HMD RESPONSE PROGRAMMES IN THE MIDDLE EAST - LEBANON

In April 1996 the Israeli Army began military action in Southern Lebanon against Hizbullah and the civilian population. After the shelling of the UN base at Quana (where civilians were known to be sheltering and 120 were killed) on 18 April the Lebanese government called for emergency action to be taken by international organisations to help them in providing relief. At that time there were approximately 400,000 people who were displaced from there homes.

Emergency Provision by HMD Response :

In response to an appeal for medical assistance from the Embassy of Lebanon to the UK, John Beavis, Medical Advisors Board and Philip Garvin CEO for HMD Response, visited Southern Lebanon in April in order to assess the situation and formulate an appropriate response to meet the needs of the man made disaster.

This investigative mission made the following recommendations after consultations with local government agencies, NGOs and medical personnel:

1. Need of medical kits of basic emergency goods
2. Medical teams equipped to address public health concerns

There was found to be an overwhelming need for ‘on site’ medical activities. That is, a need for nursing staff with the ability to work independently of medical practitioners and with an interest in teaching local nurses.

Any such team of nurses should then be involved in the following:

• Monitoring of pregnant women and children;
• Observation for post- traumatic stress;
• Management of general medical problems, particularly for the elderly;
• Serve the health needs for the more remote parts of the South.

The mission thereby concludes that nurses, besides having general nursing experience, should be specialised in the following:

1. Obstetrics
2. Paediatrics
3. Psychiatry
4. Community Nursing
5. Care of the Elderly
6. Health visiting

It was also recommended that a General Practitioner with Community Health training would be useful.

The recommendations further included the need for the medical personnel to work from a mobile clinic to expedite treatment and turnover of cases in outlying villages. The mobile clinic would consist of an ambulance with basic diagnostic equipment including ECG, urine analysis and simple gynaecological apparatus and preferably a diagnostic ultra-sound device.

It was felt by the mission that although the main purpose of the mobile clinic, with its supporting medical staff, would be to provide immediate assistance it would provide long-term education and training of indigenous staff, thereby helping develop the skills of the local community.

On completion of the mission, although the main purpose of the mobile clinic would be to provide immediate assistance, it would also provide long-term education and training of indigenous staff, thereby helping develop skills within the local community.

On completion of the mission the recommendations were implemented:

• Medical kits of basic emergency goods were distributed
• Medical staff with the recommended specialities was recruited and a mobile clinic set up
  

Future Prospects :

At present, the mobile clinic and the medical staff are working in Tyre and Tibnin Hospitals and the surrounding villages. It is hoped that they can continue work there. As the emergency situation abates the team will focus their efforts more on educational aspects of work.

"The tragedy of the refugee massacre at Quana attracted world attention and, thankfully, focused efforts to bring this conflict to a close… the medical facilities presently available are useless when dealing with the problems that will occur in the largely rural communities in Southern Lebanon resulting from the bombardment of, and damage to, the infrastructure. Even without war such communities are precariously balanced between a healthy, successful existence and disaster. They are, as we know, far more susceptible to the vicissitudes of weather epidemics and communication problems than their cousins in large towns and cities”

(John Bevis, HMD Response)

"The majority of the displaced are women and children who have fled with no or minimal belongings. Conditions are extremely precarious as facilities are unavailable and the electricity supply is limited, in turn affecting the supply of potable water.”

(UN Flash Appeal for Internationally Displaced Persons as a Result of the Emergency in Lebanon)

"The visit by HMD Response to the area was invaluable because it demonstrated that there is a need to tackle the inevitable, massive, public health problem which is about to strike Southern Lebanon. Whether by intention or not, the bombardment has hit water supplies, sewage conduits and roads. We were given an estimate that in some places up to 90 per cent of the rural dwellings had either been destroyed or damaged in some way. It was emphasised that these people will never live in tents as it is completely alien to their culture. Instead they will live tighter in whatever accommodation there is available and suffer the inevitable consequences of massive overcrowding. The need for civil engineering reconstruction is therefore of paramount importance and collaboration between the local UN forces and visiting experts will be invaluable.”

(Mr. John Beavis, Consultant Orthopaedic Surgeon and HMD Response Medical Board Member, April 1996)

"Israel will come under scathing criticism from Amnesty International tomorrow when the organisation publishes its report on the massacre of civilians at the UN’s headquarters in Qana and on other civilian casualties of Israel’s April bombardment of Southern Lebanon… Amnesty has already condemned such attacks as a breach of international law and is understood to have repeated this condemnation in its report.”

(Robert Fisk, The Independent, 23 July1996)