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Operation Lifeline Sudan.

The provision of aid in war zones can be fraught with political difficulties and may itself foster inequalities, as it is rare to be allowed access to civilians on both sides of a conflict. Over the past decade, a United Nations (UN) brokered agreement has allowed Operation Lifeline Sudan (OLS), a UN "umbrella" organisation, to provide the diplomatic cover and operational support to allow long term humanitarian and emergency food aid to both the government and the rebel sides in the long-running south Sudanese civil war. Over the years, the destruction of infrastructure in the country has meant that the provision of basic health care has been seriously hampered. Operation Lifeline Sudan has coordinated the work of most of the non-governmental organisations (NGOs), working in this part of Africa. Each NGO has had responsibility for a particular area of the country and has worked closely with the local Sudanese authorities on either side of the conflict, conforming to strict codes of conduct or "ground rules", based on neutrality. Operation Lifeline Sudan has provided an air-bridge for emergency relief supplies in regions where road access is impossible, either because of landmines, or simply because the roads do not exist. The war continues, however, and the underlying causes of war-economic exploitation, marginalisation of communities, lack of political representation, and systematic violence and abuse remain unsolved. The warring factions have brought some OLS operations in south Sudan to a standstill recently, for certain political reasons that could have compromised the neutrality of the OLS-coordinated humanitarian aid schemes. It would appear that the only resolution to the country's problems are external political pressure to get the respective combatants to negotiate and, less probably, an undertaking by countries of the developed world not to continue to supply arms. Nevertheless, OLS may serve as a model for how medical aid can be delivered in an even-handed way to the populations of countries where there is civil war, irrespective of where they may live.

Delivery of Health Care↗

The Bhopal tragedy--what has Swedish disaster medicine planning learned from it?

On December 3, 1984, a leak of methylisocyanate (MIC) from a chemical plant in Bhopal, India, affected 150,000 to 200,000 people. More than 10,000 people were severely injured and approximately 2,500 died. In this article a survey of symptoms, treatment, and rescue work is given. On the basis of this, we discuss ways to help reduce the effects of a major release of an irritant gas. People living in the vicinity of potential health hazards need information on how to behave in case of accidents. Rescue workers and medical personnel must be trained to operate under "toxic conditions." There must be planning for treatment of thousands of patients at the same time, a circumstance that will often require temporary "satellite hospitals" to be opened. As symptoms and injuries are of the same kind, even if the magnitude and the effect may differ, treatment can, in many ways, be standardized. Therefore members of the health care team, irrespective of their daily different specialty fields, can work with the most urgent missions.

Accidents, Occupational↗

Disaster preparation and the functioning of a hospital social work department during the Gulf War.

The nature of the Gulf War and its consequences for the public at the personal and community levels, called for considerable alterations in organization and management at the Chaim Sheba Medical Center, the largest government general hospital in Israel, with constant adaptation to the changing situation. The preparations and exercises preceding the state of emergency, combined with the knowledge and experience gained in similar situations in the past, equipped the staff of the Social Work Department to function adequately and to make appropriate decisions and changes in the face of moral and ethical dilemmas, as well as immediate physical threat. This article presents the rationale for the model of intervention that guided the hospital during the Gulf War in offering services to casualty victims and their families. Also discussed are the process of developing an organizational framework and its content that meets wartime demands, and the implications for social work practice in dealing with a war crisis.

Adult↗

Lunotriquetral arthrodesis. A controversial procedure.

12 male (mean age 28) and 11 female (mean age 32) patients treated with lunotriquetral (LT) arthrodesis were reviewed with a median follow-up of 28 months (range 18-40 months) for this retrospective study. At first presentation 12 patients were unable to work, and at follow-up only three men remained out of work. The relief of pain was significant (P < 0.001) and the median Culp (1993) wrist score obtained 74 (min. 45, max. 96); however, only one patient was totally free of pain and seven men had to change their occupations. Men lost 455 working days, women 191, a highly significant difference (P = 0.006). This loss correlated (P = 0.007) with the LT angle measured in the frontal plane: all patients but one with a LT angle of less than 31 degrees returned to work within 1 year, but only four with a greater angle (P = 0.007). This emphasizes the importance of correct positioning of the triquetrum, which seems hard to achieve with two AO lag screws. Furthermore, even two screws seem unable to ensure solid fusion as shown by the high rate of pseudarthrosis (57%). LT fusion cannot be considered as a routine procedure and results are not yet predictable. According to these results, we feel that a bone graft placed in a slot from lunate to triquetrum is the procedure of choice. In the presence of a chondromalacia in the ulnar midcarpal joint, a four bone fusion is primarily recommended.

Adult↗

[Injuries following a hurricane in Nordmøre].

In this article we describe the efforts of local authorities to detect and treat casualties caused by a hurricane that struck the west coast of Norway January 1st, 1992 and prevent further injuries. Wind velocity exceeded 100 knots (117 mph), the strongest ever recorded in Norway. The damage to buildings, trees and power lines was so devastating that the Nordmøre area, with approximately 50,000 inhabitants, was left without electricity for five days. Altogether 56 casualties were reported by physicians and the local hospital (one death, caused by hypothermia and exhaustion, and six admissions to hospital) in the period 1-5 January. Nine old people suffered injuries by falling in the dark in their houses, and ten men were injured during repair work.

Adult↗

Stress and health during medical humanitarian assistance missions.

The present research examined stress and health among service members deployed on a medical humanitarian assistance mission to Kazakstan. Team members were surveyed before and during their deployment. Team members underestimated how much stress they would experience in terms of isolation and inability to help the local population. Team members also used less adaptive coping mechanisms than anticipated and showed elevations in alcohol and cigarette consumption. Despite these negative experiences, reports of depression and physical symptoms did not increase during the deployment. This may have been a function of team members being personally involved in important and relevant work during the humanitarian operation.

Adaptation, Psychological↗

[The prediction of the magnitude and structure of the health losses in the catastrophic flooding of the area of a large city].

Using the developed methodological approaches a multivariant forecast has been worked out of a possible magnitude and structure of sanitary losses in a disastrous flood in the territory of a large city. It is shown that forecast-related materials can become the basis on which preparation might be initiated of force and means of the health system towards work under such conditions, with its functioning being ensured under swiftly changing conditions of an emergency situation.

Cities↗

Management of refugee crisis in Albania during the 1999 Kosovo conflict.

The report presents key data on Kosovo refugees in Albania during the 1999 crisis in Kosovo. In a three-month period, from March through May 1999, Albania received, accommodated, and cared for 479,223 officially registered refugees from Kosovo (FR Yugoslavia). Many foreign governmental and non-governmental organizations helped the Albanian government during the crisis. The Government cooperated with the organizations through Government Commission, which appointed a Special Coordinator to the Emergency Management Group that coordinated factors and actions in the field. A Health Desk was established by the Emergency Management Group to provide an overview of the health impact of the crisis upon refugees and domestic Albanian population. There were no serious outbreaks of infectious diseases, but the Health Desk registered 2,165 cases of diarrhea without and 14 cases of diarrhea with blood in the stool. Scabies and lice affected around 4% of the refugees. After the refugees returned to Kosovo, Emergency Management Group continued to coordinate the work on the rehabilitation of the refugee-affected areas. In this phase, humanitarian emergency work served as a bridge between emergency activities and normal development.

Albania↗

Humanitarian war: a new consensus?

The NATO bombing operation Allied Force against Yugoslavia in March-June 1999 represents the final disappearance of the narrowing divide between humanitarianism and politics: a war initiated and justified on humanitarian grounds. Although unlikely to be repeated any time soon, the Kosovo case appears to have cemented an ideological shift on the international right and even necessity of sing military force to protect civilians within sovereign states. Rather than humanitarians acknowledging the political context and consequences of their work, however, the case suggests the embrace of humanitarian principles of universality and neutrality by military organisations. This article discusses some consequences of the new consensus: neglect of the political context (both local and foreign) of such operations, interaction between the operational dynamics of relief operations and the logic of war and the political consequences of using the humanitarian legitimation and mission in such cases.

Altruism↗

Morbidity surveillance among Dutch troops during a peace support operation in Cambodia.

This prospective descriptive study presents the morbidity among 2,283 Dutch marines in northwest Cambodia from 1992 and 1993. In a field database, we recorded 4,036 consultations from 1,356 persons (59.4%) leading to 3,562 diagnoses and 392 different International Classification of Diseases codes. Most diagnoses were for tropical disorders (24.8%), musculoskeletal disorders and injuries (23.9%), and dermatological disorders (22.7%). Risk factors for morbidity were being in battalion 1 and in lower military ranks. There were 3,468 lost working days (0.91%), predominantly caused by musculoskeletal disorders and injuries (35.1%), tropical disorders (29.7%), and dermatological disorders (18.1%). Risk factors for lost working days were being in battalion 1, of younger age, and in lower ranks. Most lost working days occurred during the second month of each deployment. Despite many consultations, the overall morbidity and consequent lost working days remained low.

Absenteeism↗

Providing home care during civil unrest.

The Visiting Nurse Association of Los Angeles responded to the possibility of civil unrest during the Rodney King trial by drafting a plan for disaster readiness. Both management and staff worked together to prepare the agency for the continuation of services during civil unrest or other possible disasters.

Civil Disorders↗

Learning from each other: The social work role as an integrated part of the hospital disaster response.

Australian social workers in health care have become important members of hospital disaster response teams. The development of the role and its integration into the mainstream disaster response has progressed over the last two decades. Recent international events have given affirmation to the importance of this role. The development of national and state based Disaster Management Plans in Australia began in the mid 1970's. Recognition of the need for experienced, skilled workers to provide emotional support, practical assistance and grief and bereavement counselling has resulted in the inclusion of social workers in several key parts of the disaster management response including the specialised area of Disaster Victim Identification. Following the Bali Bombing in October 2002, social workers worked with the Police Missing Persons Unit to provide support to families and facilitate the collection of ante mortem information. The process by which new services come about can be intricate and complex. In the field of health social work, the contribution of international programs such as the Mt Sinai Leadership Enhancement Program cannot be underestimated. As the Social Work Director of Westmead Hospital, one of the largest hospital social work departments in the country, participating in this program provided opportunities to share professional experience with international colleagues, many of whom are experts in their field. The social work role in disaster response has become internationally recognised and is an example of how collaboration and shared information and learning, can result in a profession working together to support key principles and values of practice for the benefit of those in need.

Australia↗

Home care during the aftermath of Hurricane Hugo.

During the course of field observations for an ethnographic study of home care nurses' job stress, Hurricane Hugo struck the community, causing extensive damage. The nurses' office building was heavily damaged by wind and water, and their office was not habitable for almost a week. The author had observed the nurses' work practices over 10 weeks before the hurricane. In the aftermath of the storm, the nurses were simultaneously disaster victims and caregivers for other victims. They experienced grief, anger, and frustration about their losses, as well as conflict between their family- and work-related responsibilities. Their experiences and behaviors were consistent with those described in prior disaster research literature, lending further support to the earlier studies. A major asset for these nurses was their open, supportive work environment. They were able to accept and affirm one another's negative feelings and to provide support to each other as they dealt with their losses.

Anger↗