"They therefore easily become infected if not rapidly treated. And because bullets and bomb fragments strike at such high velocity, they generally cause more damage than other types of injury. The resulting wounds have to be managed in a way not usually taught at medical school".

Dr Baldan and fellow ICRC surgeon Harald Veen are in the Gaza Strip to hold a seminar on war surgery from 11 to 13 March. The two have a total of over 25 years working in conflict zones. Dr Baldan has just returned from Kenya, while Dr Veen has recently operated in Iraq and Chad.

The Gaza seminar brings together over 65 Palestinian surgeons and other staff from hospitals throughout the Gaza Strip. They will discuss the latest techniques for managing weapons injuries, with sessions on ballistics, orthopaedics and prosthetics, vascular and abdominal injuries.

During the recent escalation in fighting in Gaza at the end of February, many hospitals were overwhelmed with casualties. Dealing with mass casualties in difficult circumstances is precisely one of topics featured at the seminar.

"A massive influx of casualties poses enormous challenges," says Dr Veen, who himself worked in Gaza in an ICRC surgical team in June 2007. "Saving lives depends on hospitals being adequately equipped and having skilled staff who will take the right decisions quickly.” Doctors and nurses in Gaza already have a great deal of knowledge, he said, because they deal with complex injuries all the time. The seminar would therefore also be an opportunity to share experiences.

During the past 25 years, ICRC surgeons have treated over 100,000 weapon-wounded patients around the world. More than 35,000 cases have been entered into a database that uses a wound-scoring system. The resulting data have helped the ICRC draw up basic principles for the management of war injuries.

The ICRC organizes seminars for war surgeons from countries such as Iraq, Sri Lanka and Lebanon, and currently has teams of it own working in Chad, Kenya, Sudan, Democratic Republic of the Congo and Afghanistan.

This is the third war-surgery seminar in Gaza, following previous events in 2002 and 2004. In addition, the ICRC supports hospitals and emergency medical services with surgical supplies according to need, and coordinates transfer of patient to hospitals outside Gaza. Since November 2007, the ICRC has also been providing limb-fitting and rehabilitation services inside the Gaza Strip.