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A Survey of National Physicians Working in an Active Conflict Zone: The Challenges of Emergency Medical Care in Iraq

Published online by Cambridge University Press:  17 May 2012

Ross I. Donaldson*
Department of Emergency Medicine, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California USA International Medical Corps, Baghdad, Iraq
Patrick Shanovich
Department of Emergency Medicine, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California USA
Pranav Shetty
Department of Emergency Medicine, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California USA
Emma Clark
International Medical Corps, Baghdad, Iraq
Sharaf Aziz
International Medical Corps, Baghdad, Iraq Ministry of Health, Baghdad, Iraq
Melinda Morton
Department of Emergency Medicine Residency Program, Johns Hopkins University, Baltimore, Maryland USA
Tariq Hasoon
International Medical Corps, Baghdad, Iraq
Gerald Evans
International Medical Corps, Baghdad, Iraq
Correspondence: Ross I. Donaldson, MD, MPH Department of Emergency Medicine University of California, Los Angeles Harbor-UCLA Medical Center 1000 West Carson Street, Box 21 Torrance, CA 90509 USA E-mail



There has been limited research on the perspectives and needs of national caregivers when confronted with large-scale societal violence. In Iraq, although the security situation has improved from its nadir in 2006-2007, intermittent bombings, and other hostilities continue. National workers remain the primary health resource for the affected populace.


To assess the status and challenges of national physicians working in the Emergency Departments of an active conflict area.


This study was a survey of civilian Iraqi doctors working in Emergency Departments (EDs) across Iraq, via a convenience sample of physicians taking the International Medical Corps (IMC) Doctor Course in Emergency Medicine, given in Baghdad from December 2008 through August 2009.


The 148 physician respondents came from 11 provinces and over 50 hospitals in Iraq. They described cardiovascular disease, road traffic injuries, and blast and bullet injuries as the main causes of death and reasons for ED utilization. Eighty percent reported having been assaulted by a patient or their family member at least once within the last year; 38% reported they were threatened with a gun. Doctors reported seeing a median of 7.5 patients per hour, with only 19% indicating that their EDs had adequate physician staffing. Only 19% of respondents were aware of an established triage system for their hospital, and only a minority had taken courses covering ACLS- (16%) or ATLS-related (24%) material. Respondents reported a wide diversity of prior training, with only 3% having some type of specialized emergency medicine degree.


The results of this study describe some of the challenges faced by national health workers providing emergency care to a violence-stricken populace. Study findings demonstrate high levels of violent behavior directed toward doctors in Iraqi Emergency Departments, as well as staffing shortages and a lack of formal training in emergency medical care.

Donaldson RI, Shanovich P, Shetty P, Clark E, Aziz S, Morton M, Hasoon T, Evans G. A survey of national physicians working in an active conflict zone: the challenges of emergency medical care in Iraq. Prehosp Disaster Med. 2012;27(2):1-9.

Original Research
Copyright © World Association for Disaster and Emergency Medicine 2012

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