James M Ryan’s research while affiliated with St George's, University of London and other places

Conflict and Catastrophe Medicine: A Practical Guide 3e follows its successful predecessors in providing a framework for use by health professionals visiting a resource-constrained environment. Aimed at health professionals, Conflict and Catastrophe Medicine: A Practical Guide 3e encompasses problems brought about by local conflict or natural disasters. It covers preparation, organisation, logistics, treatment of major trauma and medical emergencies, and the special problems of delivering medicine in a hostile environment. This book will provide the reader with a mix of theory, opinion and practical advice to guide him through areas of conflicts, catastrophes and remote locations.

The need for humanitarian assistance throughout the world is almost unlimited. Surgeons who go on humanitarian missions are definitely engaged in a noble cause. However, not infrequently, despite the best of intentions, errors are made in attempting to help others. The following are seven areas of concern: 1. Leaving a mess behind. 2. Failing to match technology to local needs and abilities. 3. Failing of non-governmental organizations (NGO's) to cooperate and help each other, and and accept help from military organizations. 4. Failing to have a follow-up plan. 5. Allowing politics, training, or other distracting goals to trump service, while representing the mission as "service". 6. Going where we are not wanted, or needed and/or being poor guests. 7. Doing the right thing for the wrong reason. The goal of this report is to discuss these potential problems, with ideas presented about how we might do humanitarian missions more effectively.

The essence of conflict is the actual or implied use of violence. Recovery implies a return to a previous state. Recovery may be rapid (measured in days or months) or may take many years. What may be called the onset of recovery varies - it may begin almost immediately during the acute phase of a conflict or a catastrophe. The immediate provision of humanitarian provision of food, water, sanitation, and shelter in the first days is an illustration of a very early manifestation of conflict recovery. However, the process typically begins in the postemergency phase, when a degree of stability and safety allows a more comprehensive approach.

Confucius's phrase "May you live in interesting times" can be interpreted equally as a blessing or a curse. When directed at a prospective humanitarian aid volunteer, eager to embark on an overseas mission in the new millennium, the pConflict and Catastrophe Medicine a Practical Guide: Second Editionhrase leans more toward the latter.

Practical and meaningful interventions during the recovery from a conflict or disaster are diffuse, complex, and open ended. The problems outlined in this article for hospitals might as easily be applied to restoration of other services (such as education systems), assistance to industry or agriculture, and restoration of vital government departments.

Afghanistan fits the definition of a "failed state" with disintegration of the normal political, economic, and professional structures making restoration of health care a difficult and longterm task. Within this field there are few opportunities for clinically directed "quick impact" projects of significance. There are, however, many opportunities to proceed with quick impact projects in the areas of infrastructure and supply of consumables. Sustainable clinical projects will have to be deferred until improvements in estates and facilities create an appropriate environment into which clinical sustainable programs can be built. It is in the area of clinical and teaching support where medical schools in the United States and the United Kingdom have much to offer. However, a more secure and stable environment will be needed before expatriate medical educators may be safely deployed.