Conflict Medicine: Healing in the Midst of Turmoil

Vol. XXII, No. 1, 2024

Conflict medicine practitioners work in some of the most demanding environments worldwide, providing medical care to people who have been injured, displaced, or traumatized by the ravages of conflict. In these circumstances, hospitals are often reduced to rubble, and medical workers must scramble to provide care in makeshift clinics, with patients arriving in horrific condition and inadequate resources to go around.

In these extreme environments, doctors must learn to function with limited resources and adapt to ever- changing circumstances. They may have to perform complex surgeries in provisional clinics or triage injured people despite having few personnel to treat them, and yet, through it all, they are expected to provide the best possible care to their patients.

Regions marred by armed conflicts and escalating climate disasters have, unfortunately, become all too familiar with the field of conflict medicine, which has emerged as a crucial pillar of healthcare. This specialized discipline, dedicated to providing medical care in the midst of strife and instability, plays a lifesaving role for countless civilians caught in the crossfire of violence and environmental upheaval.

Dr. Ghassan Abu Sitta is an experienced conflict medicine practitioner who has worked in Gaza to treat the scores of civilians injured by the conflict. He is the codirector of the Conflict Medicine Program at AUB’s Global Health Institute (GHI), the first of its kind in the region, and has seen firsthand the devastating impact of conflict on human health, having treated patients who have been shot, bombed, and burned.

“Conflict medicine recognizes that strife has a profound impact on our health,” says Dr. Abu Sitta. “It can lead to physical injuries, mental health conditions, and chronic diseases, disrupting access to healthcare and social services, and exacerbating health inequalities.”

Despite the challenges, Dr. Abu Sitta is passionate about his work, believing conflict medicine is essential to saving lives and alleviating suffering in conflict zones. He is committed to training the next generation of conflict medicine practitioners to ensure that they are prepared for the realities their communities might face.

Conflict medicine asks: What is the role of treatment and the physician in armed conflict, and how can we care for patients amid a military crisis? To answer this, medical professionals such as Dr. Abu Sitta are calling for medical schools to incorporate conflict medicine into their curricula so students will be prepared with the necessary tools and knowledge to serve their communities. “When you’re producing the next generation of doctors in places like Sudan, Gaza, or Libya, where the junior doctors are the ones in the emergency departments, they need specific skills to provide lifesaving treatment to patients while in extreme circumstances,” says Dr. Abu Sitta. “Otherwise, you are failing both the doctor and the patient.”

The gap in conflict medicine education is particularly evident in regions like the Middle East, where armed conflicts have been a persistent reality for decades. AUB, recognizing this critical need, has established the Conflict Medicine Program within its Global Health Institute. Launched in May 2016, the program is the first to be established within a civilian academic institution. The Conflict Medicine Program combines academic expertise with AUB’s strategic location in the MENA region, which offers direct access to conflict zones and populations impacted by conflict. This framework builds on local, regional, and international partnerships to engage professionals from academic and nonacademic organizations to treat, recover, and rehabilitate war injuries among civilians.

Dr. Fouad Fouad, professor of public health practice at the Faculty of Health and Sciences at AUB, emphasizes the need to expand the traditional definition of conflict medicine to encompass a broader understanding of the interconnectedness between health and conflict. “Conflict medicine is more than just medicine,” he asserts. “It encompasses the politics, social sciences, and history of how healthcare is delivered in conflict settings.” Dr. Fouad highlights the stark reality that healthcare is often used as a weapon of war, as seen during the Syrian Civil War and in the recent war in Gaza, with hospitals and medical personnel deliberately targeted in acts of violence.

This weaponization of healthcare underscores the urgent need to integrate conflict medicine into medical education. Dr. Fouad lamented the current shortcomings in medical curricula, which often fail to equip healthcare professionals with the skills and knowledge necessary to navigate the complexities of conflict zones.

Skills learned from conflict medicine programs were initially meant to turn medical students studying in conflict zones into doctors who can save lives in settings of extreme unrest. But the benefits of this education go beyond war-impacted regions. With the ever-increasing threats of climate-related disasters, volatile environments are now a part of life worldwide. Hurricanes, wildfires, and superstorms are wreaking destruction on our planet, and the health impacts from these events are similar to those found in conflict zones.

How do you provide medical treatment when hurricanes have eliminated your access to electricity for medical equipment? How do you treat burn patients when wildfires have consumed an entire community and you can’t provide aid in a hospital setting? “With the changing climate, doctors need to learn to function with limited resources and austere environments,” says Dr. Abu Sitta. “One of the critical things that conflict medicine teaches you is to develop resilience and adaptability to work in those circumstances.”

With the changing climate, doctors need to learn to function with limited resources and austere environments. As we confront the escalating humanitarian crises of our time, conflict medicine stands as a vital beacon, offering a pathway to alleviating suffering and preserving human life. New generations of medical professionals will face difficult medical settings brought on by conflict and the increasing climate catastrophe. Preparing them to meet these challenges is just as vital for them as it will be for us.

Editor’s Note: The interview with Dr. Ghassan Abu Sitta was conducted before the War in Gaza began. Since that time, Dr. WAbu Sitta has spent countless hours treating the wounded civilians of Gaza. The AUB community thanks Dr. Abu Sitta and his colleagues with Médecins Sans Frontières for their selfless service, upholding their Hippocratic Oath in the direst of conditions.

Statistics:

In Syria from March 2011 through May 2019 there were: 566 separate attacks on 348 medical facilities;

Nearly 900 medical workers are reported to have lost their lives in these attacks;

59% of Syrians were directly affected by attacks on the health system;

78% of surveryed health workers witnessed at least one attack;

24% reported being unable to receive medical treatment due to an attack on a health facility.