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War surgery - the temporary expatriate surgeon in a conflict zone

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Since the cold war ended, most warfare has been conducted between groups of militia in disintegrating former nation states. The results have been civilian casualties and lack of medical support for the injured. Where local facilities are deficient, surgical services may be provided by non-governmental organizations employing doctors on temporary contracts. This article outlines developments in three key areas of this work. Firstly, the difficulty in recruiting young surgeons with experience as true general surgeons, particularly as sub-specialty training is brought ever earlier into the training curriculum. Secondly, why patterns of energy transfer in missile wounds, combined with the delay in their presentation, are reasons why low-technology treatments are still the preferred method of treating war-wounds. Finally, how considering war as a global health problem is a rational approach to the problem of war injury. Injury prevention is obviously an unrealistic goal, but doctors have a role in preventing the development and use of weapons designed to cause superfluous injury and unnecessary suffering. The recent 'superfluous injury or unnecessary suffering' (SIrUS) project is discussed as a means of defining the problem and directing international rulings on weapon deployment.


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