A Volunteer Surgeon in War Zones: Experience of 35 Years and a Call to Action

The aphorism of Hippocrates has become a cliché. From Larrey to Pirogov, Winnett-Orr and Trueta to DeBakey, the cliché has been proven to be a reality. The idea that surgery during armed conflict advances our knowledge of medicine and surgery has become commonplace. After 35 years’ experience, I think back on some of the implications of these clichés and commonplace ideas. Some progress has been due to technological developments, some to a better understanding of pathophysiology, and some simply due to the development of more efficient techniques. More than anything, the improved organisation of medical services should not be underestimated. This is especially the case in prehospital first aid. Indeed, it has been shown that good first aid and resuscitation decreases mortality more than what might be called Bprecocious^ emergency surgery [1]. Nonetheless, and despite the technical progress, I think that many Bold-fashioned^ techniques are still best. There is not, of course, only one school of surgery practiced in time of armed conflict. Four different distinct levels of sophistication can be defined and described depending on the socioeconomic development of the country in question as well as other external constraints of the environment [2]. Surgical techniques and organisation of medical services must be adapted to each specific situation.