Hybrid warfare and counter-terrorism medicine

Tin, Derrick; Barten, Dennis G.; Granholm, Fredrik; Kovtonyuk, Pavlo; Burkle, Frederick M.; Ciottone, Gregory R.

doi:10.1007/s00068-023-02230-y

Cited by 12 publications

(6 citation statements)

References 16 publications

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“…Compounding the issue is the lack of accurate data on the current number of working medical professionals. 72 As of January 2023, approximately 45,000 internally displaced medical personnel have found employment in other health-care facilities across the country. This includes more than 2000 physicians, and 1500 mid-level medical professionals (such as nurses, midwives, paramedics, and pharmacy).…”

Section: Resultsmentioning

confidence: 99%

Social and Healthcare Impacts of the Russian-Led Hybrid War in Ukraine – A Conflict With Unique Global Consequences

Khorram‐Manesh

Goniewicz

Burkle

2023

Disaster med. public health prep.

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Russia’s fear of Ukraine becoming a member of the European Union and the North Atlantic Treaty Organization catalyzed the current conflict in Ukraine. The invasion also alarmed other countries, such as Finland and Sweden, who have themselves considered a formal partnership with NATO. Russia’s actions to date have created massive instability and political tensions that uniquely influence the health and socio-political life of civilians in Ukraine and the entire region. The direct and indirect threats of war “gone regional,” “global”, or “nuclear” have energized these countries and their historical alliances to reassess their own socio-political, environmental, and health-care consequences. All countries of the region have clear histories of forced occupation and decades of threats resulting from World War II and its aftermath. The purpose of this rapid communication is 2-fold. First, it discusses the socio-political and health-care consequences of the ongoing Ukrainian conflict in Finland, Russia, Sweden, Poland, and Ukraine. Second, it clarifies the most essential elements of the Hybrid War which cause uniquely distinctive violations of humanitarian laws, treaties, and conventions.

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Section: Resultsmentioning

confidence: 99%

Social and Healthcare Impacts of the Russian-Led Hybrid War in Ukraine – A Conflict With Unique Global Consequences

Khorram‐Manesh

Goniewicz

Burkle

2023

Disaster med. public health prep.

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“…Both military and civilian health systems must make it a high priority to prepare for managing large influxes of traumatically injured patients, many of them with the types of injuries more commonly seen in combat. 37 The identification and training of medical staff as a very central key element is one of the most important building blocks in planning for these types of events. [38][39][40][41][42] The military trauma system is composed of tiered levels of care that facilitate the stabilization of patients as near to the point of injury as possible, followed by transport between levels for further stabilization and "The mid to late career subspecialists (uro-oncology and gyn-oncology) performed well in the abdomen.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of urological and gynecological surgeons as force multipliers for mass casualty trauma care

Andreatta,

Graybill,

Bradley

et al. 2024

J Trauma Acute Care Surg

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BACKGROUND The clinical demands of mass casualty events strain even the most well-equipped trauma centers and are especially challenging in resource-limited rural, remote, or austere environments. Gynecologists and urologists care for patients with pelvic and abdominal injuries, but the extent to which they are able to serve as “force multipliers” for trauma care is unclear. This study examined the abilities of urologists and gynecologists to perform 32 trauma procedures after mentored training by expert trauma educators to inform the potential for these specialists to independently care for trauma patients. METHODS Urological (6), gynecological surgeons (6), senior (PGY5) general surgery residents (6), and non-trauma trained general surgeons (8) completed a rigorous trauma training program (ASSET+). All participants were assessed in their trauma knowledge and surgical abilities performing 32 trauma procedures pre/post mentored training by expert trauma surgeons. Performance benchmarks were set for knowledge (80%) and independent, accurate completion of all procedural components within a realistic time window (90%). RESULTS General surgery participants demonstrated greater trauma knowledge than gynecologists and urologists; however, none of the specialties reached the 80% benchmark. Pre-training, general surgery and urology participants outperformed gynecologists for overall procedural abilities. Post-training, only general surgeons met the 90% benchmark. Post-hoc analysis revealed no differences between the groups performing most pelvic and abdominal procedures, however knowledge associated with decision making and judgment in the provision of trauma care was significantly below the benchmark for gynecologists and urologists, even after training. CONCLUSION For physiologically stable patients with traumatic injuries to the abdomen, pelvis or retroperitoneum, these specialists might be able to provide appropriate care; however, they would best benefit trauma patients in the capacity of highly skilled assisting surgeons to trauma specialists. These specialists should not be considered for solo resuscitative surgical care. LEVEL OF EVIDENCE Therapeutic/Care Management, Level III/IV.

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“…Disrupting the healthcare system in a country using hybrid attacks has the ultimate aim of destabilizing trust in government and key organizations, but also directly reduces the effectiveness and capabilities of healthcare as a key strategic resource. 8,23 In this aspect, prehospital care and emergency medicine are main targets of aggression, since a decrease in their capacity would seriously affect a country's ability to care for war casualties. 23 Ensuring the protection of healthcare, encompassing access to and delivery of healthcare services, is a joint responsibility that falls upon all parties engaged in an armed conflict.…”

Section: Discussionmentioning

confidence: 99%

“…7 Attacks on healthcare are clearly being observed during the ongoing war in Ukraine, raising significant concerns amongst health experts globally. 8,9 Beyond the direct effects of physical and psychological injuries, deaths, and destruction of healthcare infrastructure, attacks on healthcare lead to wider disruptions of routine and acute emergency care, maternal and child health, and may enhance the spread of infectious diseases, including SARS-CoV-2, hepatitis, tuberculosis, and human immunodeficiency virus (HIV). [10][11][12] The prevention of attacks on healthcare facilities is of paramount importance and documentation is essential to identify violations, create mechanisms for protection and accountability, and develop the political will to enforce them.…”

Section: Introductionmentioning

confidence: 99%

Attacks on Ukrainian healthcare facilities during the first year of the full-scale Russian invasion of Ukraine

Barten,

Tin,

Granholm

et al. 2023

Preprint

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BackgroundAlthough the Geneva Conventions and Rome Statute demand protections for healthcare facilities during war, breaches of these protections are frequently reported. The ongoing war in Ukraine is no exception, with several healthcare attacks eliciting widespread condemnation. The Ukrainian Healthcare Center (UHC) has been collecting, verifying and documenting attacks on health infrastructure since the Russia-Ukraine War was launched. The aim of this study was to assess UHC documented healthcare facility attacks during the first year (24 February 2022 to 25 February 2023) of the full-scale Russian invasion of Ukraine.MethodsThe Berkeley Protocol on Digital Open Source Investigations was used to document healthcare attacks. Data collection included temporal factors, location, facility type, attack and weapon type, number of killed and injured healthcare personnel and civilians, and whether facilities were damaged, destroyed or attacked more than once.ResultsThere were 334 documented attacks on 267 Ukrainian healthcare facilities, with 230 facilities being damaged and 37 destroyed. General hospitals, primary care clinics, emergency departments and children’s hospitals were most frequently targeted. The majority of attacks took place during the first three months and in eastern Ukrainian oblasts. Heavy weaponry was employed in almost all attacks. The total number of casualties included 97 fatalities and 114 injuries.ConclusionsDuring the first year of the full-scale Russian invasion of Ukraine, there were 334 attacks on 267 Ukrainian healthcare facilities documented by the UHC. Heavy weaponry was commonly used, and the direct impact of attacks was considerable in terms of facility damage and casualty tolls.

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Hybrid warfare and counter-terrorism medicine

Cited by 12 publications

References 16 publications

Social and Healthcare Impacts of the Russian-Led Hybrid War in Ukraine – A Conflict With Unique Global Consequences

Social and Healthcare Impacts of the Russian-Led Hybrid War in Ukraine – A Conflict With Unique Global Consequences

Evaluation of urological and gynecological surgeons as force multipliers for mass casualty trauma care

Attacks on Ukrainian healthcare facilities during the first year of the full-scale Russian invasion of Ukraine

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