Page 156 - JSOM Spring 2018

Medicine on the Edge of Darkness

Peter Anders Christensen, MD

ABSTRACT
Austere care of the wounded is challenging for all Western The ICRC is an independent, neutral organization ensuring
medical professionals—nurse, medic, or physician. There can humanitarian protection and assistance for victims of armed
be no doubt that working for the first time, either for a non- conflict and other situations of violence. It acts in response
government organization or in the Special Forces, you will be to emergencies and, at the same time, promotes respect for
taking care of wounded patients outside your training and international humanitarian law and its implementation in na-
experience. You must have the ability to adapt to and over- tional law.
come lack of resources and equipment, and accept standards
of treatment often very different and lower than that common The International Red Cross and Red Crescent Movement is
in western hospitals. The International Committee of the Red the largest humanitarian effort in the world. In 2015, 31.3
Cross (ICRC) was asked to provide relief for the Pakistan Red million people received access to water with sanitation im-
Crescent in 1982 and set up the ICRC Hospital for Afghan proved, 13 million people were provided with basic aid such
War Wounded in Peshawar on the border to Afghanistan. as food, 2.9 million health consultations were conducted,
This article relates how a western-trained young anesthetist 929,900 detainees were visited, and 479,000 calls were made
on a ICRC surgical team experienced this, at the time, austere between family members. ICRC expenditure totaled approxi-
environment. mately $1,500 million, using $1,300 million for field opera-
tions and $200 million for headquarters. The ICRC employs,
Keywords: austere; ICRC; Pakistan; Afghanistan; nongovern- on average, 14.000 personnel and, last year, was active in 80
ment organization* countries. 1

The raison d’être of the ICRC is to ensure respect, through its
Introduction neutral and independent humanitarian work, for the lives, dig-
nity, and physical and mental well-being of victims of armed
0200 on a hot muggy night and my ICRC team had been work- conflict and other situations of violence. The ICRC directs
ing nonstop since 0800 the same morning. I was prepping an- and coordinates international relief activities in “international
esthesia while the rest of the team was preparing the patient and non-international armed conflicts” and in situations of
2
and the operating room [OR] for a below-the-knee amputa- “internal strife and their direct results.” It also directs and
2
tion. We were in Peshawar, Northern Pakistan, in the summer coordinates activities aiming to restore family links in any
of 1985 at The ICRC Hospital for Afghan War Wounded and situation requiring an international emergency response.
2
the patient was an Afghan Mujahideen wounded by a near- For many years, The ICRC has assisted national Red Cross
miss bomb blast while fighting the Soviets inside Afghanistan. or Red Crescent organizations with trained medical person-
His evacuation time had been 4 to 5 days without any treat- nel, including surgical teams, in support of health care. During
ment, so the wound was severely infected with no chance of 2015, the ICRC supported, regularly or on an ad hoc basis,
saving the leg. Suddenly, the door to the OR burst open and 476 hospitals in 29 countries. Statistics were available for
eight tribal fighters surrounded my team with raised AKs, de- 166 of these hospitals, where 48,115 weapon-wounded and
manding we stop working on the patient. Then a tribal elder 98,491 nonweapon-wounded surgical patients were admitted,
with a long grey beard, as I understood later, the patient’s fa- and 132,312 operations were performed.
ther, strode into the room to inspect the wound and to ensure
that we Westerners were not just amputating a healthy leg of The political upheavals in Afghanistan during 1978 and 1979
a righteous Muslim. A lot of tension and aggression quickly had already initiated a refugee exodus to Pakistan, but the
dissipated when he both saw and smelled the terrible wound. Soviet invasion in December 1979 and the intensified war
They disappeared, and we got on with the job. against the Mujahideen increased this exodus to epic propor-
tions. In 1983, the Soviets shifted from a tactic of driving the
The International Committee of the Red Cross (ICRC) is Mujahideen from the countryside to forcing the population
based on the additional protocols and statutes of the Geneva out of contested areas, with widespread use of aerial bom-
Conventions of 1949 and those of the International Red Cross bardment. Soviet forces regularly targeted civilians and de-
and Red Crescent Movement, and the resolutions of the In- ployed land mines across the country, including urban areas.
ternational Conferences of the Red Cross and Red Crescent. This was a terrible war of attrition on the civilian populace.
Address correspondence to Toggerbovej 4, 8420 Knebel, Denmark or toggerbo@gmail.com
Maj (Ret) Christensen is a consultant for The University College Cork, Ireland, who teaches Special Operations Medicine on all levels at NATO
Special Operations Headquarters, Belgium.

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