Amid conflict and catastrophe

Jim Ryan is one of the leading figures in Britain in the emerging field of conflict and catastrophe medicine, and his experiences encompass humanitarian and military interventions around the world, including Afghanistan, Iraq, Pakistan, and Azerbaijan as well as the Balkans and the Falkland Islands. He has recently retired from the post of Leonard Cheshire professor in conflict recovery at University College London, where he is also honorary consultant in accident and emergency medicine. James I D M Matheson caught up with him on his return from Indonesia

It was largely unintentional. I left the Royal Army Medical Corps in 1994 after the closure of service hospitals and was immediately approached by Leonard Cheshire International, an international charity for disabled people around the world, with a proposal to establish an academic centre for conflict health.

The Leonard Cheshire Centre of Conflict Recovery (LCC) is not a non-governmental organisation but is university based. Its remit is to study the medical, surgical, and logistical consequences of war and conflict. The LCC responds to specific requests, which may come from non-governmental organisations, governments, and international agencies. Usually the request is to gather data or to carry out specific assessments of health needs.

One example is the rapid surgical needs assessment of Sri Lankan hospitals affected by the tsunami in 2004, which was done at the request of Leonard Cheshire International and the Sri Lankan Ministry of Health. A team of two orthopaedic surgeons, two trauma surgeons, one vascular-trauma surgeon, and a psychiatrist visited each hospital that had received injured people. The results were accurate and immediate. The data collected were made available to the Ministry of Defence and other agencies. More than $1m (£500<thin>000; €740<thin>000) of orthopaedic trauma equipment was delivered to hospitals. The Royal College of Surgeons visited to organise trauma training courses. And some Sri Lankan surgeons were seconded to UK hospitals for higher training. Other agencies were directed to non-trauma areas of need.

The director of Leonard Cheshire International envisions a move away from trauma and surgical areas and wants to focus on social anthropology, human rights, the plight of disabled people in conflict, and advocacy in general.

Absolutely. To my mind, it is one of modern medicine's neglected stepchildren. The faculty of conflict and catastrophe medicine at the Society of Apothecaries of London, which I helped found, is beginning the huge task of academic study on the provision of care in war, conflict, and disaster, and it is the future. The diploma in the medical care of catastrophes is quietly becoming the accepted standard for deployment.

Medical skills, of course, but also resourcefulness, leadership, and organisational skills. Some specialties are more useful than others-it depends on the nature of the disaster. In war and conflict, surgeons, anaesthetists, and emergency doctors are most needed. Emergency doctors (of at least year three specialist registrar) are the most adaptable because of the general nature of their higher professional training. In many natural disasters the needs are more general and include experts in the fields of public health and infectious diseases. Many more skills than simply medical are needed, and they concern provision of water, shelter, food, and sanitation.

A great deal. They will find out a lot about themselves. They will experience comradeship and team cooperation in austere environments that will stand them in good stead during crises in their professional lives. Most important of all they will give back a little something, will be less inclined to complain about their lot in life, and will have a better understanding of the wider and less fortunate world beyond our shores.

Of course. They will broaden their skills. They will have improved self confidence. Working as a generalist they will learn of clinical care outside their narrow UK specialty. They will learn to better appreciate their colleagues in allied disciplines, such as nurses, physiotherapists, paramedics, and nutritionists.

With care, I'm afraid. Most organisations typically only accept quite senior specialist registrars or young consultants. It is all to do with governance, audit, and the risks of litigation. That does not mean that medical students or senior house officers should not become involved. Many of the large organisations welcome junior membership and will offer training and academic opportunities and posts abroad as the doctor becomes more senior.

Be informed. Be trained. Be flexible. Be an optimist. Be careful. Choose the organisation you deploy with carefully. Check the websites of the medium and large non-governmental organisations. Look in particular at Merlin (Medical Emergency Relief International) and RedR.

Two field trips to Afghanistan-one to Kabul and one to Mazir E Sharif. These were multi-agency studies of the fate of a selection of Afghanistan's medical schools and teaching hospitals. It was most memorable because of the beauty of the country and the quiet dignity and courage of the Afghan people in the face of awful adversity.

I think 28 years of army experience helps. I have had exposure to horror and suffering in Northern Ireland, the Balkans, the Falklands, and other areas during my service. This exposure gives a kind of inoculation, however, it does not dent your compassion or take away your anger.

I hope to work abroad on a consultancy basis for a few more years yet. I will remain at the university, with involvement in major incident planning and the management of severe injury.

Competing interests: James Matheson is the student representative of the faculty of conflict and catastrophe medicine at the Society of Apothecaries of London.