Military Response to Crossing Over: When Yesterday’s Enemy Becomes Today’s Patient

Chris J. Neal, MD
Michael K. Rosner, MD

We read with interest the experience of Drs. Soustiel and Tobias as they discussed the care of casualties from the Syrian uprising that has occurred over the last four years at their facility. Neurotrauma related to war and other armed conflicts is inherently challenging given the different mechanisms of injury and the complexity of the wounds. As medical providers that serve these patients, we turn a blind eye to their nationalities or allegiances once they enter our facilities, and instead focus our energies and efforts towards either saving or improving the quality of their lives. For more than 12 years now, U.S. military neurosurgeons have been in the theater of war, both in Iraq and Afghanistan, caring for those who have suffered injuries similar to what the authors describe. In general, we practice an early, aggressive treatment strategy for our war-wounded as we hold a strong belief that this provides them the best opportunity for recovery.

Modern neurosurgery is a medical subspecialty filled with complex technology and equipment that is lacking in forward deployed areas. In addition, the availability of neuro-rehabilitative care for local nationals is very limited, widening the disparity between what is available in-country and what is considered the standard of medical care “back home.” Despite perceived limitations, we do our best with the situation at hand. As Theodore Roosevelt said, “Do what you can, with what you have, where you are.” We would like to thank the authors for their initial contribution to our understanding of their experience with the Syrian conflict.

NEUROTRAUMA RELATED TO WAR AND OTHER ARMED CONFLICTS IS INHERENTLY CHALLENGING GIVEN THE DIFFERENT MECHANISMS OF INJURY AND THE COMPLEXITY OF THE WOUNDS. IN GENERAL, WE PRACTICE AN EARLY, AGGRESSIVE TREATMENT STRATEGY FOR OUR WAR-WOUNDED AS WE HOLD A STRONG BELIEF THAT THIS PROVIDES THEM THE BEST OPPORTUNITY FOR RECOVERY.

The opinion and assertions contained herein are the private views of the authors, and are not to be construed as official or as representative of the views of the Department of the Army, Navy, or the Department of Defense.