Consequences of War on Medicine and Health Care

Issues Faced By Doctors and Humanitarian Workers in Conflict Areas

Sep 24, 2009 Noreen Kassem

Moral dilemmas, inadequate training, resources & knowledge to provide care in an area of war and conflict are some of the concerns and risks to medical relief workers.

War and armed conflict is currently the most serious threat to health in both direct and indirect ways (World Health Organization). According to statistics published by the United Nations, for every combatant killed in war, up to nine civilians are also directly killed, with the numbers of injured and disabled in increasing numbers.

Further numbers of civilians die due to forced migration, loss of shelter, lack of basic necessities such food, water, sanitation and electricity, lack of security and medical care as well as disease epidemics. Contamination of land and water, landmines and unexploded ammunition are other serious risks that can remain for generations or indefinitely.

Like all aspects of life during war and in a post-war society, providing medical and humanitarian aid requires facing varying extreme and abnormal circumstances and consequences. This is true for both local health workers as well as volunteer humanitarian workers in non-government organizations and visiting military doctors and health care personnel. Relief workers and care givers are also faced with the problem of address greater needs with very little resources and little or no equipment and in many cases damaged or destroyed infrastructures.

Physical and Psychological Issues and Risks Affecting Relief Workers

Besides the direct impact on safety caused by war and weaponry, visiting doctors face temperature adaptation problems and the risk of heat stroke and dehydration in hotter climates. Welfare workers also face disease and illness that may be epidemic or common in the area, as well as a lack of personal care due to chaos and loss of infrastructure. Proper preparation, health assessments and vaccination requirements must be conducted before arriving in an area of war. How much time a humanitarian worker should spend consecutively in the field is also a question that must be assessed.

There is also a psychological and emotional toll. War and conflict may cause immense trauma and psychological distress on doctors and humanitarian workers. Isolation and feelings of helplessness and sadness may be overwhelming. Support before, during and after working in areas of war is necessary.

Logistical Issues and Practical Concerns of Practicing Medicine in a Conflict Area

The requirements and needs of a people who have been victims of war should be assessed before getting volunteers and workers on the ground. Trauma injuries, wounds, disease outbreaks, vaccinations, malnutrition, torture, psychological stress and injury, diabetes, cardiovascular disease, renal disorders and others require different specialist care and support. Support groups to ensure that water, electricity and resources can be efficiently maintained are also required.

Preparation for and maintaining aid in an area of war includes the logistics of moving large amounts of resources, medical supplies, medications and food to an area with little or no security and possible ongoing violence. Resources to provide power, clean water and build shelters may also be required.

Communication and Information May Be Limited In War

Doctors and humanitarian workers often arrive with little knowledge of the language, culture, religion and customs of the area. Barriers in language make it difficult to organize facilities and communicate effectively with patients. Other sociological issues may also be a barrier to communication. Interpreters must be obtained and present during all meetings.

Technology is severely limited or non-existent in areas of war. This causes a lack of information and delayed or incorrect information to humanitarian organizations. Outbreaks of potentially fatal diseases may not be reported in time for humanitarian to reach the affected individuals. There may be information blackouts by local or outside government forces. Risks of attacks and violence may also not be reported effectively. This increases dangers and hinders medical aid.

Medical Ethics and Political Concerns During War

The abuse of human rights, triaging and providing care to large numbers of civilians as well as combatants under extreme situations may give rise to moral dilemmas for doctors and humanitarian workers. It may be logistically impossible to provide any or complete care for the immense numbers of people affected. Even if a patient can be treated medications and dispensing facilities may not be available to provide long term, consistent care.

Health assessment of asylum seekers requires doctors to take into account factors on physical and psychological health that occur in conflict situations. These include imprisonment, torture, rape, psychological damage, human trafficking, loss of health and physical disabilities and injuries.

Doctors and other humanitarian workers also face pressures from local governments or leadership in areas of war and conflict. These tensions can be very volatile and are important to consider. This may include control of hospitals and resources, permission to remain and work in an area, mobility in the area and support of local people. There is a risk of inadvertently undermining the local leadership by gaining the respect of civilians who are not being cared for by their governments. Humanitarian workers must remain impartial and respectful of governing bodies regardless of political stance.

Security and Safety of Humanitarian Workers

Doctors and relief workers require protection from combatants and civilians who may be armed, as well as from theft and kidnappings. However, being associated with or in the presence of military personnel may cause distrust and further harm.

Doctors and aid workers are often put in the position of making critical decisions including when and if to evacuate their teams and personnel as well as patient. Deciding who goes and who must stay and how to evacuate safely is important in conflict situations.

War and armed conflict create extremely tragic situations in which doctors and humanitarian workers face ethical and logistical dilemmas. It gravely hinders the patient’s right to treatment and medical care and the ability to provide it.

For related information on this topic, see:

Reference:

Gross, Micheal: Bioethics and Armed Conflict: Moral Dilemmas in Medicine and War, The MIT Press, Boston USA. First Edition 2006

The copyright of the article Consequences of War on Medicine and Health Care in International Affairs is owned by Noreen Kassem. Permission to republish Consequences of War on Medicine and Health Care in print or online must be granted by the author in writing.
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