Complexity of the Operational Medical Support Chain during a United Nations Mission in Sub-Saharan Africa: a Case Report

Abstract

Context : The United Nations (UN) Stabilization Mission in Mali is the deadliest of UN missions (116 dead and 500 seriously injured since 2013). The care for the wounded is carried out by a chain of operational medical support and its complexity will be illustrated through a case.

Clinical case : A Malian civilian along with his vehicle on a mine is the victim of an explosion. After an initial takeover by the UN military of the convoy and a contact with the medical regulation of the theater of operation, a Dutch paramedic team was sent through helicopter. Due to the severity of the lesions (especially severe craniofacial trauma and haemorrhagic shock), the regulation has decided to evacuate the patient to a Togolese military level 2 hospital (HN2-Togo) deployed at Kidal in Northern Mali. The evacuation was done at night without illumination on board the aircraft for safety reasons. Upon arrival at the hospital, the patient has been given a therapeutic treatment before being evacuated for the final treatment in Senegal.

Discussion : Within the framework of the UN missions, the goal of the medical support chain is that they should ensure that all staff receives a quality care, under the best conditions and within the deadlines. The constraints of the Malian theater (security, heat, sand, surface, multiple speakers and nationalities) make this channel complex. This clinical case, however, shows that it is possible to achieve in a degraded context a quality medical care, under the best conditions and delays.