War surgery: dealing with security problems, finding appropriate methods
Interview with Marco Baldan, organiser of the ICRC's 19th Surgical Seminar (28-30.03.08). Dr. Baldan, ICRC head surgeon, has worked for the organisation for nine years, at HQ and in various countries of Africa. Previously he worked in Iraq, Uganda and Cambodia.
The ICRC has been sending surgical teams to the field for three decades; how has the work changed over that time?
On the one hand, we now benefit from 30 years of experience in the field of war surgery, treating more than 100,000 war-wounded patients. This has allowed us to standardize their management through protocols and guidelines. On the other hand, the security factor now represents a major challenge, preventing us from reaching patients in some conflict areas, such as areas of Iraq and Afghanistan.
Where has the ICRC been most active in the past year?
From the medical point of view, the main areas of activity were in Israel and Occupied and Autonomous Territories, Sudan, Afghanistan, Somalia, Iraq, the Democratic Republic of Congo and Chad.
What are the challenges facing the ICRC when deploying in the field, apart from security threats?
Making sure we answer to the specific needs of the context, including medical supplies, equipment, infrastructure rehabilitation, medical staff and management of the system.
Once health facilities are able to provide adequate medical care, the problem can be making sure the patients have access to them! Patients may not access them for reasons of cost, because of difficult security in reaching the hospitals, distance, and so on.
What are the criteria that the ICRC sets before it sends a surgeon or a full team?
An assessment has to be done: to confirm the needs (that there are war-wounded patients, how many, etc); to know if there is a lack of experienced medical staff in this field; to have a request from local medical authorities – or their acceptance of our presence; and an analysis of the security situation.
Where do most of the ICRC's surgical personnel come from? Is it hard to persuade people from "safe" countries to go to war zones? Are they qualified for such tasks?
Nowadays our surgical personnel come from all over the world: Africa, the Russian republics, Europe, Middle East, Asia, Australia, Central and South America, Canada. The strict security rules put in place by the ICRC, the idea of a humanitarian mission to escape from the daily routine and the challenges posed by war wounds combine to attract specialists for a surgical mission. It can happen that some of them do not want to go back to their previous job and remain in the humanitarian world!
On the other hand, the trend towards a high degree of specialization, plus the lack of specific training in war surgery in most countries, make it more and more difficult to find experienced specialists. By that I mean people who are able to deal with the range of injuries that weapons of war may cause, and who can apply techniques and technologies that are appropriate to war situations where resources are limited.
You just came back from the Gaza strip where you organised a seminar for local surgeons. What did you learn about their experiences?
Due to the situation, our Palestinian colleagues have a great deal of experience in the management of war injuries. Their approach to the management of war-wounded patients is now made more difficult by the increasing problems they face in keeping the system running and by the lack of follow-up possible, as many patients are referred abroad a few days after the operation.