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 Health threats are so varied that one of the Middle East's main
teaching hospitals, the American University of Beirut Medical
Centre, has introduced a conflict-medicine programme to equip
students to cope in an environment afflicted by chaos.
"What you need is a completely different way of viewing war-related
ill health that goes beyond the shrapnel, bullets and the blast
injury and looks at the bigger system," said Ghassan Abu-Sittah,
co-head of the AUBMC programme.
As fighting has engulfed Syria, Iraq, Yemen and Libya since 2011,
doctors and nurses have had to adjust not only to treating terrible
injuries but to a faster spread of disease and growing threats to
their own safety from combatants.
The International Committee of the Red Cross (ICRC) warned on Sunday
that the drawn-out crises plaguing the Middle East "could lead to
the total collapse of health systems".
Doctors, universities and aid agencies must respond by sharing
experience and expertise, and by adapting research and medical
practices, said Abu-Sittah and other participants at a conflict
medicine conference at AUBMC.
One growing problem is the disruption of vaccinations. Ali Batarfi,
dean of the Hadramawt College of Medicine in Mukalla, Yemen,
described a recrudescence of dengue fever that had been
comparatively rare before the war there.
"These children, they will not be vaccinated, so the disease which
was eradicated will emerge again," he said.
Yemen is suffering from a cholera outbreak after more than two years
of a war that has crippled public services, fostered malnutrition,
hindered the import of adequate medical supplies and hobbled
hospital capacity with war injuries.
The collapse in national health systems has accelerated resistance
to antibiotics because of drug usage in excess of prescribed limits.
At the same time, infections have spread as war has destroyed
sanitation and clean water systems and triggered chaotic population
movements.
IMPACT BEYOND WAR ZONES
The impact ripples beyond countries at war. Lebanon's health system
has grappled with the extra patients from around the war-ridden
region attending its hospitals, including some from the more than
one million Syrian refugees now in the country.
"Conflict-related ill health is a big part of the disease load that
we are facing and that the medical students that we teach will be
facing in the next 20 years," said Abu-Sittah.
A fifth of patients at AUBC are from Syria and Iraq, of whom the
overwhelming majority suffered from war wounds, though the burns
department noted a big rise in cases among children because of tent
fires in refugee camps.
Doctors in war zones have had to radically alter their approach,
rationing resources, operating in primitive conditions and changing
the way they treat trauma injuries.
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"Sometimes you operate under a tree. But you bring scientifically
based surgical care even if not everything is perfect," said Dr
Christos Giannou, a veteran conflict surgeon who co-wrote the ICRC
war surgery manual. "You make compromises and you have to use your
imagination."
Surgical treatment of injuries is very different when those wounds
have been caused by high-velocity bullets or shrapnel - something
traditionally trained surgeons must learn as war has spread in the
Middle East.
In Mukalla, Batarfi said, a Syrian doctor with war experience had
helped advise his team on ways to adapt to conflict. War had
isolated the southern Yemeni region, broken supply chains and cut
the electricity supply.
"They stop doing routine operations because if they conduct (them)
as usual they will face the problem of no oxygen. There are no
materials for the operation: sutures, gauze, all the equipment," he
said.
Sometimes new technology is useful, like the social networking group
that doctors in embattled areas of Syria are using to seek guidance
and advice from surgeons abroad in treatment of limb injuries,
sharing x-rays and case histories.
But without access to new or replacement equipment, and with
electricity often out for long stretches, sometimes more traditional
methods work better, such as clinical examinations rather than
electricity-thirsty CT scans.
"People (once) practiced very good medicine (and) surgery without
all of this sophisticated technology available today and it's a good
thing to remind them of that," Giannou said.
Increasingly, warring sides in conflicts are targeting medical
facilities, seemingly aiming to reduce their enemies' stomach for
battle by aggravating the suffering of civilians.
"When I started for MSF, my MSF jacket was my bullet-proof vest,"
said Dr Anja Wolz, emergency coordinator at Medecins Sans Frontieres
in Brussels, who has worked recently at the MSF field hospital in
Mosul. "Now you feel like a target."
(Editing by Mark Heinrich)
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