Iraq: Urgent need to safeguard life-saving medical action

Dr Chris Giannou is a senior ICRC surgeon and has just arrived back from Iraq, where he has been running a seminar on war surgery. He spoke to us about the challenges facing both victims and medical staff and explains why training medical staff will remain a priority, along with support to emergency services and the renovation of health infrastructure.

The ICRC organizes seminars for war surgeons from countries such as Iraq, Sri Lanka and Lebanon, and currently has teams of its own working in various countries. During the past 25 years, ICRC surgeons have treated over 100,000 weapon-wounded patients around the world.

What challenges do Iraqi medical services currently face?

Despite improved security in some areas of the country, military operations and indiscriminate attacks on civilians continue to take a heavy toll.

Hospitals are dealing with casualties in difficult circumstances. They often lack medicines, equipment, suitable infrastructure and experienced staff.

And by experienced staff we mean not only people with the necessary scientific background and practice but also surgeons, doctors and nurses who have worked in stressful conditions and have dealt with war injuries, which are complex and differ substantially from injuries encountered in civilian contexts.

Iraq has produced a generation of medical staff well experienced in war surgery, of whom the most senior worked during the Iran-Iraq war and then the wars in 1991 and 2003.

However, many of these people are now either retired or have left the country for economic or security reasons. Medical personnel, including academics, have been the target of assassinations, death threats and kidnapping, and this has contributed to the brain drain.

Today, medical teams still put their lives at risk in the performance of their duties, even though international humanitarian law requires that medical staff and facilities be protected from attack. Raising awareness of obligations towards medical services could help save their lives and make their work easier.

What is the ICRC doing to enhance the capacity of the medical services to save lives?

Supporting hospitals and emergency medical services by providing surgical supplies and adequate equipment is important, but it is not enough. Having skilled staff who take the right decisions quickly is essential, and that is why training for medical staff remains a priority.

Currently, a new generation of surgeons is running hospitals. The conditions under which they are working are far more difficult than those previously obtaining in Iraq. There is a shortage of medicines and equipment, and infrastructure has been damaged by the consecutive conflicts and by sanctions. In most countries, junior surgeons and medical staff work under the supervision of more experienced colleagues. Many of Iraq's hospitals lack the senior staff to provide this support.

Since 2006, the ICRC has been able to resume its seminars in Iraq, offering Iraqi surgeons an opportunity to share experiences with fellow surgeons from Iraq and abroad.

I am just back from Erbil, where we held two seminars from 18 to 23 October, bringing together 40 surgeons and 20 doctors from all over the country. Iraqi surgeons shared their particular experiences, and ICRC surgeons talked about the difficulties of working in emergency contexts with limited resources, which is pertinent to the Iraqi context. This is a natural and crucial process in the medical field. Topics included emergency surgical care, the treatment of wounds caused by weapons and an introduction to international humanitarian law, explaining the rights and duties of medical staff in times of armed conflict.

Another seminar on advanced first aid for war casualties took place from 18 to 22 October and was attended by 20 paramedics from the ministry of health.

These seminars cannot totally replace the continuing medical education young surgeons need, but they do at least allow some degree of continuity and upgrade their knowledge.

The ICRC and the ministry of health have agreed to step up this cooperation for the benefit of the hospitals, the staff and, ultimately, the patients.

Plans are also under discussion as to how to strengthen emergency services through the transfer of expertise. The ICRC will be sending two teams of experts in the field of emergency service management to hospitals in Iraq.

Are any structural changes needed in the provision of health care?

In Iraq, there is currently a great deal of emphasis on curative medicine and not enough on preventive medicine. This is something we see all over the world. By curative medicine, we mainly mean hospital care, whereas preventive medicine mostly involves primary health care at a community level. Primary health care includes immunization programmes and health education, which can prevent such diseases as cholera. Providing clean water to the population is one thing, but teaching them how to keep the water clean is another.