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It’s impossible to save everyone, and in a place where many people are at high risk of injury and death, things can get heartbreaking at times.
Dr. Nott reported that sometimes snipers would shoot patients in the same place multiple times a day. "You'd know that, at the start of the day, if you got a patient shot in the right arm, you'd have six or seven more shot in the right arm," he said.
Neurosurgeon Omar Ibrahim, who worked in Syria for a number of years, gives an example: "In most bombings you see one or two children with severe brain injuries. I have [seen] hundreds [of children with brain injuries] ... It is very sad to see them and [know] you cannot help save their lives."
Sources: (International Humanitarian Law) (The Guardian) (The Conversation) (Grunge) (Reuters)
See also: Countries that were in the most wars
Being a doctor in a war zone is a very stressful job. Some end up working days in a row in hospitals, which takes an extra toll on their physical and mental health.
Doctors working in such extreme conditions must reassure patients they are in control. “The initial doctor-patient relationship must provide that, and instill a feeling of confidence that the doctor will be able to help and do the right thing, and take away the pain of injury," said Dr. Nott.
Being a doctor in a war zone is not as highly remunerated as it should be. Sometimes they don’t even get paid.
"In terms of what we call vaccine-preventable diseases, the status in Ukraine was that the population was not vaccinated to the extent which you would get herd immunity like you would in many other European countries or in the US," said Kate White from Doctors Without Borders.
“You need to be able to make decisions about what is right for the patient without recourse to hi-tech investigations such as CT scanners, or x-ray machines, which are few and far between on the frontline,” he added.
Being an all-rounder is yet another skill required when working in war zones. According to Welsh war doctor David Nott, who has worked in Sarajevo, Gaza, and Syria, "you have to know a bit of everything — neurosurgery, maxillofacial surgery, chest surgery, abdominal surgery, orthopedics, plastics, pediatrics, how to deliver a baby."
Being comfortable with helplessness and unpredictability is a skill war doctors must develop.
The lack of sanitation, electricity, and vaccinations in certain countries increases the risk for patients and doctors.
Chair of the Ukrainian Diabetes Foundation, Valentina Ocheretenko, described the situation as dangerous. "I fear for people with diabetes, it's too much," she added.
In 2022, patients with Type 1 diabetes struggled to get access to insulin during the beginning of the Russia-Ukraine conflict.
Doctors work with people, so they are exposed to risk at all times. "We are forced to work in a place like this where we are exposed either to shells or artillery or tanks. We have to be among the civilians to treat them." said British surgeon Abu Shamel, who worked in Syria.
Working with limited resources is a reality for most doctors in war zones. Dr. Maher Saifo, who worked at Albairouni University's Cancer Care Center in Syria explained how power cuts interfered with radiation treatments, and how there wasn’t sufficient diagnostic equipment available.
Doctors are not only at risk of being attacked. There have been instances where they have been kidnapped.
Doctors are required to speak out and report atrocities, regardless of which side commits them.
In 2022, a Ukrainian doctor who treated wounded Russian soldiers during the conflict opened up about how morally challenging it was. "I think we should help them, but of course, sometimes the feeling I have about it is horrible. It feels like I'm doing something wrong. Like, I can be helping my people, but I have to spend time helping that piece of ****."
Doctors can't pick and choose who they treat—they must treat everyone, including enemies. They can't discriminate based on nationality, religion, or any other factor.
But “they lose their protection if they commit, outside their humanitarian function, acts harmful to the enemy.”
Loss of protection may occur if medical vehicles are involved in the “transport of healthy troops, arms or munitions and the collection or transmission of military intelligence.”
Medical vehicles are equally protected, but it too can lose protection if it's used to participate in the conflict in any way.
Rule 25 of the IHL says that “medical personnel exclusively assigned to medical duties must be respected and protected in all circumstances."
According to the IHL, doctors cannot partake in the war… But they can use weapons to protect themselves.
International Humanitarian Law (IHL) defines the roles of doctors and their code of conduct in war zones.
As Dr. Alan de Lima Pereira who worked in Yemen wrote, "The moments of helplessness faced by a wartime doctor are many. We know there will always be another flood of patients pouring into our hospital."
This was indeed the case back in 2017 in Yemen, where doctors worked for a year without getting a paycheck.
The doctors in question were working for the charity Doctors Without Borders. "Working for a year without pay, many are doing whatever possible to keep health services running, however minimally, while wondering how to keep their families fed, clothed, and safe, " said Melissa McRae, medical coordinator in Yemen.
A number of civilians helped the medical community during the Russia-Ukraine conflict. Many donated blood, while restaurants provided food for doctors.
Being a doctor is already a highly demanding profession, but add an armed conflict to the job description, and you have one of the most challenging jobs on Earth. Many people choose the path of medicine to help others and make a difference, and many go a step further by putting themselves on the (front)line. But what rules do these medical professionals have to follow in war zones? What are their main concerns and challenges?
In this gallery, discover what it's like to be a doctor in a war zone. Click on.
What is it like to be a doctor in a war zone?
Saving lives on the front lines
LIFESTYLE Medicine
Being a doctor is already a highly demanding profession, but add an armed conflict to the job description, and you have one of the most challenging jobs on Earth. Many people choose the path of medicine to help others and make a difference, and many go a step further by putting themselves on the (front)line. But what rules do these medical professionals have to follow in war zones? What are their main concerns and challenges?
In this gallery, discover what it's like to be a doctor in a war zone. Click on.