Healthcare providers in war zones face increased risks on the front lines, often with limited resources and constant pressure.
By Paige Anderson, CRDH
We may see images of the devastation—burned and bombed-out buildings, crumbling bridges, refugees fleeing their homes—but much of the daily struggle of living and working in these areas never makes it into the headlines.
Soldiers and civilians in war zones still need cavities and broken teeth repaired. They still struggle with infections. However, working in war zones can be an intensely traumatic experience for doctors and dentists alike.
What specific challenges do healthcare workers face when they work near armed conflicts, and how do those experiences affect their mental health?
Clinician Trauma
Doctors, medics, dentists, and other medical professionals working in war zones are at very high risk for PTSD and other stress-related disorders.
Even without the added stresses of active war, healthcare workers deal with incredible strain that can result in PTSD. Dentists are at especially high risk for stress-related mental health disorders such as suicidal ideation and actions.
Taking these careers into a war zone (or having a war zone dropped on you, as many dentists in Ukraine and Gaza have experienced) compounds these risks for trauma in several specific ways.
Constant Threat
Dentists and doctors working in active war zones are constantly exposed to violence.
People living in war zones frequently report that they become accustomed to the sounds of air raid sirens, gunshots, and detonating bombs. Even so, proximity to armed conflicts puts extreme strain on the sympathetic nervous system, and this type of numbing effect isn’t always a good sign and can have long-term damaging effects on many aspects of health.
Medical support personnel should be insulated from violence, even in war zones. International laws of engagement strictly prohibit the targeting of medical facilities or personnel.
Sadly, these laws are frequently violated, whether intentionally or not. Hospitals and clinics are frequently bombed, and health workers may encounter violence or threats of violence on their way to and from work or even in their own homes.
Even if it never happens to them personally, dentists and doctors working in these areas may constantly have the thought in their minds.
They may need to rehearse for chemical weapons exposure and other catastrophic events. While preparedness exercises are very valuable, the reality of the likelihood that these skills will come into use can be stressful in and of itself.
Limitations on What You Can Do
There are few worse feelings for a healthcare provider than realizing you can’t give your patient what they need to recover from an illness or injury fully.
Working in a war zone often means working without the equipment or materials you would ideally have. Supply chain disruptions, destruction of power grids, and lack of predictable access to clean water can all compromise your ability to do your job well.
Dental clinics and hospitals are often the targets of looting, leaving them without essential equipment and sometimes even without furniture to treat patients.
Feeling like you’re failing your patient can be emotionally and mentally devastating for healthcare workers.
Then, cognitive dissonance can come with ethical gray areas for military doctors. Where does your role as a soldier end and your role as a healer begin? Many dentists and doctors currently in Ukraine and the surrounding areas are pressured to treat Russian soldiers, even as their clinics are targeted for artillery strikes.
All told, the mental strain of wanting to do what you can to improve access to care for people who need it most but realizing you may not be able to deliver the quality of care they need can wear on doctors in war zones and make them question how much good they’re doing.
Limited Staff and Overwhelming Load
In the wake of the COVID pandemic, many healthcare workers know the stress of being understaffed and overwhelmed. That situation is magnified to an extreme extent in war zones.
For dentists living in Ukraine, they work with little to no support. In many cases, they’re the only dentist in the area and may be responsible for thousands of patients, many of whom are struggling with severe injuries and dental emergencies.
Even if you’re working in the military, dental and medical roles are frequently understaffed, and many sectors call on civilian support to fill necessary roles.
That may work well in many cases, but in active war zones, finding civilians willing and capable of providing support becomes pretty challenging.
Extreme Situations
Providing care for people in war zones means repairing damage beyond what you would see in a typical workday in peacetime.
This is especially true for dentists, who may be called to help in mass casualty events and support trauma surgeons.
In a 2013 interview, one dentist described several situations in a war zone where he needed to work drastically outside his regular skill set. From working on military dogs (an experience many military dentists share) to assisting trauma surgeons by holding a patient’s intestines, he experienced many extreme situations that he otherwise never would have.
Any Silver Linings?
Many dentists and medical professionals volunteer to care for people in war zones and severely impoverished areas without access to care.
While it’s important to consider the adverse psychological effects these experiences can have, it’s equally important not to dismiss the profound sense of fulfillment that can come with it.
Without doctors and dentists willing to put themselves at risk, patients in these areas would have nowhere to turn for care. Decay can turn into life-threatening infections. Soldiers living in the constant stress of battle often live with broken teeth from blunt trauma and grinding.
Healthcare providers in war zones are uniquely positioned to save lives and help patients find moments of respite and normalcy when the world is coming down around them.
Those moments can be profoundly healing for patients and clinicians alike.
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AUTHOR: Paige Anderson is a certified registered dental hygienist with eight years of clinical experience and an English degree. She blends her two areas of expertise to create resources for dental providers so they can change lives by giving their patients the highest possible standard of care.
