Page 136 - JSOM Fall 2018

The Mosul Trauma Response

A Case Study

Spiegel PB, Garber K, Kushner A, Wise P. The Mosul Trauma Response. A Case Study. The Johns Hopkins Center for
Humanitarian Research; February 2018; 140 pages.
Review by COL (Ret) Warner “Rocky” D. Farr, MD, MPH

he Battle for Mosul was probably the largest urban war • Successful coordination among local leaders, partners,
Tsiege conducted since World War II. Lasting from October and civilian and military officials occurred, but field co­
2016 to July 2017, Iraqi and Kurdish forces fought to retake ordination could have been better resourced.
Iraq’s second largest city, Mosul, which had fallen to ISIL (Is­ • Deconfliction from all these various new players could
lamic State of Iraq and the Levant; a.k.a., Daesh) in 2014. have been better.
Backed by US­led coalition military forces, more than 940,000 • What is the real take­home message from this study? It
civilians fled during the siege. Thousands were injured while is that battlefield medicine can be outsourced, privat­
seeking safety from the fighting. It became ized, contracted, be not neutral or indepen­
obvious early on that the Iraqi government dent, be embedded into combat formations,
military forces did not have adequate, or­ show up without all levels, roles, or eche­
ganic, medical force structure or capacity lons of care and generally not meet the ex­
to provide trauma care, despite the require­ isting mold of medical support we all grew
ments and obligations under several Ge­ up with and expect in ground combat.
neva Convention protocols to do just that.
The World Health Organization (WHO) In the report, the authors provide a
and its partners stepped in to fill this huge thoughtful list of recommendations, such
and somewhat novel emerging gap, as did a as: “Accept a pluralism in the balancing
number of contractors and other new 21st of humanitarian principles among differ­
century battlefield medical players. ent humanitarian actors; medical teams
operating directly with a combatant force
This marks the first time WHO has played should not be identified as humanitarian;
the leading role in coordinating care in a frontline medical services could be provided
large conventional wartime conflict and the by specialized groups explicitly trained to
first time civilian trauma settings and ca­ work directly with combatant forces, pos­
pabilities were attempted by such medical sibly contracted as military support services
players at the war’s frontlines. focusing on providing frontline medi­
cal services for both injured soldiers and
Some of the key findings in the report The civilians.”
Mosul Trauma Response. A Case Study, by Paul B. Spiegel and
colleagues, are: The authors also recommend the following:

• Between 1,500 and 1,800 lives, military and civilian, may • “Using private medical organizations to provide human­
have been saved through this novel war trauma response. itarian services in conflict settings needs further study.”
• By applying existing Western military standards of • “Humanitarian organizations must be extremely care­
trauma care (not including the golden hour) and forward ful to avoid being instrumentalized as part of a conflict
deployment, WHO and its partners challenged existing strategy by governments, militaries, and armed combat­
humanitarian laws and custom principles, particularly ants in the future.”
those of the complete neutrality and independence of • “Only organizations and professionals with conflict ex­
nongovernmental organizations (NGOs) and private perience, international humanitarian law training, and
voluntary organizations (PVOs). This is just yet one a strong understanding of the high­risk environments
more thing that fills today’s battlefield with contractors! in which they will be working should be deployed near
• The Iraqi military did not have medical force capacity to frontlines.”
fulfill obligations to protect and care for wounded civilians
on the Mosul battlefield, and the US­led coalition did not This report not only gives one much to think about the evolv­
provide substantial medical care for wounded civilians. ing face of medical support in today’s changing battlefield
• WHO­supported field hospitals filled many important but also completely fits in with the ongoing discussion of the
gaps in trauma surgical care, while postoperative and problems with the golden hour and its applicability. I can see
rehabilitative care needed greater support. completing medical contractors bidding now: “I can guarantee

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