Managing mass casualties

During armed conflict, a lack of medical resources is compounded by sudden increases in patients needing critical medical attention, leaving health workers in the precarious position of having to decide who gets care first with minimal means. Triage is a tool that our doctors and nurses use to manage a situation like this.

What is triage? In simple terms, triage is the process of sorting patients into priority groups based on the severity of their injuries or condition and their likelihood for recovery, and several criteria are used to do this. In ordinary circumstances, patients who are in critical condition are generally given first priority, however, this changes in an emergency situation and tough decisions must be made quickly.

Where’s the electricity?

Consider the logistics it takes to run a hospital under ‘normal’ conditions. Power, water and medicines are essential, but in a conflict situation, none of these are guaranteed.

Warrick Windell, an MSF Southern Africa logistician working in Mocha, Yemen, in 2020 tells us, “The city water would only be available about half the time, and city power was only available a few hours per month.” For a logistician, this meant having to truck in water and ensure that generators were available at all times. Without these two essentials, a hospital cannot run.

Working in restrictive conditions such as this means that additional resources and endless logistical adaptations are required to ensure our patients get the care they need.

No hospital available

In extreme cases, the hospitals we work in come under attack and the results are always devastating. Sometimes the hospitals are completely destroyed, leaving patients without care at the most critical of times. Sometimes patients and staff are forced to evacuate, which means crucial care is interrupted.

During the Syrian war in 2015, at a time when MSF had its widest reach in hospitals, 94 airstrikes and rocket attacks hit 63 health facilities we were supporting, and killed or wounded 81 of the medical staff. In response to the lack of safety and facilities available, doctors used a cave and a farmhouse to provide safe surgeries.