̽��ֱ�� of Cambridge - military

Opinion: ̽��ֱ��challenges faced by doctors and nurses in conflict zones

Anonymous — Tue, 15 Mar 2022 15:34:40 +0000

Quite aside from the deadly and disorienting consequences for Ukraine’s citizens, Russia’s invasion places unique pressure on its doctors and nurses.

Cardiac arrests, caesareans and appendectomies are now often accompanied by injuries that should be relatively rare: gunshot and shrapnel wounds, third-degree burns, double or triple amputations, loss of sight, brain and spinal cord injuries. Were chemical weapons to ever be deployed, one can add blistering, convulsions and muscle paralysis. Then there are decisions unimaginable to many of us but unavoidable when resources are scarce: who will live and who will not.

With advance notice, medical staff can stock up on vast blood supplies, platelet-rich plasma and refrigerators. They can hone the specialist skills required for resuscitating and then repairing what war destroys. During the long war in Afghanistan, for example, military medical staff from allied forces underwent rigorous training before deployment. British surgeons and anaesthetists were required to complete a five-day military operational surgical training course at the Royal College of Surgeons where they practised damage control surgery on human cadavers, deliberately “wounded” to mimic typical injuries sustained during war.

From London, they’d move to an old aeroplane hanger outside the ancient English cathedral city of York to reappear, as if by magic, in a replica of Camp Bastion field hospital in Helmand province, Afghanistan. Here, they relied on actual amputees and theatrical makeup artists to reenact the patient journey from a helicopter to an intensive care unit. Even the thumping of an approaching Chinook was played over the sound system as doctors and nurses rolled up their sleeves.

Given the speed at which the conflict is advancing, Ukraine’s doctors make do instead with a 12-hour online equivalent designed and run by Dr David Nott and Dr Henry Marsh. Nott has 30 years’ experience working in conflict and disaster zones as a general and vascular surgeon and, through his David Nott Foundation, offers lifesaving treatment for victims by better equipping local doctors who care for them.

Unseen injuries

Other challenges facing doctors and nurses are more subtle, longer lasting, and more personal. War can be deeply traumatising, even for doctors and nurses not in the line of fire, meaning that rates of post-traumatic stress disorder (PTSD) are often as high for medical staff as for those at immediate risk of injury or death.

Until recently, the causes of PTSD were not well understood. We now know more about the extent to which cultural expectations, professional role identity, and organisational protocol (or formal rules) can exacerbate feelings of senselessness, futility, and surreality, and threaten people’s existential grounding.

This is because these contexts can trigger and amplify repeated experiences of senselessness (or the inability to justify war and its consequences), of futility (or the inability for medics to live up to their own expectations of “making a difference” as “compassion fatigue” sets in), and of surreality (or the inability to reconcile the absurdities of war with “life as normal”).

Senselessness, futility and surreality characterise the experience of war for many who are exposed to it. And when these experiences are sustained, they can dislocate a person’s sense of what they consider “meaningful”, “good” and “normal” to the point where they become an existential threat. They are war’s invisible injuries.

To compensate for this sense of dislocation, doctors and nurses have been observed to resort to innovative coping strategies. For example, they will refrain from publicly criticising the war effort for fear of hurting morale. They avoid emotional engagement by not attending funerals. They use humour to deflect and manage constant exposure to the cruelty of war. They establish enclaves of normality by importing home comforts (for example, in Camp Bastion, doctors organised Friday night pizzas and Sunday morning pancakes). They create improvised spaces in which to temporarily withdraw from war and catch up on Netflix. They grow flowers in the most uninhabitable spaces.

Sadly, the unintended consequence of this is often that it makes war even more surreal and cruel and the ability to help turn the tide more difficult.

Under circumstances such as those facing doctors and nurses in Ukraine today, the best prevention may be to accept that war is ugly, indiscriminate and savage. It is also a reminder of what is lost and what we must now work hard to preserve and repair.

This article is republished from ̽��ֱ��Conversation under a Creative Commons license. Read the original article.

Professor Mark de Rond from Cambridge Judge Business School outlines some of the unique pressures faced by doctors and nurses in Ukraine, in this piece originally published in ̽��ֱ��Conversation.

Ministry of Defense of Ukraine

Patient being treated in a Kharkiv hospital during a 2015 military operation

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

Yes

Licence type:

Attribution-ShareAlike

Military spending did not 'crowd out' welfare in Middle East prior to Arab Spring

fpjl2 — Tue, 24 Jul 2018 11:00:34 +0000

Research casts doubt on the widely-held view that spiralling military expenditure across the Middle East and North Africa (MENA) 'crowded out' investment in healthcare and public services, leading to civil unrest that eventually exploded in the Arab Spring revolutions.

̽��ֱ��so-called 'guns versus butter' or 'welfare versus warfare' hypothesis – that prioritised military spending resulted in neglect of health and education, thereby creating conditions that fomented public rebellion – is considered by many experts to be a root cause of the uprisings that gripped the region during 2011.

However, a team of researchers who analysed economic and security data from MENA nations in the 16 years leading up to the Arab Spring found no evidence of a trade-off between spending on the military and public services, specifically healthcare.

̽��ֱ��researchers from Cambridge and the Lebanese American ̽��ֱ�� argue that much of the evidence for the ‘guns versus butter’ causal link come from analyses of wealthy European nations, which has then been assumed to hold true for the Middle East.

They say the study’s findings, published today in the journal Defence and Peace Economics, provide a “cautionary note” against a reliance on simplistic correlations based on data from OECD nations to draw important policy conclusions about the causes of turmoil in the Middle East.

“Our research finds reports of this apparent spending trade-off prior to the Arab Spring to be somewhat spurious,” said Dr Adam Coutts, based at Cambridge ̽��ֱ��’s Department of Sociology.

“Academics and policy-makers should be careful in assuming that models and results from studies of other regions can be transplanted onto the Middle East and North Africa,” he said.

“Determining the cause of unrest is a rather more complex task than some experts may suggest. Historical experiences and political economy factors need to be considered.”

While only Saudi Arabia is in the top ten global nations for military spending in terms of hard cash, when calculated as a share of GDP six of the top ten military spenders are MENA nations.

Coutts and colleagues ran World Bank data through detailed statistical models to explore the trade-off between spending on military and on welfare – health, in this case – of 18 different MENA nations from 1995 up to the start of the Arab Spring in 2011.

̽��ֱ��team also looked at casualties resulting from domestic terror attacks in an attempt to estimate security needs that might have helped drive military spending in a region plagued by terrorism.

They found no statistically significant evidence that increased military spending had an impact on health investment. “Contrary to existing evidence from many European nations, we found that levels of military expenditure do not induce or affect cuts to healthcare in the Middle East and North Africa,” said co-author Dr Adel Daoud from Cambridge’s Centre for Business Research.

̽��ֱ��researchers also found no evidence for casualties from terrorism affecting either health or military spending – perhaps a result of the routine nature of such occurrences in the region.

“There may have been a policy adaptation in which regional conflicts and security threats are no longer the main influence on government security and military spending decisions,” said Daoud.

Adam Coutts added: “It has been argued that Arab populations accepted an ‘authoritarian bargain’ over the last forty years – one of societal militarisation in return for domestic security – and that this came at the expense of their welfare and social mobility.

“However, health and military spending cannot be predicted by each other in this troubled region. Policy analysts should not single out military spending as a main culprit for the lack of investment in public goods.

“Once again we find that straightforward explanations for unrest in the Middle East and North Africa are tenuous on close analysis.”

Findings dispute 'guns versus butter' narrative as a major factor behind the Arab Spring. Researchers caution against uncritically applying lessons from Western nations to interpret public policy decisions in the Middle East.

Policy analysts should not single out military spending as a main culprit for the lack of investment in public goods

Adam Coutts

Hossam el-Hamalawy

Medics transferring injured protesters in Abbassiya Square, Egypt

Yes

Licence type:

Attribution-ShareAlike