‘Until he extends his compassion to include all living things, man will not himself find peace’.
Albert Schweitzer, Nobel Laureate
Expect the unexpected. This may well have been the mantra with which all delegates set forth to distant conflict areas, when accepting a mission with the Swiss humanitarian organisation, founded by the Geneva based business man and philanthropist, Henri Dunant, in the mid nineteenth century.
Doctors who volunteer their services to the ICRC do so as part of a specific remit to work within a multi-disciplinary team, either as surgeons or anaesthetists at a field hospital near to a battle zone, or as medical delegates coordinating urgent health action into the field where civilians need health protection, shelter and basic primary care. In other actions, under the auspices of the Geneva Conventions and their Protocols, medical delegates accompany Protection Teams to visit political prisoners across the Globe. The Geneva Conventions, of which the International Committee of the Red Cross are the guardians, permit (under international humanitarian law) the right of access to persons detained by a State on grounds of national security. ICRC delegates are privileged to visit these persons without any witness or guard being present, and to take details of their circumstances and conditions of incarceration, endeavouring wherever possible to ameliorate suffering. The same privileges are extended to the ICRC to visit prisoners of war and ensure their safety and health under the terms of the Geneva Conventions.
In 1993, having assisted the Irish Red Cross with three training programmes for potential future overseas delegates, I was invited to undertake a mission in South Sudan as a medical coordinator. Initially, I flew to Geneva and had what may be described as an intensive, if short briefing over a few days on the ‘situation on the ground’, the logistics, the health care and self care and the scope of my responsibilities. This would entail arranging the evacuation of wounded combatants, almost always by air in small aircraft capable of short takeoff and landing, from the battle zones to a safe location across the Sudan-Kenya border where a field hospital had a team of surgeons on standby. The mission commenced when I flew to Khartoum for more intense briefing, passing through Cairo airport en route and parting company with a cherished Waterman fountain pen, ‘borrowed’ by an immigration control officer. First lesson, travel light and carry nothing of value!
Then, flying in a small Red Cross Beechcraft, we flew another 1200 km to the Turkana desert base and a field hospital with a capacity of some 350 beds during emergencies. Here between two and three surgeons from a variety of National Societies worked within a thirty strong ex-patriot team to conduct emergency and life saving surgery for gunshot and spear wounds, including shrapnel injuries sustained when their nomadic villages were bombed. In addition, during cessation of hostilities, a team of six primary care nurses with public health and midwifery training, principally from Europe and Australasia, provided an incredible service with the minimum of equipment to isolated villages dotted over South Sudan,. For the next two years home was a stone floored, whitewashed mud and thatched tukul in Kenya’s Turkana Desert, in a sheltered compound surrounded by local native Turkana people. Some were employed as local staff for domestic work but otherwise there was no direct contact with the local people, since the team was mandated to work in the conflict area across the border or in the diplomatically protected zone of the hospital.
But we were afforded the luxury of running water and cold showers, with an excellent canteen and the wonderful company (for the most part) of a multinational work force of doctors, engineers, nurses, logisticians and an agronomy and fisheries expert. Days went quickly, busy on medevac runs when security clearance was given, ferrying severely injured to the hospital, many with tetanus and early gangrene and wound infection. At other times there was planning with water and sanitation engineers to restore damaged wells or rig up India pumps for a supply of safe water, since many of the nomadic tribes people of the Dinka and Nuer clans depended on herds of cattle and goats for their survival. Every six or eight weeks time off was given for rest and recuperation, flying to Nairobi across the Equator and perhaps on to Kenya’s Masai Mara, Zanzibar or Mombasa for a few days. Because of the stress of field work, in the presence of much visible injury and death, and sometimes bombing threats or rocket fire in the field itself, considerable attention was given to expatriate healthcare and psychological monitoring. Malaria was a constant health hazard in the rainy season but accidents were fortunately rare.
The missions spent with the Protection teams in the ensuing seven or eight years, visiting political prisoners in Asia, the Caucasus and the Middle East were of a totally different nature, demanding some knowledge of public health and skin diseases, especially with recognition of conditions such as beri-beri, scabies, tuberculosis and nutritional deficiencies. Sadly too was the evidence of ill treatment and torture, matters which needed to be handled with extreme diplomacy and discretion. The efforts to engage in meaningful dialogue with prison doctors, without appearing judgmental and being aware of their own difficult position, presented more challenge.
Later on, other members of the delegation were assigned to raise issues at both State and diplomatic level based on reported findings of the Protection teams. While there was certainly personal satisfaction in being able to conduct an amount of compassionate healthcare, much of the work was fraught with elements of frustration and helplessness in the face of real war situations (bombing and rocket fire, bicycle bombs in crowded markets, checkpoints with armed militia etc) and the attendant natural fear reactions such situations evoked. One had always to realise that whether it was to rescue casualties of war or bring some outside contact to prisoners, there was no realistic likelihood that these actions would change the minds of those having the authority to proscribe war or indeed take it upon themselves to extract information, from those in their custody, by whatever means and in contravention of international humanitarian law.
The concept of privilege in being able to work with the International Red Cross, the experience of living and working among many different cultures and the safe return to my family and family medicine in Ireland, almost physically and psychologically in one piece, has provoked the persistent search and yet to be attained goal, recognised by Schweitzer as ‘peace’.
John Good, MICGP
Irish Red Cross Delegate