Two Arab universities will soon become the first to teach conflict medicine, with a curriculum devised by the pioneering surgeon Ghassan Abu-Sittah and based on his experience of wars in Iraq, Palestine and Lebanon.
“This is the first time that war surgery has been taught at the university level as part of basic medical education,” said Abu-Sittah, who is currently a lecturer at the Centre for Blast Injury Studies at Imperial College London, in a phone interview.
Conflict medicine is a specialty until now practiced by the military or by humanitarian organizations. Abu-Sittah, a British-Palestinian plastic and reconstructive surgeon, co-authored a manifesto issued by Doctors Without Borders in 2016 which defined conflict medicine as “a systematic approach to address the clinical, social and public health consequences of contemporary warfare.”
The new curriculum, to be used by the University of Baghdad and the Islamic University of Gaza, reflects developments in casualties caused by the use of advanced weapons in wars in the Arab region.
“Conflicts create a new environment for the residents of these areas. They define new patterns of their ways of life, as well as their health systems, even the sorts of diseases and infections that are transmitted,” Abu-Sittah said. (See a related article, “Studying Medicine in Time of War.”)
“We usually treat casualties who live in conflict areas in the Arab region based on information and research from Western institutions, which are not aligned with our health systems and capabilities.”
Obstacles for Arab Doctors
Christos Giannou, a former chief surgeon for the International Committee of the Red Cross, agreed on the need to rely on research drawn from local environments of conflict areas.
Giannou recorded his experiences of treating wounded people in Palestinian camps under Israeli siege in Lebanon in his book “Besieged: A Doctor’s Story of Life and Death in Beirut.”
“The main obstacle for war doctors in Arab regions is the lack of information and research that helps to understand the nature of casualties,” he said in a phone interview, stressing that most research is done by foreign military personnel or short-term employees of nongovernmental organizations.
“The main obstacle for war doctors in Arab regions is the lack of information and research that helps to understand the nature of casualties.”Christos Giannou
A former chief surgeon for the International Committee of the Red Cross
Giannou believes many people are qualified to practice conflict medicine in the Arab region and that there is abundant data on traumatology and other war-related injuries for the new generation to study. (See a related article, “Medical Students Get an Education Treating Syrian Refugees”.)
“Much of this expertise is not transferred to the next generation of medical practitioners,” he said. “Each new generation of surgeons must learn the basic rules of war surgery in a core curriculum and train new medical staff.”
A War Surgeon
Abu-Sittah was inspired to specialize in conflict medicine by Ang Swee Chai, the Malaysian-born British founder of the charity Medical Aid for Palestinians, who worked with Palestinian casualties in the camps in Lebanon after the Israeli invasion in 1982. (See a related article, “A Lebanese Scholar Wants to Improve Refugees’ Lives”.)
“Seeing foreign doctors in Arab conflict zones performing their duties was a strong motive to specialize in this field,” Abu-Sittah said.
His own experience of war medicine dates from 1989, when he volunteered as a doctor in the first Palestinian Intifada; it continued in southern Lebanon, Iraq, and the four wars in the Gaza Strip.
Ang Swee Chai participated in Abu-Sittah’s training at the Department of Plastic and Reconstructive Surgery of the Royal London Hospital in 2006. They had previously cooperated to treat casualties of the London bombings on July 7, 2005, and they traveled together to Gaza in 2007. And documented her experiences in the book “From Beirut to Jerusalem.”
“Ghassan has an extremely analytical mind and is always able to perceive connections and formulate hypotheses on the spot, then robustly test them during major events, as well as being one of the best surgeons in his specialty,” she said in an email.
Among the scenes that stick in her memory is Abu-Sittah’s success in formulating a comprehensive plan to treat hundreds of casualties in Gaza during the 2007 war, after the destruction of more than half the homes and the lack of water and electricity.
“He was not only a brilliant academic, but an excellent leader and coordinator for many of the projects they put together. But most of all, is being a merciful academic.”Ang Swee Chai
Founder of the charity Medical Aid for Palestinians
“He was not only a brilliant academic, but an excellent leader and coordinator for many of the projects they put together. But most of all, is being a merciful academic,” she said.
Important Work in Beirut
Abu-Sittah’s involvement in seven wars as a field doctor and his studies on the impact of war on child mortality, malnutrition rates and targeted health institutions in Palestine and Lebanon, led to his contributions as a co-author and editor of the book “Reconstructing the War Injured Patient.”
But his most prominent achievement was to set up the Conflict Medicine Program at the Global Health Institute of the American University of Beirut in 2015, in response to the increase at the university hospital of patients injured in the Syrian war and Iraqis with complex injuries after the American invasion of Baghdad.
Abu-Sittah explains that the main goal for establishing the program was “to create a multidisciplinary program to understand war injury as an endemic reality within this region.”
At that time, Abu-Sittah published several research papers on subjects including the impact of the American war on Iraq on child mortality and malnutrition, and how to improve health institutions in countries affected by war.
He also served as head of the Plastic and Reconstructive Surgery Department at the AUB Medical Center from 2012 until last September.
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Since leaving AUB, he continues to direct the conflict medicine program, and is supervisor of much of the research done in cooperation with the Centre for Blast Injury Studies at Imperial College London, where he works as a professor.
He is currently working on a study of the injuries caused by Israeli army snipers on demonstrators in March 2018. Other projects of his include the manufacture of surgical fixators for fractures in war zones, and research into war injuries suffered by children, especially those who are subject to amputation.
“War is not a contingent event that has a beginning and an end, because its effects are of long-term nature on the population, the environment and all the influences of life,” he said.
“There must be international legislation that places sanctions on all parties to the conflict to ensure that such tragic incidents do not happen again.”