Conflict is an unfortunate but recurring theme in human history. Although the rationale and setting for violence varies, the latest conflict in Ukraine has provided a tapestry of events that remind us of the dire consequences of 21st century warfare. The purpose of this commentary is to describe the health care challenges created by the modern battlefield and international disaster response and to provide brief reflections on opportunities and challenges for clinicians who provide medical assistance, based on the authors’ personal experiences. War has been described as a humanitarian crisis in disguise, disrupting the fabric of society and promoting violence, terrorism, and social injustice.2 The nonlinear and expansive nature of the modern battlefield typically creates an early surge of both military and civilian casualties. Military weapons increase the risk of lethal hemorrhage from high velocity penetrating injuries; burns and multiorgan trauma from the thermal and blast effects of explosive munitions are common.3 As of November 21, 2022, the United Nations (UN) Office of the Commissioner for Human Rights reported 16,784 confirmed civilian casualties in Ukraine, including 6,595 deaths.4 The Ukrainian health system, already challenged by chronic tensions with Russia and strain from the COVID-19 pandemic, has experienced further damage as hostilities have progressed.5 Although international humanitarian law stipulates that the medical neutrality of health care systems must be protected in time of war, the World Health Organization has documented 544 attacks on health care facilities in 15 Ukrainian oblasts as of November 15, 2022.6 Military actions have created barriers to causality evacuation, humanitarian aid delivery, damaged infrastructure, and disrupted essential services that include energy, water, communications, food, and sanitation. Currently, almost every hospital in Ukraine is treating military and civilian wounded; even major referral centers are using generators and internal radio communication and stockpiling clean water. Unofficial Ukrainian reports suggest approximately one-half of the health care workers who staff these facilities have either fled or joined the military response as a combatant or medic ...
Language: en
LA - en SN - 0012-3692 UR - http://dx.doi.org/10.1016/j.chest.2022.12.021 ID - ref1 ER -