areas in Asia and Africa. To overcome the shortage of trained nursing staff, the ICRC established teaching programmes to give untrained helpers the basic skills needed to work in wards and care for surgical patients. The training of these “nurse assistants” enabled the safe, effective treatment of thousands of emergency patients.
The ICRC's hospital assistance policy has since shifted towards supporting existing health structures and away from independent, parallel systems. Its goal is to improve the capability of these structures to cope with conflict and post-conflict needs. A key component is the training of health staff – nurses in particular – in ways that now complement and conform to national training standards and qualifications.
The ICRC has unique experience of operating its own surgical facilities in conflict zones and of providing emergency support to local health services in the form of specialist surgical teams, equipment and medical supplies. It also helps build capacity through training programmes and the organization of war surgery seminars which enable dialogue between national health system medical personnel and ICRC specialists. Based on this experience, it has established basic protocols and procedures for war surgery techniques and for patient management in dangerous and limiting environments.
Operating in the midst of armed conflict – where regular medical services may be limited or lacking entirely – is often dangerous and imposes many limitations. The pathology of high-energy penetrating missile wounds is unfamiliar to most non-military surgeons – treatment of civilian gunshot wounds in a normal hospital does not readily compare. Not least, in addition to medical ethics, the care of war wounded is governed by the rules of international humanitarian law.
The ICRC’s war surgery seminars draw on many years’ experience of war surgery and patient management. The first seminar was held in Mogadishu in 1989 and over 100 have been organized in conflict zones since. It also organizes an annual seminar in Geneva that is attended by military and civilian experts and by surgeons, anaesthetists and nurses already in or planning to undertake humanitarian missions in conflict zones. This is a leading forum for sharing knowledge of war casualty treatment and management.
ICRC support to hospitals can include:
• Surgery & medical services
• gynaecology and obstetrics
• mental health
• hospital management & administration
• provision of consumables, equipment and expertise.