Medical Management of Iraqi Enemy Prisoners of War during Operation Telic

Military Medicine, Mar 2005 by Tuck, Jeremy John Hobart

Objective: To describe the background to the provision of medical support to enemy prisoners of war (EPW) and the clinical activity undertaken at the EPW medical treatment facility. Methods: Data were recovered from operational diaries and individual patient records to show EPW attendance rates at routine sick call, diagnoses made, and medications prescribed. Results: EPW presented at an average rate of 1.2 cases per 100 EPW per day. Trauma, musculoskeletal, and dental problems accounted for 52% of presentations. Medications for mild/moderate pain and broad-spectrum antibiotics accounted for nearly 65% of prescriptions. Cultural and security issues presented additional challenges to medical staff members. Conclusions: Provision of medical support for EPW is an enduring task covered by the Geneva Conventions. EPW present a wide range of ailments at routine sick call that require suitable medications, all provided in a culturally appropriate and secure environment.

Introduction

OperationTelic was the United Kingdom's contribution to the combined joint military action to enforce Iraq's compliance with U.N. Security Council Resolution 1441 concerning the identification and destruction of its research, development, and deployment program of weapons of mass destruction. This was the largest deployment of British troops since Operation Granby, which saw U.K. forces deployed to the Middle East in 1990-1991, although the time frame for Operation Telic, compared with Operation Granby, including planning, deployment, and commencement of offensive operations, was compressed into 13 weeks rather than 6 months.

Medical planning concerning enemy prisoners of war (EPW) was initiated before deployment. and further refinement of the plan was conducted in theater. Working from first principles and using the Geneva Conventions1 and current doctrine2-4 as a framework, a medical estimate was completed to identify tasks and begin to allocate resources and priorities. There was little information available concerning what the basic health status of EPW might be. This made allocating troops and priorities difficult, and there was a risk that medical coverage for EPW might be inappropriate to the level of need encountered.

The evidence base concerning the management and treatment of EPW is limited. What had been published before the last Gulf war was focused on the experiences of Western (and mainly American) troops from World War II, the Korean War, and the Vietnam War. However, the experiences of the 46th Combat Support Hospital5 and the 300th Field Hospital6,7 generated some data concerning clinical activity and general management of EPW. Additional work from Operation Desert Storm described malingering among EPW,8 combat stress reactions,9 provision of pharmaceutical services,10 the continuing importance of the provision of environmental health support to EPW holding areas,11 and ethical concerns of deployed military physicians.12

Only the 300th Field Hospital published data relating to uptake of primary care-type services, using information generated from routine sick call. The article described average weekly percentages of those reporting sick (10.26-27.45% per week during the air campaign and 1.71-3.32% per week during the ground campaign). The most common conditions seen and medications prescribed were also described.

Dental disease, upper respiratory tract infections, headache, gastrointestinal conditions (diarrhea and constipation), urinary tract infections, and dermatological conditions accounted for approximately 75% of consultations. Simple analgesics and broad-spectrum antibiotics were the most commonly prescribed items but methyldopa, nitroglycerin, prochlorperazine, and phenytoin sodium were also prescribed. Communication problems and the provision of security in the hospital were also discussed. The aims of this article are to describe the organization of medical assets, present a synopsis of the clinical work of the medical facility deployed to the Corps EPW handling area, and discuss some the issues that arose during the operation.

Initial Planning and Operations

Planning

Under the terms of the Geneva Conventions, there was a requirement to provide EPW with the same levels of medical support as friendly forces, with access being decided on the basis of need alone. This would require provision of NATO role/ echelon 1, 2 and 3 medical care.13 Table I summarizes the capabilities of each NATO role/echelon medical treatment facility.

At the point of capture, EPW would be treated by medical personnel from the capturing unit. At the Corps EPW holding area, there was a requirement to provide NATO role 1 and 2 care (with the exception of resuscitative surgery), and this was organized from an area medical support troop (AMST), a mobile primary care facility with a limited holding capability of up to 15 personnel for 48 hours. The complement was eight officers (four medical, two dental, and two nursing) and 25 personnel of senior and junior ranks. Medical staff members had no formal training in the provision of medical services in a transcultural setting, although some personnel were able to call upon previous experiences to assist the younger, less experienced staff members.