Treating victims of a modern war
When I planned a work experience placement in my motherland of Iraqi Kurdistan it seemed like an ideal place to get exposure to a medical environment that was different from the NHS. What I did not anticipate was being thrust into a healthcare setting that was coping with fallout of the war between the Islamic State and the Kurds in Iraq.
For my placement I was stationed at Sulaymaniyah Emergency Hospital in the east of Kurdistan, which had not yet been affected to any great extent by conflict. I arrived for my first shift at 7 pm in the emergency department to shadow the director of the emergency hospital and to observe common presentations, similar to those you would see in the United Kingdom. Everything happened at a frantic pace. There was a continuous rush of patients all individually triaged by the director. He examined each patient in less than a minute and sent them either for imaging or to a bed according to their priority. Often he treated several patients at once, with their families lingering around him. I was amazed at his speed, but I was also surprised that he was able to understand the patient’s problem after such a short consultation.
To add to this chaotic environment, at about 9 pm that evening the emergency department was flooded with over 20 wounded soldiers and civilians from what staff described to me as a battle between Kurdish soldiers and Islamic State forces in the town of Jalawla, two hours’ drive away. The towns surrounding the Jalawla area lacked sufficient medical staff and facilities to respond, so the wounded made the long trip by car to Sulaymaniyah to receive treatment.
The soldiers were men mostly in their early to mid 20s and all accompanied by at least one fellow soldier. The civilians varied in age and sex, but the most striking case was that of a heavily injured boy, around 11 years old, who was the only member of his family to survive the clash. As I looked at him I couldn’t help but imagine how he would soon have to face the news about his family as well as coming to terms with long term health complications caused by his injuries.
The director’s already exceptional efficiency went into overdrive. Patients with non-urgent conditions were told to wait while he examined every casualty. Many had shrapnel wounds on various parts of their bodies. The patients with more minor injuries who were suitable for quick treatment were treated in the emergency department, but those who had more complicated injuries were sent for computed tomography scans or laparotomies or kept stable until the morning when a relevant specialist or surgeon could assess and treat them. There were also many junior doctors sitting or standing around waiting to start administering drugs or suturing wounds—but only after the director’s instruction.
After two weeks of working at the hospital I realised that my first shift was just a typical day in the region. I was shocked that soldiers were treated adjacently to the general public and expected them to be treated in special centres nearer to the frontline, with only the more serious cases being brought to hospital. But the suddenness of this siege and the lack of resources meant that casualties had to travel long distances, with public hospitals like Sulaymaniyah Emergency Hospital expected to pick up the pieces. I thought that instead there should have been some extra preparation, such as more doctors on call or a section of the hospital designated to treat the wounded.
The conditions imposed on the hospital at Sulaymaniyah meant that the approach to medicine had to be more instinctive and less bound up in following protocols or guidelines, as we are used to in the day to day NHS. During my time there it felt like the effects of the war were just an extension of normality, yet the department remained professional, calm, and upbeat throughout. Hospital staff seemed to revert to a type of muscle memory that enabled them to react to a well worn path and take these chaotic events in their stride.Arez Mohamed, fourth year medical student
1University College London, UK
Correspondence to: firstname.lastname@example.org
Competing interests: None declared.
Provenance and peer review: Not commissioned; not externally peer reviewed.
Cite this as: Student BMJ 2015;23:h1908