When Peacekeepers Themselves Are Victims.

On 17 March 1998, a Bell 212 helicopter crashed in a mountainous area of Guatemala, bordering Mexico. All nine passengers were members of the United Nations Mission for the Verification of Human Rights in Guatemala; seven lost their lives. One of the two survivors was severely burned and had to be evacuated to a clinic in Houston, Texas, United States. As soon as his state of health allowed it, he was evacuated to a hospital in New York where his family lived. After a few months, he recovered fully and was able to return to the field. The other survivor, whose neck bone had been broken, was kept in Guatemala at a specialized clinic. He also eventually recovered and was able to return to work.

Whenever a medical emergency occurs in one of the United Nations peacekeeping missions, the doctors of the United Nations Medical Service Division, located at the Organization's Headquarters in New York, take charge. In cooperation with medical personnel in the field, they decide whether or not an evacuation is necessary, contact the air ambulance and the staff of the hospital where the injured person is brought, and follow the patient's medical development through recovery.

"When peacekeeping expanded in the beginning of the 1990s, we were just starting", explains Dr. Ingrid Laux, former Director of the Division. "But by now the medical component of peacekeeping missions is very well established. If anything happens to a staff member, we will know within a few minutes and something will be done for the person." Her colleague, Dr. Serguei Oleinikov adds: "In terms of the field staff, we work around the clock, seven days a week. We never interrupt our service. Even on weekends and holidays, we have one doctor who is on call, and this doctor can be reached immediately."

Some of the principal causes of injuries are landmine and motor vehicle or air traffic accidents. But endemic diseases such as malaria and polio are also severe health threats. "When staff members accept to go on mission for the UN, they put themselves at high risk", Dr. Sudershan Narula says. For that reason, the Medical Service attempts to prepare personnel as fully as possible before they go abroad.

The first step is medical clearance. "We have to ensure that every person who goes on mission is physically capable of the work in the field", Dr. Narula emphasizes. This medical clearance is not only provided for staff members from Headquarters.

United Nations Medical Service physicians also have to literally check thousands of medical files for all military observers and civilian police involved in UN missions.

The Medical Service sends guidelines to the troop-contributing countries to make sure that their soldiers will be properly examined before they start work in a UN operation in the field. In addition, the Medical Service offers pre-mission consultations and briefings for personnel in New York. This preparation also includes appropriate vaccinations, depending on the country where a staff member will be sent. "In order to be able to advise staff members and to know what kind of vaccination is necessary, it is a must that we travel ourselves", Dr. Laux points out. All the Medical Service physicians try to visit two different countries each year to assess the health facilities and study the endemic diseases of the area. "This gives us quite a comprehensive overview of the health situation worldwide", she adds.

For the past seven years, the Medical Service was also assisted by the gratis personnel of the Medical Support Unit of the Department of Peacekeeping Operations (DPKO). These men and women were provided at no cost by certain Member States. At first, members of the Unit helped mainly in procuring medical supplies for the missions; but as the number of peacekeeping missions increased, their role also expanded. They began to assist the UN Medical Service in planning and budgeting medical support for new missions. Another task under their charge was to identify the level of medical units and personnel required for new and ongoing missions, and to ensure that the requisite support from troop-contributing countries was provided. The Medical Service, on the other hand, would see to it that, in cases where no military clinic was brought along, a nearby civilian medical facility would be able to assume care of UN personnel. If that were not possible, a medical station would be created for the mission on an urgent basis.

The cooperation worked, but after the General Assembly decided in 1998 that gratis personnel provided by Member States would be phased Out, the five physicians of the DPKO Medical Support Unit also had to dose shop. "We hope that soon they will be replaced by a new Support Unit, with at least two doctors who will work in the full service of the UN", says Dr. Laux. Meanwhile, a retired member of the UN Medical Service is helping to maintain as best as possible the work m that area, assisted by the Medical Service team, until new staff members can be recruited.

Another need that the doctors point to is expanded psychological support for mission personnel. At this point, only a few duty stations have a trained psychologist assigned to the medical staff. Yet, while on mission, UN employees shoulder very heavy responsibilities, all the while navigating a foreign culture, often in hardship areas, and while separated from the support of their families. Moreover, they are often exposed to hostile and extremely dangerous situations.

These circumstances can be extremely stressful. "There is a demand from the field to be attended by at least one psychologist in every peace-keeping region.

This request is supported by the Staff Counselor's office and also by us", Dr. Narula says. But because of limited financial resources, implementation is very difficult. For staff members who return to New York from their mission, the Medical Service also offers post-mission examinations and consultations. Their staff cooperates where possible with the Staff Counselor's office and outside psychologists in addressing any psychological wounds that might be brought back. In order to provide all these services, the UN Medical Service staff often ends up working a lot of overtime. "We try to do the best we can, but some things are just not possible. There are too many financial obstacles", Dr. Laux stresses when talking about what could be done to improve the state of health of UN field personnel. "We wish that the situation will change for the better. In the end, it would be a longterm investment. If you invest in the health of your staff, it will always pay back", she adds.

(Dr. Laux has retired and her successor is Dr. Bernard Demure.)

Inadequate Preparation of Emergency Aid Workers

A study commissioned and carried out in 1998 by the World Health Organization (WHO) in Rwanda, Uganda and the United Republic of Tanzania found that the preparation of emergency and relief workers for rigorous duty under difficult and dangerous conditions was sometimes inadequate.

Aid workers often received little training on living and working conditions awaiting them in the field, and the recruitment procedures used by many relief agencies were less than professional. According to the study, many staff were recruited hurriedly and casually with little time for checking their capability. Briefings on security issues and political matters appeared to be especially deficient and, therefore, aid workers sometimes felt placed at unnecessary risk.

The staff's preparation on health issues was of particular interest for the WHO study Of the more than 200 relief workers questioned, 53 per cent had not received any personal medical briefing prior to departure and 20 per cent were not aware of whether their vaccination status had been verified. To make matters worse, advice about food and water safety, as well as on infectious and parasitic diseases, was often lacking, and inappropriate assumptions seemed to be made on what relief workers already knew about health protection.

The psychosocial health of the staff was another key factor analyzed by the study. Only half of those studied felt that they were able to function well on the day they were interviewed and a high proportion of respondents reported general fatigue (59 per cent) and headaches (50 per cent).

The study pointed out that the reported frequency of sleeping difficulties, anger and irritability was also noteworthy, not only because of its immediate implications on the health of staff themselves, but also of its wider implications on team work and performance under pressure. Fortunately, the reported increases in smoking and alcohol were small (under 10 per cent), lower than might have been anticipated.

Common causes of anxiety for field workers were usually related to contract and employment, security, and family and health issues, while the main general health concerns were over diarrhoeal diseases, other digestive problems and skin ailments. Almost 20 per cent of those surveyed which reported having a diarrhoeal disease episode in the two weeks prior to the interview, suggested that more had to be done in terms of information, education, management of food and water consumption. Almost one quarter said they had been recruited solely on the basis of written correspondence and had not been asked to provide any references.

In view of those results, Dr. Harald Siem, Chief of WHO's Inter-Agency Cooperation Unit for Emergency and Humanitarian Action, stated: "It is, not easy. The time taken to recruit field workers is often an issue, and support and supervision at long distance are difficult. We are convinced that much can be improved." The study represented the first stage in a project that would as a next step, have WHO approach relief agencies at their headquarters to discuss current policies and identify obstacles to the implementation of good recruitment and health practices for aid workers.