Medics in minefields: The silent heroes of mine action
No humanitarian demining team tasked to travel and work on high-risk demining sites and in remote locations can do so without the essential presence of a dedicated national trauma trained medic.
Project Masam currently has 42 medics deployed in Yemen: 32 national manual mine clearance (MMC) team medics, two national doctors — medical co-ordinators headquartered in Ma’rib and in the de-facto capital Aden — and four international medics, who are assisted by three fully-qualified national medics operating in Project Masam’s clinics and in the field.
The role of the international medics is to train, coach and mentor the national team medics and provide any other medical support to Project Masam as may be required.
‘Minefield medics’
“The environment in which mine clearance medics work can be very challenging and the types of injuries they encounter is what differentiates a demining medic from medics who may work in other sectors,” Dr Julian Spaans, Medical Coordinator for Project Masam said from the eastern city of Ma’rib.
“A patient who is involved in a mine accident generally has severe life-threatening injuries which often includes traumatic amputations and severe internal injuries and our medics need to always be prepared to treat and stabilise such patients out in the field.”
The teams often work in relatively isolated areas, so Level 2 (high dependency unit) or 3 hospitals (intensive care) are often some distance away from the accident site.
“Our medics often do not have the luxury of calling on additional medical support and they have a huge responsibility in doing all that they can in getting the patient to hospital in a relatively stable condition,” Spaans added.
Continuous training
Whilst Project Masam’s demining medics are already qualified trauma nurses or medical assistants, with many having previous experience with working in hospital ERs, they are trained in advanced life support skills by the international medics once they have joined Project Masam to ensure they have the knowledge and skills to administer lifesaving treatment to any casualties in the field.
“Whenever we do go into the field, international medics will provide ad hoc training and updates to the MMC medics. We talk about cleanliness in such environments, we remind them of the extent of their function such as also monitoring break time, access to water, checks, etc…,” International Medic Attie Kruger explained from his clinic in Aden.
“We do rely a lot on our medics. The qualification level — nursing diploma — is high to enter this job. We prefer our primare care experts to have obtained practical work in ICU and ER, but after that we do give them a practical and theoretical training for them to confidently operate in uncontrolled and unforgiving environment.”
The new-comers receive a combined medical training (advanced life support) with a focus on primary health and medical care (“around 90% of their function”, Kruger pointed).
“They must know their team inside-out, spot the signs of dehydration, heart attack or stroke before it is too late,” Kruger added. “Prevention is better than cure.”
During this training, international medics also go deep into trauma care to improve survival rate of injured patients.
Refresher training is also provided to the team medics on an annual basis to ensure they are up to date with the latest international medical treatment protocols. This includes a CASEVAC drill with the whole team. The latest weeks-long refresher training was carried out after the holiday of Eid-ul-Fitr in April 2023 in both Aden and Ma’rib.
Importance of Quality Assurance
Kruger, who is based in Aden, explained that, despite difficulties accessing certain demining teams due to the terrain and the ever-evolving security conditions near frontlines, his team prioritises Quality Assurance.
“If we can’t go to visit the MMC medics due to security reasons, that documentation will still be completed: monthly medical records of patients seen, record of those transported to hospital and the treatment given, any work-related injuries on duty.
“Then, there is the medical equipment checklist, the medication check list, visitors’ logs, CASEVAC training logs, any damage to equipment, as well as assurance that field stretchers are in serviceable condition.”
Every month, Kruger said, documentation prepared by the MMC medics is sent to headquarters. This also includes checks of medical equipment and medicine expiry dates, to ensure the best possible care can be administrated during any medical or trauma incident conditions on site.
“Some equipment doesn’t have an expiry date, but medics still need check that they are still in their sealed packages. In minefield conditions, medics can’t 100% work sterile, but they try to achieve sterility as much as possible to prevent infections setting in, in the post-effect of any trauma incident.”
Essential emergency drivers
Another factor in the ability of medics to deliver the best care is that the ambulance, or emergency vehicle, is in a sound mechanical condition and that it is parked at the Control Point with the nose facing towards the shortest route to the road, with keys in the ignition and the driver available at the Control Point.
“That will ensure that in the unlikely event of an incident taking place, the emergency vehicle will be immediately available, ensuring no time is wasted — and patients are treated in the golden hour,” Kruger highlighted.
Every team’s emergency vehicle driver and MMC medic are required to know where and how to get to the closest medical facility for stabilisation of a patient. In the event that the hospital cannot handle the case, the patient will be transported to the closest appropriate facility, which might be a regional hospital such as Taiz or Marib, or in Aden.
The MMC medics work hand-in-hand with Yemeni medical coordinators, who are doctors and described as the middlemen between international medics and MMCs. They allow the foreign medics to understand local medical procedures and are the link to the best possible care for patients.
Their access to medical reports allows Project Masam to decide whether a patient can be treated locally, or medevacked to the Yemeni city of Seiyun or Egypt for specialised treatment through Project Masam’s medical insurance policy.
This training and hands-on supervision ensures readiness and availability of medical equipment and medical professionals on-site, and ensures Project Masam complies with its contractual terms and conditions as well as mine action international standards.
In the words of Yemeni Medic Abdulsalam Ahmad Ali Abdullah, who visits the local MMC medics, carries out inspections and is an interpreter for the international medics providing training and support, demining medics are the pillar of any team operating in minefields.
“The conditions in which MMC teams are working are high risk: it’s mountainous, it’s desert, it’s coastal and sandy; it’s dusty and hot. Medics are not there just for trauma but also for medical conditions related to the environment in which deminers operate,” Abdullah explained from the clinic he shares with Kruger in Aden.
An on-site MMC medic will help address certain health conditions or injuries that can arise from the job (heat exhaustion, dehydration, possible allergic reactions, flaring-up chronic illnesses) or even nature-related injuries such as spider or snake bites, scorpion stings, and poisonous plants, as well as trauma injuries.
“All these things they must deal with — in worst case scenarios, they might face multiple casualties — following a motor-vehicle accident (MVA) or mine incident,” Abdullah added. “Your initial golden hour treatment is not going to be adhered to without them. You’ll have more permanent injuries, or more deaths following the initial incident.”
Helping others
“In some area, we have members of the public coming to ask for help. We’ve had mothers coming with their dying children. One was three-years old. How can you say no? This is also part of operating in these areas. Because it is a demining project, deminers are of course in the forefront, but medics are operating in the background, and because our deminers work closely with the local population, civilians now look at us medics for help, especially when it is an emergency or critical,” the Yemeni medic explained.
Describing the importance of medics in mine action, Abdullah added: “On site, it’s like a society without a doctor or a hospital. It’s like a place without medical facilities or professionals available: your simplest disease or fall can cause either permanent injury or death. That is what our medics mean in the demining team dynamic.”
A high-risk role
“We have unfortunately had accidents involving our demining teams resulting in deaths and serious injury, and even our own team medics have been seriously injured in some of these accidents,” Senior Medic Spaans said.
“We had an unfortunate incident of one of our medics suffering severe injuries to his lower extremities after the emergency vehicle he was travelling in drove over an anti-tank mine.”
Tareq Abdullah Dhaif-Alla Al-Awadi, a medic for the Survey Team 30 in Ma’rib, was injured in the blast on 26 October 2020. A deminer was also injured in the accident. Footage of the torn and blackened vehicle shows the pick up feet away from a very large crater in the sand.
“We were lucky to have another demining team working close by the accident site and that team medic was able to assist and treat the injured medic and deminer until they arrived at hospital.”
Discussing the incident, Kruger, who was in Ma’rib at the time, said that medics operating in the mine action field are at higher-risk because of the nature of the environment in which they operate and that landmines and explosive items are the number one threat for deminers and medics alike.
“A landmine is a perfect soldier: it lies in the ground for years and attacks on its own. It will not discriminate between a military officer, a civilian or a medic. [In Al-Awadi’s case] it didn’t matter that our emergency vehicle had a recognisable cross painted on it: the landmine exploded and injured our medic.”
After surgical procedures were performed on his leg and he attended rehabilitation, the injured team medic recovered from the orthopaedic injuries sustained, but was no longer able to operate in the field.
Having greatly suffered during the incident, which caused permanent damage to his heel and ankle, Al-Awadi’s lower limb was amputated. Given his injuries, Tareq was medically boarded from operating as medic for Project Masam in March 2022.
Following amputation, Tareq underwent further rehabilitation and received a prothetic limb under Project Masam’s Duty of Care policy.
By Elsa Buchanan
