Abstract
It may be difficult to see the benefit in conflict. Preventing war is akin to preventing disease, but medicine's role in conflict is as old as war itself. Doctors and other health professionals play a brave and commendable part in healing or providing palliation to casualties. The nature of conflict is such that any medical intervention is urgent, rapid, and often overwhelmed. Conflict takes human behaviour to an extreme and the medical response is tested to its limits. In this high-pressure environment, innovation has flourished. So has comedy, in the guise of MASH, the Mobile Army Surgical Hospital.
The specialty of trauma medicine, especially, owes a deep debt to advances developed by the armed forces. Unending wars in recent decades have benefited from the greatest era of medical progress. They have needed to. A shift in tactics in most low-intensity modern conflicts, say Catherine Chatfield-Ball and colleagues in a clinical review this month, place greater emphasis on maiming soldiers instead of killing them. 1 Medical and logistic developments mean that even injuries previously deemed ‘unsurvivable' are eminently survivable.
Hence, the global burden of morbidity in conflict is increasing. Medical advance and innovation has helped here but one sure way to reduce the global burden from conflict would be to end wars. While wars continue, however, the greater benefit from advances in battlefield care is realised away from armed conflict. The authors describe trauma as a ‘neglected epidemic' in low- and middle-income countries. Trauma, in civilian and conflict settings, causes more deaths each year than HIV, malaria and tuberculosis combined, without the attention or the funding those diseases receive.
Battlefield medicine has brought us intraosseus needles, tourniquets, and blood transfusion. Management of catastrophic haemorrhage, pain and, traumatic brain injury have advanced. Conflict, then, is the mother of innovation, and civilians in high-income countries have benefitted from the fruits of that innovation. But it is low- and middle-income countries who might stand to gain the most because of the simplicity and low cost of innovations made in warfare.