Management of limb injuries during disasters and conflicts

Speech given by Mr. Peter Maurer, President of the ICRC. Launch of the Handbook 'Management of limb injuries during disasters and conflicts'

For the millions of people who are trapped within the clutches of conflicts and natural disasters around the world today, the physical and psychological pain can be devastating.

Not only do many people suffer horrendously from direct physical shocks, they are often at risk of compounded injury, because of inadequate or inexistent medical treatment. Currently, a baseline standard of care for the victims of many crises is far from guaranteed.

In fact, poorly prepared and ill-equipped medical teams can actually heighten risks for the most vulnerable, even if such teams have the best of intentions. The medical response of the international community in Haiti in 2010 was a bleak reminder of how inadequate medical care can be a burden for the local population rather than a relief.

I have seen the horrors of conflict reflected in the eyes of people who have lost their limbs in conflict.
If we do not improve our capacity to provide quality medical assistance, the costs will be human lives and long-term disability. And these costs will be immense.

This is why, in 2014, the ICRC launched a new health strategy, which charts a promising path for improving healthcare for the most vulnerable. Not only are we working hard to improve the quality of our medical services, but we are also chartering new ways to scale up and broaden our impact. For example, the ICRC has launched the world's first humanitarian impact bond: an innovative funding mechanism that draws in new capital to support physical rehabilitation. Many of the people who will benefit from this initiative are those who have lost limbs in conflict. By helping to bridge the substantial gap between needs and resources for physical rehabilitation, we will help more people overcome the destructive impact of losing limbs, and to re-establish productive, dignified lives. It is not only individuals who will benefit, but also societies as a whole, through long-term improvements in social cohesion and economic growth.

The aggressive and brutal impacts of conflict and disaster demand a treatment that is different from common trauma management. Conflict and disaster-specific training of medical staff is therefore crucial to effective relief. The majority of patients suffering during war and disaster – that is, those who reach hospitals alive - have limb injuries, mostly with open and infected fractures. They also frequently suffer from ballistic injury. As the technologies of modern warfare change, it will be imperative that we advance our treatments.

Inadequate treatment will result in unnecessary, preventable complications that threaten life and limb. Not only will poor surgical treatment fail to reduce suffering, it may actually increase harm.

Recognising the potential for crisis to be compounded by poor medical care, in 2015 the ICRC and the WHO undertook to establish a global consensus on treatment standards for the most frequent injuries caused by disaster and conflict: limb injuries. As is the case with so many of our activities, we cannot and should not act alone. We gathered a group of academic, military, and humanitarian specialists, and used the power of collaboration to establish solid standards of treatment.

Funding from the AO Foundation has made this significant endeavor possible, and we are now able to see the fruits of this collaboration. It is my pleasure to be able to launch, today, the field guide on management of limb injuries during disasters and conflicts. This marks an important step in our mission to improve care and mitigate long-term impairment and loss of life. I congratulate the team that worked hard to make this achievement possible.

The launch of this guidebook is not an endpoint, but rather the start of a continuous process. As the world encounters new disasters and conflicts, we will need to ensure that the guidance is up-to-speed and responds to needs as they develop.

The international community has learnt its lessons from Haiti. Looking forward, emergency medical teams will be better prepared to improve the health of people who are suffering from the debilitating impacts of disaster, violence and conflict.

By combining our collective expertise and ingenuity, we have a clear opportunity to deliver the best possible assistance. It is my hope that the international community will continue to share knowledge and build upon these strong foundations, in an effort to provide more effective relief, and to facilitate productive, dignified futures.

The lives of the most vulnerable hang in the balance.