After the implementation of the UN Iraq-Kuwait Observation Mission (UNIKOM) at the end of the first Gulf War in 1990, a medical team was set up in 1991 to support the UN troops in their difficult tasks in the demilitarised zone (DMZ), a remote desert area between Kuwait and Iraq. The medical team was designed to take care of the medical treatment for the UNIKOM members and the nomadic people living in the DMZ as pointed out in UN Secretary-General reports S/2001/287 and S/2001/913 on the official UN website

Bartke, V.

Bronnert, J.

Domres, B.

Ehmann, V.

Gebler, M.

Pohlers, M.

Schneider, B.M.

Schneider, M.

Woltering, H.

English

James Madison University

Journal of Conventional Weapons Destruction Volume 8 Issue 1 The Journal of Mine Action Article 14 June 2004 Mine Injury Casualties Report from the Iraq-Kuwait DMZ B.M. Schneider WADEM Landmine Task Force V. Ehmann WADEM Landmine Task Force M. Gebler WADEM Landmine Task Force M. Pohlers WADEM Landmine Task Force J. Bronnert WADEM Landmine Task Force See next page for additional authors Follow this and additional works at: https://commons.lib.jmu.edu/cisr-journal  Part of the Defense and Security Studies Commons, Emergency and Disaster Management Commons, Other Public Affairs, Public Policy and Public Administration Commons, and the Peace and Conflict Studies Commons Recommended Citation Schneider, B.M.; Ehmann, V.; Gebler, M.; Pohlers, M.; Bronnert, J.; Schneider, M.; Bartke, V.; Woltering, H.; and Domres, B. (2004) "Mine Injury Casualties Report from the Iraq-Kuwait DMZ," Journal of Mine Action : Vol. 8 : Iss. 1 , Article 14. Available at: https://commons.lib.jmu.edu/cisr-journal/vol8/iss1/14 This Article is brought to you for free and open access by the Center for International Stabilization and Recovery at JMU Scholarly Commons. It has been accepted for inclusion in Journal of Conventional Weapons Destruction by an authorized editor of JMU Scholarly Commons. For more information, please contact dc_admin@jmu.edu. Mine Injury Casualties Report from the Iraq-Kuwait DMZ Authors B.M. Schneider, V. Ehmann, M. Gebler, M. Pohlers, J. Bronnert, M. Schneider, V. Bartke, H. Woltering, and B. Domres This article is available in Journal of Conventional Weapons Destruction: https://commons.lib.jmu.edu/cisr-journal/vol8/iss1/14 'T1 0 (') c:: II) l11is article is dedicated to tbe L'ictim~ we were unable to belp iu spite of all our efforts. Introduction After th e implementation of the UN Iraq-Kuwait Observation Mission (UNIKOM) at the end of the tlrst Gulf War in 1990, a medical team was set up in 1991 ro support the UN troops in their difficult tasks in the demilitarised zone (DMZ), a remote desert area between Kuwait and lraq. 1 The medical team was designed ro take care of the medical treatment for the UNIKOM members and the nomadic people living in the DMZ as pointed out in UN Secretary-General rcporrs S/200 1/287 and S/200 1/913 on the official UN web-sitc.2 Despite the continuing mine clearance and the UN Mine Awareness Program on both sides of the DMZ, the management of mine injuries remained a challenging rask for our medical teams.3 In addition to these major problems, the usual day-to-day outpatient department (OPD) visits fo r the militaty and local staff personnel, dehydrations, scorpion bites, infectious diseases and road traftlc accidents also had ro be managed.4 During rhe tlrst few years, the medical duties and responsibilircs for rhc troops from 33 nations were carried out by an Austrian and later a Norwegian Medical Team (NORMED). In October 1995, this role was given to Germany, and since then, 15 voluntary German Medical Teams (GERMED I w 15), equipped and managed by the Foreign Service of the Knights of Malta hom Cologne, were responsible fo r providing the emergency medical service (EMS) in the desert of the DMZ between Kuwait and Iraq until the second Gulf War began in March 2003.5 Mine InJury-Related cxpenences During the Missinnc: From 1996 to ?00? The rescue area included 3,800 sq km of rhe DMZ and the remote desert surroundings. Five ambulances from three rescue sta-tions with seven paramedics equipped with necessary supplies provid-ed 24-hour service fo r the 1 ,200 UN personnel and the nearby nomadic population. During 200 I , there were about 4,000 regular OPD visits and about 50 calls for casualty evacuations (CASEVACS). Forry percent of the CASEVACs were mine-related and most of these injuries happened on the Iraqi side of rhe DMZ. Therefore, this prob-lem was greater than the road accident problem and had a political component as well because the injuries happened in the Iraqi rerrito-rics to the south of the DMZ where no domestic help was available for the victims. In many cases, the victims had to be transported to the southern paramedics rescue station to get access to the medical service carried our from rhe United Nations within this area. The mine clearing was always carried out by the TABLE 1: CASEVACs for GERM ED 12 Road Traffic Accidents Mine Injuries Diseases Others TOTAL CASEVACs 8 10 3 3 24 Argenrenian Engineering (ARGENG) demining specialists. During each of the 75 mine blasting days, ARGENG had to be accompanied by our paramedics. To prepare the medical teams for their new tasks, mine injury treatment guidelines and the International Committee of the Red Cross (ICRC) classit!cation of the mine-injured patients were dis-cussed and compared with the regional mine injury epidemiology of previous missions. These basic prepara tions for the medical teams were usually accompanied by weekly concurrent medical education based on the advice of R. Coupland from ICRC as well as M. King and P. Bewes in their handbook Primary Surgery (on the web ar www.meb.uni-bonn.de/dtc/primsurg).G T he basic preparations also included training for special situations as well as some research abour possible tclcmedicine support for medical treatment in these remote areas.? The medical challenges in this remote area required the stric t cooperation of the medical team members wirh representatives of dif-ferent disciplines within the multinational ON-peacekeeping military envtronment. The chain of rescue from the two forward medical posts out in the deserr to rhe UN level one hospital was equipped with rescue equipment nearly approaching the European Standard (EN), and the equipment had to be maintained within the extreme climatic circum-stances, which included dust and temperatures up to 50 degrees Celsius. Long rescue rimes had to be managed in certain instances in rhe difficult environment of the desen. To achieve the minimal rescue by Dr. B.M. Schneider, V . Ehmann, M. Gebler, M. Pohlers, J . Bronnert, M. Schneider, V . Bartke, H. Woltering and B. Domres, WADEM Landmine Task Force times, rwo helicopters from Banair, a company that specializes in test-ing equipment, or one of the rhree available ambulances had to be coordinated in the most eftlcienr manner. Unfortunately, sometimes rhe road conditions of the DMZ were nor easily manageable. The UN level one hospital was located in rhe UNIKOM headquarters. Therein basic life support could be provided and emer-gency operations could be done under emergency anesthesia-both with limited resources. No X-ray, computerized tomography (CT) or intensive care units (ICUs) from known EN were available. Due to political reasons, the well-equipped Kuwaiti Health System was nor available for the Iraqi patients. After rhe emergency treatment by the United Nations, those patients had to be referred to their country. Based on the reports of the former medical reams, the figures of the missions were as shown in Table 2 . It is interesting to note that the number of mine incidents increased within the years of interest in sp ite of the improving mine clearance conducted by the ARGENG demining teams. TABLE 2: UNIKOM: Mine Injuries YEAR Mine Injury Incidence 1996 8 1997 7 1998 5 1999 3 2000 30 2001 24 2002 N/A 2003 N/A TOTAL 78 TABLE 3: Average Times for GERMED 12's CASEVACs Range Times Access Time 2-85 min 18 min Response Time 5-80 min 44 min Scene Time 10-75 min 28 min Transport Time 2-125 min 44 min 1 [Calculatt'd from 23 C4SEVACS (I 3 ground transport, I 0 air transport} - 3 hours) According to M. Helm, the chance of survival in these severe injuries lowers by one percent for every three minutes of rescue time. The Injury Severity Score (ISS) for the mine-injured patients from GERMED \2 varied from 50 to 2. According to the Trauma Injury Severity Score (TRISS), the survival probabilities resulting from these and other necessary parameters had to be calculated berween 9 .5 percenr and 96.8 percent mostly depending on the complexity of the injuries described in Table 4. . : • -. Injury Pattern GERMED12 Total from 1996 to 2002 Head 4 17 Thorax 2 4 Abdominal 2 37 Limbs 7 88 Upper Body 3 37 Lower Body 4 51 Both Sides 3 7 Amputation > 32 For comparison, read Husum and Strata 5 2002 report on measuring injury severity. 8 In spite of the large number of injuries in the lower extrem-ities, some individual patients' injury patterns with injuries only in rhe upper part of the body gave evidence that some of the patients had been handling UXO or mines before the explosions of Hazards No. TABLE 5: Fatalities Report (according to the UN documents2) YEAR Fatalities * 2003 N/A 2002 6 2001 7 2000 >2 1999 N/A 1998 N/A 1997 N/A TOTAL > 15 III.2.1.2.9 • The UN official reports only mention the ji~ttzlities. For comparison, read janunlu, Husum and Wisborg's rl'port. 10 These figures extracted from the official UN documents arc to be seen as minimal figures. Some dead on-the-scene patients from accidents from outside the DMZ didn't get access to the help from the UN medical reams in time. The follow-up for patients mostly referred to care from the Basra hospitals with limited resources, which at that time were not accessible to UNIKOM authorities. t.,;onchJ<:Inn From the end of the t!rsr GulfWar (1991) until the begin-ning of the second Gulf War in March 2003, UNIKOM attempted to guarantee the stability of this post-conflict area between Kuwait and lraq. Mine-related injuries remained the major problem fo r the EMS services. Most victims were young Iraqi civilians who had been enter-ing through the southern part of the former DMZ to get basic med-II) ::;) (.) 0 Ll. 1Schneider et al.: Mine Injury Casualties Report from the Iraq-Kuwait DMZPublished by JMU Scholarly Commons, 2004, 0 (') c (/) Appendix: Anaesthesia in the Field During the GERMED-12 Mission During the GERMED-12-Mission anaesthesia was started in the field. According to the recommendations of the UN Peacekeeping Mission, the paramedics did the basic-level medical support. An ambulance car was available at this level of primary care. The treatment included cardiopul-monary resuscitation, haemorrhage control, fracture immobilisation, wound dressing, casualty transport and evacuation. There was the possibil-ity of communication and reporting by radio, so the paramedic had to report the emergency situation to the doctor on duty at the operations cen-tre. The medical treatment was coordinated on the advice of the emergency physician. For treatment and evacuation of casualties the tactical operation, casualty evacuation (CASEVAC) was started. Especially under the condi-tions of the United Nations Iraq-Kuwait Observation Mission (UNIKOM), a Forward Medical T earn (FMT) was sent to provide short-term medical support in the field. The FMT was transported by helicopter or ambulance car to the emergency scene. Both were equipped with modern emergency appliances and medicine. The task was to perform emergency resuscitation procedures: maintenance of airway, breathing, and circulation and advanced life sup-port, haemorrhage control, and life- and limb-saving emergency procedures. Especially in GERMED-12 the physicians were trained to use Ketamine in combination with intubation and ventilation. Ketamine could be used in most wounded patients without problems. It proved to be very safe and had only a few side effects: • Hyper salivation: Atropine is necessary. • Hallucinations: Diazepam or midazolam was given to prevent these. • Increased blood pressure: Preferred medicine for hypovolaemic patients. The transportation time was sometimes over one hour (see Table 3 on previous page) before arriving at the Level-One medical support facil-ities. In our field hospital, it was possible to do surgery under general anaesthesia in an operating room. We used an apparatus from the Drager Company. We have administered general anaesthesia with nitrous oxide and oxygen in combination with Ketamine. One physician was the anaesthetist and two surgeons, one nurse, and one paramedic were on duty daily. At this level, we could perform limb and life-saving surgery. It includes laparotomy, thoracocentesis, wound exploration, and debridement, fracture ftxation and amputation. For post-operative monitoring at our ward, we have used emer-gency medical equipment like mobile ECG and transportable respirators. A nurse or paramedic did the post-operative observation. Literature I. Medical Support Manual for United Nations Peace-keeping Operations. 2. Robin Gray: War Wounds: Basic Surgical Management; ICRC 19943. Matthias Pohlers, MD Anaesthesia, Intensive Care Medicine, Emergency Medicine E-mail: m.pohlers@klinikum-weimar.de ical support from the different UN medical reams pro-vided in the UN level one hospital in the former UNIKOM headquarters near Umm Quasr. The lessons learned have been used to estab-lish the World Association for Disaster and Emergency Medicine (WADEM) Landmine Task Force to formu-late an u pdate of WADEM's 1997 declaration on the mine hazard siruarion of rhe world at rhe beginning of the new millennium (preliminary URL: www.dismed-master.de) . Further work has to be done ro learn more about rhe outcome and rhe rehabilitation of the surviv-ing victims. For th is purpose, contacts have been estab-lished to the reaching IC RC's Superfluous Injury or Unnecessary Suffering (S irUS) Project Team from Geneva, the UN Portfolio of M ine Action Projects Team in New Yorkl l as well as the journal of Mine Action and surrounding institutions. We are hoping that these contacts will help ro improve the living conditions of the survivors of landmines. References I. United Nations Iraq-Kuwait Observation Mission; Chapter 33 in The Blue Helmers: A Review of United Nations Peace-Keeping; ISBN 92- 1- 10061 1-2, New York 1966. 2. Website: www.un.org/dcpts/dpko/missions/u nikom/ index.hrml. 3. A.Y. Al-Gh unaim. "Landmines and the Destruction of the Environment of Kuwait," Report of the Official Commission of Kuwait 1999. ISBN: 99906 -32 -20-0 . 4. B.M. Schneider, et al.: "Basic Telemedicine During UN Mission to the Middle East in the DMZ: T ELEMED." 2002: p. 158-162. ISBN 3-9808-6530-4. 5. Piehlsticker. "GERMED in UNIKOM; H istory and Activities." UNIKOM News No. I. 200 1. 6. R. M . Coupland: "Amputation For War Wounds 1992." IC RC Publication. 7. R. M. Coupland: "The Sl rUS Project 1998 ." ICRC Publicat ion. 8. H. H usum, G. Strata: "Measuring Injury Severity: ISS vs NISS for Penetrating Injuries." l'rehospital and Disaster Medicine. Vol. 17 (1). 2002. 9. K.O. Sundnes, M .L. Birnbaum: "Health Disaster Management Guidelines for Evaluation and Research in the Utstei n Style." Prehospita! & Disaster Medicine. Vol. 17 (3)., p. 39. I 0. H.R. Jahunlu, H. Husum, T. W isborg: "Mortality in Landmine Accidents in I ran." Prehospita! and Disaster Medicine. Vol. 17; No.2: p. 107 - 109. II. UN Mine Action Sum mary: www.m ineaction.org with actual PORTFOLIO of Mine Action Projects. Contact Information: WADEM Landnllne Task Force Dr. Med. B.M. Schneider FICS, EMDM Surgical Department SKH Noerdlingen Stoffelsberg 4 86720 Noerdlingen Tel: +49 I 172-8273642 Fax: +49 I 9081-299- 4280 E-mail: bm.schneider@medizin.uni-ulm.de Preliminary Website: http://www.dismedmaster.de () · ~ Jordan is a country ri ch rn history and beauty. Throughout the years, w ith the increase of tensions in the Middle East, Jordan has been forced to protect its borders. As a resu It, Jordan has become a major actor in the mine action community and has taken a different approach by promoting the use of its military for demining and its non-governmenta l organi zations (NGO s) for rehabilitation and mine awareness. History The first mines were laid in Jordan in 1948 during a war with Israel. Later, during the Six-Day Arab-Israeli War in 1967, when Israel occupied the West Bank and developed a new cease-fire line, Jordan began planting more mines along its western border. In the 1970s, Jorda n experienced a Syrian threat, and numerous internal problems led to more mine planting. Thus, Jordan quickly moved from a mine-free country to a kingdom burdened with minefields along its western and northern borders. Over 15,000 acres of land, bountiful in natural resources and sacred sites, quickly became consumed with mines. The total number of landmines stretched beyond 300,000, of which over 225,000 were laid by the Jordanian Armed Forces (JAF) and over 70,000 by Israel.! Before his death, His Majesty King Hussein called for the clearance of all minefields by the year 2000. In March 1993, the Jordanian government implemented its first phase in a three-phase demining plan. In 1998, Jordan signed and ratified the Ottawa Treaty. Today, the govern-by Kristen Frahler, MAIC ment continues to support numerous mine action conven-tions and conferences, and submits updates on the status of its stockpile destruction program.2 King Abdullah commissioned the National Demining and Rehabilitation Committee (NDRC) in MaKh of 2000. Th-is committee participates in vMious demining aspects from mine risk education (MRE) to mine clearance. New associations continue to emerge in Jordan, such as the Hashemite Society for Soldiers with Special Needs, Landmine Survivors Network, the In ternational Committee of the Red Cross (ICRC), and the Al Hussein Foundation for the Habilitation and Rehabilitation of the Disabled , and Queen Noor still plays an active role in dem-ining. However , the Jordanian army's Royal E ngineers Corps (REC) remains the key force in demining.3 Through the REC's success in Jordan, the army has begun to stretch its boundaries. Currently, the REC is working in Afghanistan in an effort to demine the country and return the land back to the Afghan people. Aiding Afghanistan in its move to rebuild a country torn apart by the Taliban is not only noble, but it will also provide the REC with more experience in battling its problem at home. (/) :::) (,) 0 .... 2Journal of Conventional Weapons Destruction, Vol. 8, Iss. 1 [2004], Art. 14https://commons.lib.jmu.edu/cisr-journal/vol8/iss1/14

Mine Injury Casualties Report from the Iraq-Kuwait DMZ

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Mine Injury Casualties Report from the Iraq-Kuwait DMZ

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