Viewpoint: Making a difference - working in conflict and disaster zones

Responding to global emergencies is hugely rewarding – despite the many challenges, says Peter Skelton.

There are increasing opportunities for physiotherapists to respond to international emergencies. To work in a conflict zone or after a disaster can be very rewarding, but there are many challenges, both clinical and personal. It’s fantastic to be able to put our skills to use in a setting where there is often a huge need, and incredible to be able to work alongside and support talented local staff. Days are always very long and living conditions can sometimes be difficult. The stories and circumstances of those we work with can be harrowing, whether treating the lone survivor of a family killed by shelling in Gaza, or a child with a spinal cord injury from the recent earthquake in Nepal. It’s important in these circumstances that those deployed to emergencies have the right skills, and do so through professional organisations that can provide the right expertise and support, or work as part of a national team such as the UK Emergency Medical Team. 
Often the most unexpected challenge for those who deploy occurs not while they are away, when they are focused so strongly on the job at hand, but when they return to the their normal lives in the UK. With time to reflect, the contrasting circumstances between our lives in the UK and the lives of those with whom we have worked with can be difficult to grapple with. Explaining what you have seen or done to friends or colleagues can be a challenge.
The media in emergencies tend to portray those we are working with as helpless victims, and those going to help as heroic. But, in reality, it’s the local responders on the ground, working for local or international organisations such as Handicap International, who have done the main work in the days following the disaster, and continue doing so long after we have returned home. They are also the ones who have been personally affected, whether that has meant dodging fire to get to their local hospital, or working without a day’s rest following an earthquake while sleeping with their family under a tarpaulin as their house has been damaged. Unlike international responders, they can’t simply fly home. Knowing this, it can be hard to respond when someone says ‘it must have been awful’ or ‘you are so brave’ when you are home again. 
Despite the hard work and challenges, those who work internationally, including those who work in emergencies, gain from deployments as well as giving. We learn from our local colleagues, and we learn about ourselves. When surveyed following our Gaza and Nepal responses, everyone who took part said the experience had benefited them personally 
and professionally. 
When done right, we can make an enormous difference when we deploy, but we also gain skills and experiences that improve our work back home. 
The Chartered Physiotherapists in International Health and Development (Adapt) network offers information on working abroad, and has a buddy system to support members who are thinking of going or are already away.
Peter Skelton

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