Global & Disaster Medicine

Archive for the ‘Conflict’ Category

Gaza: Baby dies from tear gas

Washington Post

“…..The dead included at least seven children under the age of 18, among them a 15-year-old girl, the ministry said. The baby was eight months old and died after inhaling tear gas at the main protest area east of Gaza City…..”


Democratic Republic of Congo: A recent wave of brutal fighting has broken out in Ituri province leading to 260 deaths and the flight of hundreds of thousands.

NY Times


Chemical terrorism in Syria: A Chronology

NY Times

Chlorine Sarin Mustard

NY Times

NY Times



On Saturday, April 7th, at 7:45 PM local time, amidst continuous bombardment of residential neighborhoods in the city of Douma, more than 500 cases -the majority of whom are women and children- were brought to local medical centers with symptoms indicative of exposure to a chemical agent.

NY Times


“Following a brief ceasefire that only lasted for a couple of days, the city of Douma, East Ghouta, was again subjected to heavy shelling that resulted in dozens of casualties and hundreds of injuries. The attacks included the systematic targeting of medical centers and civil defense teams, resulting in the  the destruction of the majority of the civil defense centers and a large number of ambulances and rescue vehicles, heavily paralyzing the medical capacity of the city

On Saturday, April 7th, at 7:45 PM local time, amidst continuous bombardment of residential neighborhoods in the city of Douma, more than 500 cases -the majority of whom are women and children- were brought to local medical centers with symptoms indicative of exposure to a chemical agent. Patients have shown signs of respiratory distress, central cyanosis, excessive oral foaming, corneal burns, and the emission of chlorine-like odor.

During clinical examination, medical staff observed bradycardia, wheezing and coarse bronchial sounds. One of the injured was declared dead on arrival. Other patients were treated with humidified oxygen and bronchodilators, after which their condition improved. In several cases involving more severe exposure to the chemical agents, medical staff put patients on a ventilator, including four children. Six casualties were reported at the center, one of whom was a woman who had convulsions and pinpoint pupils. 

Civil Defense volunteers have reported more than 42 casualties found dead in their homes, with similar clinical symptoms of cyanosis and corneal burns. Civil defense volunteers were unable to evacuate the bodies due to the intensity of the odor and the lack of protective equipment. The reported symptoms indicate that the victims suffocated from the exposure to toxic chemicals, most likely an organophosphate element.

Following the chemical attack, the target site and the surrounding area of the hospital receiving the injured were attacked with an explosive barrel, which hindered the ability of the ambulances to reach the victims.

The Syrian American Medical Society (SAMS) and the Syrian Civil Defense (White Helmets) have documented nearly 200 uses of chemical weapons in Syria since 2012. Previous United Nations Security Council Resolutions on this matter have failed in stopping the use of chemical weapons in Syria.……”

Rescuers and medics say at least 70 people have died in Syria in a suspected gas attack in Douma



April 7, 1994: The Rwanda Genocide begins

History Channel

“….Rwandan armed forces kill 10 Belgian peacekeeping officers in a successful effort to discourage international intervention in their genocide that had begun only hours earlier. In less than three months, Hutu extremists who controlled Rwanda murdered an estimated 800,000 innocent civilian Tutsis in the worst episode of genocide since World War II. The Tutsis, a minority group that made up about 10 percent of Rwanda’s population, received no assistance from the international community, although the United Nations later conceded that a mere 5,000 soldiers deployed at the outset would have stopped the wholesale slaughter.….”


Emergency Trauma Response to the Mosul Offensive, 2016-2017

Fox, H., Stoddard, A. & Davidoff, J. (2018). Emergency trauma response to the Mosul offensive, 2016-2017: A review of issues and challenges. Humanitarian Outcomes, March.

“…..Despite certain weaknesses and limitations, the WHO-coordinated response succeeded in implementing a
large-scale, military-style referral chain system in highly difficult conditions and unquestionably saved lives.
An independent analysis of the data performed by a research team at John Hopkins Centre for Humanitarian
Health estimates that the WHO-coordinated trauma referral pathway saved between 1,500 and 1,800 lives –
approximately 600-1,330 civilians and the remaining majority combatants.

The total number of people treated is impossible to independently verify. WHO reporting cites that as of 7 August
2017, ‘some 20,449 people from Mosul city were referred through the established trauma pathways’.  But these
figures include patients being counted multiple times as they passed through the referral pathway. The Iraqi
Department of Health estimated that 10,000 to 12,000 ‘medical activities’ were performed…….Despite these constraints, between October 2016 and November 2018, MSF performed 20,334 emergency room
consultations (of which 4,135 were ‘war trauma’3 cases and 1,594 were ‘red’ cases4) and 31,242 primary health care
consultations. These emergency room and primary health consultations resulted in 3,601 surgical interventions,
1,178 deliveries and 2,647 inpatient admissions……”

 case study by Johns Hopkins. :  Document

IRIN opinion

Impact of Armed Conflict on Healthcare in Afghanistan: UN Report

Afghanistan and the Protection of Civilians :  Document

“…..In 2017, UNAMA documented 75 incidents targeting and/or impacting healthcare and healthcare workers that caused 65 civilian casualties (31 deaths and 34 injured) compared to 120 incidents in 2016 that resulted in 23 civilian casualties (10 deaths and 13 injured).

Most of the civilian casualties (26 deaths and 22 injured) in 2017 occurred in the context of a complex attack by Anti-Government Elements on the Mohammad Sardar Daud Khan Hospital in Kabul city on 8 March.

Threats, intimidation, harassment and abduction of medical personnel comprised the majority of incidents in 2017.

UNAMA recorded the targeted killing or attempted targeted killing of five healthcare professionals (three deaths and two injured) by Anti-Government Elements in 2017. In one case, on 10 October, in Tera Zayi district, Khost province, Anti-Government Elements stopped a healthcare professional from a mobile team while he was riding a motorcycle, opened fire and killed him.

Throughout 2017, Anti-Government Elements abducted 22 healthcare workers in 11 incidents, killing one of them. The other healthcare workers were released unharmed, mostly without ransom, often following the intervention of local elders. In 2017, Anti-Government Elements continued to target ambulances – UNAMA recorded five such attacks, all during the first half of the year.  For example, on 26 April, in Bagram district, Parwan province, Anti-Government Elements detonated a remote-controlled IED against an ambulance driving to the site of a murder, injuring five civilians, including a forensic doctor, two investigators, and two child bystanders.

UNAMA also recorded five incidents of intentional damage to medical facilities by AntiGovernment Elements, including one case in Badghis province, on 20 September, where AntiGovernment Elements fired rocket-propelled grenades at a clinic under construction, which resulted in its destruction and caused three civilian casualties (one death and two injured) in a nearby private house.

UNAMA documented the temporary closure of at least 147 health facilities in 2017, following threats issued by Anti-Government Elements, compared to 20 such closures in 2016. These closures ranged from several hours, with partial continuation of services, to several months of complete interruption of services, and negatively affected access to healthcare for numerous people in these areas…..”


Medical security plan set during Egyptian presidential elections (3/26-28)


“…..Ministry of Health and Population declared that as a part of the comprehensive medical plan, 2887 equipped ambulances will be distributed across polling stations, centers for the final announcement of election results, as well as along main roads in each governorate …….the Egyptian Ambulance Authority has coordinated with the Critical and Emergency Care Department to provide emergency doctors for each ambulance. ….. three fully- equipped medical convoys, with different medical specialties, will be stationed in each governorate during the election. Enough emergency blood supplies and medicine for six months will be provided to all hospitals during the election…..”

WHO renews its call for the protection of health workers and for immediate access to besieged populations.


Seven years of Syria’s health tragedy

News release

After seven years of conflict in Syria, WHO has renewed its call for the protection of health workers and for immediate access to besieged populations.

Attacks on the health sector have continued at an alarming level in the past year. The 67 verified attacks on health facilities, workers, and infrastructure recorded during the first two months of 2018 amount to more than 50% of verified attacks in all of 2017.

“This health tragedy must come to an end,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Every attack shatters communities and ripples through health systems, damaging infrastructure and reducing access to health for vulnerable people. WHO calls on all parties to the conflict in Syria to immediately halt attacks on health workers, their means of transport and equipment, hospitals and other medical facilities.”

Health systems are being attacked in the very places where they are needed most. An estimated 2.9 million Syrians live in UN-declared hard-to-reach and besieged locations. WHO is providing health assistance to many of these areas but lacks consistent access.

In East Ghouta, nearly 400,000 people have lived under siege for half a decade. Basic health supplies have all but run out, and there are now more than 1,000 people in need of immediate medical evacuation.

“It is unacceptable that children, women, and men are dying from injuries and illnesses that are easily treatable and preventable,” said Dr Tedros.

Critical medical supplies are also routinely removed from inter-agency convoys to hard-to-reach and besieged locations. Earlier this month, more than 70% of the health supplies intended to reach East Ghouta were removed by authorities and sent back to the WHO warehouse. The items removed are desperately needed to save lives and reduce suffering.

Seven years of conflict have devastated Syria’s healthcare system. More than half of the country’s public hospitals and healthcare centres are closed or only partially functioning and more than 11.3 million people need health assistance, including 3 million living with injuries and disabilities.

WHO is committed to ensuring that people across Syria have access to essential, life-saving healthcare. Last year, WHO delivered over 14 million treatments across the country, including through cross-border and cross-line services.

“The suffering of the people of Syria must stop. We urge all parties to the conflict to end attacks on health, to provide access to all those in Syria who need health assistance, and, above all, to end this devastating conflict,” said Dr Tedros.


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