The purpose of World Health Organization (WHO) Emergency Medical Teams (EMT) is to provide timely, high-quality health services in the immediate aftermath of disasters and during disease outbreaks and other emergencies, including conflict and insecurity.

The war in Ukraine has presented all health-care providers with many unique challenges. This assessment addresses the importance and the complexities of the global spread of the Emergency Medical Team system challenges to meet a wide variety of crises including war, those that are unique to this very complex crisis in Ukraine, and the essential role of educational initiatives, not only in professional development but also in teamwork and cultural integration.

Humanitarian aid workers are an overlooked population within the structure of posttraumatic stress disorder (PTSD) research and assistance. This negligence is an industry-wide failure to address aid workers’ psychological health issues. The suspected numbers of death by suicide, diagnosed PTSD, depression, anxiety disorders, hazardous alcohol and drug consumption, emotional exhaustion, and other stress-related problems are impossible to quantify but are considered endemic. Tools for establishing organizational frameworks for mental health and psychosocial support are readily available. However, the capacity to implement this assistance requires the creation and practice of an open and non-judgmental culture, based on the realistic acceptance that aid work has become inherently dangerous. The possibility of developing a psychological problem because of aid work has increased along with the rise in levels of disease, injury, kidnapping, and assault. As a result, expressions of traumatic stress have become the norm rather than an exception. This commentary outlines the essential steps and components necessary to meet these requirements.

The review of the article, “Developing a Public Health Monitoring System in a War-torn Region: A Field Report from Iraqi Kurdistan,” prompted the writing of this commentary. Decisions to implement health data systems within Iraq require exploration of many otherwise undisclosed or unknown historical facts that led to the politicization of and ultimate demise of the pre-2003 Iraq war systematic health data monitoring system designed to mitigate both direct and indirect mortality and morbidity. Absent from the field report’s otherwise accurate history leading up to and following the war is the politically led process by which the original surveillance system planned for the war and its aftermath was destroyed. The successful politicization of the otherwise extensively planned for public health monitoring in 2003 and its legacy harmed any future attempts to implement similar monitoring systems in succeeding wars and conflicts. Warring factions only collect military casualty data. The field report outlines current attempts to begin again in building a systematic health monitoring system emphasizing it is the “only way to manage the complex post-war events that continue to lead to disproportionate preventable mortality and morbidity.”

The toll of civilian deaths in current wars and conflicts has been building for decades. Civilian populations, particularly since WWII, have suffered most of the consequences of armed violence and today represent the most at-risk population. This is attributed to the rise of religious and ethnic hatreds, the collapse of State structures, the battle for control of natural resources, the vast availability of weapons, the proliferation of acts of terrorism, and the spread of so-called asymmetric conflicts. Protections provided to innocent civilians under International Humanitarian Law and the Geneva Conventions have been ignored. This commentary captures the experience of the immediate care and transportation provided to military casualties of the Battle of Solferino in 1859 with civilian casualties recently documented in a Stanford-led study during the “golden hour” after injury in 13 conflicts from 1990 to 2017. Despite many advances in triage and management of war injuries over the intervening decades, the common thread of these 2 scenarios is that transport times and early resuscitation capacity and capabilities, first recognized in the 19th century wars and now accepted as global norms and markers for survival from trauma, are as unavailable today to civilians caught up in war and conflict as they were to soldiers in the 19th century.

The end of the Cold War brought with it many protracted internal conflicts and wars that have lasted for decades and whose persistent instability lies at the heart of both chronic nation-state and regional instability. Responsibility for these chronically failed states has been attributed to multiple unresolved root causes. With previous governance and parties to power no longer trusted or acceptable, the vacuum of leadership in many cases has been filled with “bad leadership.” This Concept piece argues that in a number of cases opportunistic leaders, suffering from severe antisocial character disorders, have emerged first as saviors and then as despots, or as common criminals claiming to be patriots, sharing a psychological framework that differs little from those responsible for World War II and the Cold War that followed. I describe the identifying characteristics of this unique and poorly understood subset of the population who are driven to seek the ultimate opportunity to control, dictate, and live out their fantasies of power on the world scene and discuss why their destructive actions remain unabated in the 21st century. Their continued antisocial presence, influence, and levels of violence must be seen as a global security and strategic issue that is not amenable to conventional diplomatic interventions, negotiations, mediations, or international sanctions. (Disaster Med Public Health Preparedness. 2016;10:118–128)

The lack of attention to basic safety and security standards by the humanitarian community is endemic. The tragic bombing and loss of life of the United Nations Assistance Mission in Iraq in 2003 is but one of many unfortunate examples; these incidents are increasing in number. Tools for establishing an organizational security framework are readily available. Capacity to implement this framework requires understanding the culture of safety and security and individual and organizational leadership. This report outlines the essential steps and components necessary to meet this requirement.

MacphersonR, Burkle FM Jr. Neglect and Failures of Human Security in Humanitarian Settings: Challenges and Recommendations. Prehosp Disaster Med. 2013;28(2):1-5.

The concept of protecting civilians in armed conflict is enshrined in international humanitarian law and widely acknowledged in humanitarian norms. Making this concept operational in humanitarian service delivery is a challenge. Yet, there are many ways in which humanitarian workers could learn from local people about underlying tensions in their community and with these new insights adjust service delivery accordingly.

The 2009 WG developed a qualitative verbal tool that could be used by humanitarian field staff to assist them in understanding issues of civilian protection from the local perspective. The attributes and uses of this tool are described in detail in this WG report. The fundamental aim of this tool is to enhance the capacity of humanitarian workers in their daily work to observe markers of activity and behavior and to inquire and listen from local people about what these markers might or might not mean. The WG emphasized the needs for confidentiality, focus on service delivery (not legal or advocacy work), and iterative routine integration of information gained into field team deliberations. The proposed tool is offered as a possible pilot step towards improving humanitarian understanding and response to local civilian protection needs.