Medical preparedness for humanitarian and military deployment in conflict zones Research by Radboudumc, Ministry of Defense and International Committee of the Red Cross

Medical teams deployed to conflict zones feel adequately prepared for this challenging task. At the same time, there is a demand for additional training, according to doctoral research by Frederike Haverkamp at Radboud university medical center, which she defended on April 5. She recommends a greater focus on specific medical topics, such as the treatment of children, more relevant work experience and an emphasis on communication and teamwork.   

Key insights of this thesis

• Align pre-deployment preparation with healthcare personnel’s work experience, the conflict characteristics, and local (hospital) infrastructure. 
• Invest in (international) cooperation with trauma centers to facilitate clinically relevant work experience.  
• Formal courses should focus on non-technical skills in addition to technical skills. 
• Prepare medical teams to care for and treat children with conflict related injuries.  
• Equally involve all professions of the surgical team in pre-deployment preparation activities. 

The number of conflicts worldwide has increased by a quarter since 2022, with the conflicts in Ukraine and Gaza standing out. But also due to the situation in Sudan, Myanmar and Democratic Republic of Congo, among others, one in six world citizens currently lives in a conflict zone. Surgical teams from around the world provide humanitarian or military aid in these zones, under unusual working conditions.

Surgical resident Frederike Haverkamp studied at Radboud university medical center how humanitarian and military surgical teams are prepared for their task in a conflict zone. She conducted questionnaire research among healthcare personnel deployed on behalf of the Ministry of Defense (the Netherlands, Denmark and Finland) and the International Committee of the Red Cross (ICRC). Although teams generally feel sufficiently ready for deployment, her thesis presents several challenges and opportunities for improvement.  

Clinically relevant work experience

Children make up a significant proportion of patients in conflict zones. Haverkamp assessed the injuries of nearly 6,000 child victims in seven conflict zones. These injuries, such as those caused by blasts, are rare in the Netherlands. Haverkamp: ‘That is fortunate but makes it challenging to gain clinically relevant work experience. Teams generally gain relatively little experience with these severe injuries, especially in children. Even during deployments, teams sometimes treat a low number of patients.'

Therefore, Haverkamp expects advantages from international collaborations with hospitals that treat patients with similar injuries on a larger scale. 'The Ministry of Defense has started such collaboration with a hospital in South Africa. At the ICRC, the medical staff often go along on a first mission on a supernumerary basis so that they can gain experience under supervision.  

Super specialization versus general surgical skills 

Surveyed teams requested additional preparation in a wide range of surgical subspecialties. Haverkamp: ‘This did not surprise us. In non-conflict zones, we see the trend of super specialization among medical specialists. On deployment, on the other hand, the teams are smaller, while they have to perform life-saving operations within different areas of expertise.’ Specialists may better retain these general surgical skills with more clinically relevant work experience.

Non-technical skills

Radboudumc annually organizes the Definitive Surgical and Anaesthetic Trauma Care (DSATC) course. This international trauma surgery master class is mandatory for Dutch military surgical teams prior to deployment. The emphasis here is on technical skills, Haverkamp says, ‘but an important course outcome that we found is improvement in non-technical skills, such as innovative application of the knowledge gained and increased reflective capacity. These skills are important for healthcare personnel working under such unpredictable circumstances.'  

It was striking that medical specialists feel better prepared for a deployment than (scrub) nurses. 'Therefore, invest in training for the team as a whole prior to deployment, focusing on both technical and non-technical skills,' Haverkamp advises. However, this is especially difficult within organizations that deploy healthcare personnel from around the world such as the ICRC, because these teams consist of healthcare personnel of different nationalities.

Good care is a human right 

This research contributes to the professionalization and standardization of care in conflict zones. Haverkamp: ‘I hope that as a next step we can facilitate greater work experience and set up more standardized trainings.’ She was gripped by this matter during her internships in Nepal and Suriname. 'Especially in Nepal, I saw how variable the quality of the healthcare system is, while everyone is entitled to care of international professional standards. That certainly applies to the vulnerable patient groups in conflict zones.'  

Learn more about this PhD thesis  

Thesis: Global surgery in conflicts: medical preparedness for humanitarian and military deployment - Frederike J.C. Haverkamp. (Co-)promotors: Prof. Dr. C.J.H.M. van Laarhoven, Prof. Dr. M.J.R. Edwards, Dr. E.C.T.H. Tan, Dr. R. Hoencamp.

Afbeelding: Suzanne Cuomo-Haverkamp.

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