Medical care for civilians in military conflicts as one of the main measures for their protection

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Introduction. The issue of medical and sanitary provision during the war period is acute in the world community. Over the past five years, the threats of military conflicts in the Middle East have intensified, and the global political situation is unstable. Since June 24, 2023, the Voronezh Region has been in the mode of a counter-terrorism operation in connection with the military conflict in Ukraine. As you know, after the coup in Ukraine in 2014, the Western community began to impose the ideology of "Russia is the aggressor" and transfer military equipment and weapons to Ukraine for the war with Russia. This is how the West unleashed the war in Donbas, and subsequently Russia had to conduct a special operation to demilitarize and denazify Ukraine from February 24, 2022. According to the latest data, the conflict claimed more than 14,000 lives and forced the evacuation of more than 1.4 million people. Medical specialists from different parts of Russia are sent to the war zone every year to eliminate the consequences of an emergency situation. Russian specialists are not only on the front lines themselves and provide direct assistance to citizens and the military, but also conduct training. Paramedics, nursing staff, residents and students of the medical university, as well as caring volunteers, take part in the trip to the training ground. Military personnel are trained in practical self- and mutual assistance skills. The structure for the elimination of medical and sanitary consequences in emergency situations (emergencies), which is one of the integral functional subsystems of the Unified State Emergency Prevention and Response System (RSCHS), called the All-Russian Disaster Medicine Service (VSMK), is responsible for providing medical care to the population during wartime. The issue of the volume of medical care depends entirely on the decision of this service. The structure of the VSMK is represented by regular and non-regular formations. The first includes formations that are constantly funded from disaster medicine funds, they are: mobile multidisciplinary hospital (MG), medical detachments and specialized medical care teams (BSMP). Non-emergency teams include teams that are formed at the level of a medical unit, polyclinics, hospitals, and emergency medical stations that are not part of the staff of the disaster medicine center. They perform tasks and report to the Ministry of Health. These also include departmental medical institutions: military hospitals, hospitals of the Ministry of Internal Affairs, railway hospitals, border medical institutions.[1, 2, 3].The purpose of the work is to systematize the possible volumes of medical care at the stages of evacuation of the population during wartime. Identify the best measures to provide health care.Materials and methods of research. A detailed analysis of first aid standards has been conducted. The archive of materials on the evacuation of the population over the past few years has been studied. The reports of the results on the improvement of medical and sanitary evacuation have been analyzed.The results of the study. When determining how the medical care of the population will be provided during a military conflict, it is worthwhile to analyze the aspects of the conflict itself. Because the security features directly depend on the scale of the war. The features of a local war include its limited territory and conflict between a small group of states (most often in peacetime). In turn, an armed conflict is precisely a military clash of various social and ethnic groups. Regulation takes place between the two countries.Using the example of the military operations in Ukraine, which affected the civilian population of the Kursk and Belgorod regions, it is possible to identify the impact of these conflicts on the organization of medical care.:The absence of a limited spatial scope in local wars. Even if the conflict takes place on enemy territory, attacks on targets in our country cannot be ruled out.The lack of deadlines for the duration of hostilities.Characteristic features of local military conflicts will be: cyclical and uneven intensity of hostilities, This point affects the amount of sanitary losses.The use of chemical weapons, which increases the number of victims with respiratory problems and increases the use of antidotes.Use of non-lethal weapons (non-lethal), which expands the scope of using precision weapons.The victims increase by leaps and bounds. Irretrievable losses are increasing in the structure of total losses. With the increase in losses, the military medical service is involved. Frequent changes in the dynamics, magnitude and nature of losses. Due to the wave nature, it is necessary to closely monitor the situation and act according to the emergency requirements at this time.It should also be remembered that with the development of social networks and the Internet, information about losses that is transferred to photo and video media is rapidly spreading throughout the population. The anxiety and fear of citizens also increases, and subsequently, panic. This situation requires careful monitoring and careful treatment of each wounded person, which further changes the system of providing medical care and evacuation.Possible changes in the organization of medical care are related to the time of year, climatic and geographical conditions, and the specifics of the local healthcare system.If there is a shortage of personnel, the use of military medical services, which will not be enough, and further appeal to the involvement of forces and means of the medical service of the military district, civilian health care, forces and means of the Ministry of Emergency Situations of the Russian Federation.Medical and sanitary provision during the evacuation of the population is a set of measures aimed at providing first aid in an emergency zone, sorting victims and dividing patients according to the degree of injury. The complex of events is strictly regulated by the disaster medicine service, which, in turn, relies on the regional situation and the extent of the consequences of an emergency. An important structure for providing medical care to the affected is the multi-specialty field hospital (PMG), which is designed to move into the affected area and provide assistance. The list of his actions includes: sorting and preparing for evacuation, providing qualified and specialized medical care to the affected, temporary hospitalization of affected patients and outpatient treatment.The process of medical evacuation is divided into a number of stages. In modern times, two stages of the evacuation support system are considered to be correct. The first stage refers to the formation of a disaster medicine service. These include emergency medical teams, QMS medical and nursing teams, and medical detachments. They assist in the immediate elimination of the consequences of injury, life-threatening factors, prevent the development of complications and prepare victims for evacuation to the nearest medical institutions, if they survive. If medical institutions in the region are destroyed, then they proceed to the second stage of evacuation to additional medical facilities that are no longer in the emergency zone, most often to neighboring regions. (Fig. 1). Figure 1. Stages of evacuation of the population.Regular hospitals play an important role in medical care in the territories of the LPR and the DPR, as well as the Kursk and Belgorod regions. From the stories of the military, it takes several kilometers to lead the victim to hospitals, and usually they will provide not only qualified, but also specialized care and perform complex operations. Due to the fact that a large number of the population has left, the large number of wounded does not create an overload for the medical institution. From the words of a military doctor from the Lugansk People's Militia: "Virtually all civilian medicine currently works for the military."Although Europe and the West are helping the Ukrainian military with supplies, their losses are 15-30% by minimum standards, and this is despite the fact that they are equipped with innovative American first-aid kits and are taking courses in providing assistance from NATO. American Colonel John Maza, who is also the chief surgeon, cooperates with representatives of the medical Department of the Armed Forces of Ukraine and trains the Ukrainian military. And despite all the equipment, the AFU troops do not survive due to untimely evacuation, improper provision of qualified assistance at the battalion and brigade levels. The victims were evacuated from the battlefield late, if they did not forget about them at all. It was also affected by the fact that doctors did not provide medical care for a long time, and there was no way to save.Unlike the enemy, the Russian military is able to provide first aid even earlier than medical instructors. The soldiers are disciplined and clearly perform the actions of loading the wounded and taking him to the medical center. To improve first aid in combat, it is enough to equip soldiers with tourniquet tourniquets, a universal dressing package, a hemostatic, and a decompremmion needle, if possible (according to the military: "pneumothorax is very rare, frequent injuries are still caused: bleeding, injury to limbs and head).Conclusion. Medical care for the population during wartime is critically important, because the number of lives saved depends on the quality of medical care. The following factors will affect the effectiveness: the number of trained medical personnel, the availability of medical equipment and equipment, the territorial situation in the emergency area, and the availability of nearby medical facilities.VSMK is doing everything necessary to provide medical and sanitary services to the population of the Kursk and Belgorod regions, the DPR and the LPR. And even in the absence of modern first aid equipment on the battlefield, unlike the enemy, our medical military units were able to set up a timely evacuation system and provide qualified and specialized medical care, which they could not do on the other side of the front.

About the authors

Liudmila Vladimirovna Borodkina

Voronezh State Medical University named after by N.N. Burdenko

Email: mila_miller_03@mail.ru
ORCID iD: 0009-0009-2237-4891
SPIN-code: 3810-5253
ResearcherId: KAZ-9688-2024

Студент

Russian Federation, 10 Studencheskaya str., Voronezh, 394036.

Liudmila Evgenievna Mekhantyeva

Voronezh State Medical University named after by N.N. Burdenko

Email: medkat@vrngmu.ru
ORCID iD: 0000-0002-2439-3625
SPIN-code: 6735-7330

Doctor of Medical Sciences, Professor

Russian Federation, 10 Studencheskaya str., Voronezh, 394036.

Vladimir Pavlovich Ilyichev

Voronezh State Medical University named after by N.N. Burdenko

Author for correspondence.
Email: medkat@vrngmu.ru
ORCID iD: 0000-0001-6683-257X
SPIN-code: 2696-2179

Associate Professor, Candidate of Medical Sciences

Russian Federation, 10 Studencheskaya str., Voronezh, 394036.

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