The Veterinary Record, May 14, 2005 625

IRAQ, Afghanistan, Kosovo, Bosnia,Somalia, Mozambique, Indonesia – allcountries that have suffered or are currently suffering from the effects ofconflict or natural disaster, and allcountries where veterinary expertisehas been required. While media imagesfrom such areas primarily focus on thehuman cost, livestock and draught ani-mals are often an essential part of thelives of the people affected. Subsequentto the immediate humanitarian andwelfare efforts, longer-term work isneeded to secure a sustainable futurefor both people and animals.

‘You have to take a long-term view– you can’t just parachute in for thephoto opportunity’, said Mr JeremyHulme, chief executive of SPANA,describing the charity’s increasing rolein providing emergency relief followingconflicts or disasters. Taking a short-term view could compound the prob-lems faced by people, he continued. Forexample, in a refugee camp in Darfur,where SPANA is the only veterinary char-ity currently working, feeding therefugees’ donkeys had become a prior-ity. Over 10,000 donkeys had died in thecamp because the emphasis had beenon helping the people – yet these peo-

ple relied on the donkeys for transportand for tasks such as collecting fire-wood. The camp was home to 70,000people, who now had only 1500 don-keys between them.

People affected by disaster or con-flict were often as concerned for theiranimals’ wellbeing as for their own, hesaid. For example, in Iraq, the RedCrescent had found that, at a human

health clinic it had established, farmerswould come to ask for veterinary advicefor their animals, just as much, if notmore, than for their own health careneeds.

Lessons from IraqA more detailed picture of the situationin Iraq was given by Mr John Gripper,who had visited the country after thewar had ended on behalf of WSPA toevaluate what the needs were in termsof animal welfare and how best to meetthem. Such evaluation was vital in allsimilar situations, he said, and therewere common elements, whatever thecountry or situation. Issues to be considered included not only whatresponse and aid was required, but alsohow it was to be sourced and delivered,what infrastructure was in place to support it, who would organise theresponse and delivery of aid, and whatthe budget and funding requirementswere.

There were also the matters ofaccreditation, accommodation, com-munications and transport, as well asthe language barrier – ‘if you can’t speakthe local languages or the local dialects,then you are off to a very bad start’ –and the need for an interpreter. Respectand sensitivity for local culture and reli-gion were essential if any effort was tosucceed.

Establishing partnerships with localorganisations and other non-govern-mental organisations was vital, as wasbeing prepared to ‘go to the top’. ‘It’simportant that you start at the top andwork down . . . unless you can get official approval for the work you aredoing, you will find there will be diffi-culties and problems in your way.’ In awar situation, being able to work withthe army was also necessary.

Dealing with the media was also aconsideration, he said, adding that themedia could be very helpful but had tobe given the right sort of material.Whatever charity was involved, somepart of it would want to raise money onthe strength of the work being done.

His visit to Iraq had shown thatthere had been extensive looting of allveterinary facilities; the veterinary college and state veterinary offices inBaghdad had been stripped of every-thing – not just moveable items, butalso light switches, sinks and roofingmaterial. Before the war, there had been 15 state-run veterinary hospitalsthroughout the country, and these had

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Dealing with the aftermath: the role of the vet following conflict or disaster

EMERGENCY MEDICINE

The needs of animals are often thought to be of secondary importanceto the needs of people in the aftermath of natural disasters or conflicts.However, the fate of people and animals is often intrinsically linked, andfailing to appreciate the fundamental role that animals play in the livesof people in many countries can create further problems in situationswhere life is already difficult. The vital role of the veterinary surgeon following conflict or natural disaster was discussed at a seminar organised by the Royal Army Veterinary Corps (RAVC) and the BVAOverseas Group, held at the Defence Animal Centre in Melton Mowbrayon April 14.

Mr John Gripper: respect and sensitivityfor local culture and religion areessential if any effort is to succeed

A mixed audience ofmilitary personnel andcivilians gather for thedisaster managementseminar at the RAVC’sDefence Animal Centre in Leicestershire

626 The Veterinary Record, May 14, 2005

supplied local clinics. All had beenlooted of veterinary drugs. There hadbeen virtually no private companionanimal practice.

Recommending that the focus of therelief operation should be on farm live-stock, Mr Gripper’s report of the situa-tion had suggested that the best way tohelp in the short term would be to pro-vide veterinary medicines. At the timeof his initial visit, the Food andAgriculture Organization (FAO) was inthe process of arranging for veterinarymedicines to be sent out to Iraq, butthis was going to take two to threemonths. He had discussed with Iraqistate veterinary surgeons what medi-cines would be most appropriate. It wasnot possible for vaccines to be suppliedbecause the breakdown in infrastruc-ture had resulted in failure of the elec-tricity supply and, consequently, a lackof refrigeration and a guaranteed coldchain. Therefore, it was decided thatantibiotics, wormers and vitaminswould be most useful.

Once the medicines – five-and-a-half tons, costing £92,000 – had reachedIraq, further logistical problems hadbecome evident, he said. Security con-cerns meant that the state veterinarysurgeons could not deliver them out-side Baghdad. Fourteen of the 15 vet-erinary hospitals were in US-controlledterritory, the other in British-controlledterritory. With assistance from the US

Army, the distribution of the medicineswas completed without incident.

Veterinary surgeons, while not theonly people able to deal with animalwelfare issues in disaster relief, hadadvantages over other people, MrGripper believed. For example, they hada scientific training that equipped themto think in a logical and sensible wayabout a situation; they were used todealing with disease control; they wereused to handling animals; and they hada practical, rather than sentimental,approach to the care of animals.Veterinary surgeons also had the bene-fit of the ‘veterinary community’. ‘I findthat there is, as a veterinary surgeon, animmediate advantage in being able totalk to other veterinary surgeons,’ hesaid.

Afghanistan: rebuilding theveterinary infrastructureMr David Love, who had worked as theinterim regional director of a project innorthern Afghanistan, described thedifficulties facing those who were tryingto rebuild the country’s veterinaryinfrastructure. Before the conflict in1988, there had been about five millioncattle and about 27 million small rumi-nants in the country. Today, he said,there were fewer than four million cat-tle and about 15 million small rumi-

nants. There were insufficient numbersof cattle and small ruminants to rebuildthe livestock populations – the lambingpercentage was 0·6 lambs per ewe peryear and the average calving interval forcattle was about 37 months.

One of the first tasks had been toestablish a regional office with a distri-bution centre and a training centre inMazar-e Sharif. The training centre wasnow working with its second group of25 local paraveterinarians. The Afghangovernment’s veterinary departmenthad recognised the paravet qualificationand, of the first group of 25 trainees, 23had been certified by the government.

There was no companion animalpractice in Afghanistan. However,because of the amount of unexplodedordnance buried in the country, therewas a very active mine clearance unit inKabul. There were 200 working mine-clearing dogs in the city and a breedingprogramme had been established. Theprogramme had been running forabout six years and all dogs in the unitwere now homebred. The chief veteri-

nary surgeon there was probably theonly vet in Afghanistan who workedwith companion animals, Mr Love said.

The project that he had been work-ing on involved a number of interna-tional organisations, such as the DutchCommittee for Afghanistan and the US

Agency for International Development,as well as the local Afghan VeterinaryAssociation, and aimed to give supportto the infrastructure for animal health.The budget was US$12 million overtwo-and-a-half years, and the aim wasto establish or re-establish at least 300veterinary field units throughout thecountry over that period. Each unitwould be staffed by at least one paravetand at least one veterinary surgeon; thelatter would cover no more than 10 vet-erinary field units.

The veterinary field units had orig-inally been established by the FAO butmany had fallen into disrepair. One ofthe veterinary facilities that Mr Lovehad visited had only one syringe, onefixed-handle scalpel and one (bent)needle, and an old-fashioned electricboiler, which was used to boil these up.‘That was all they had. They had nodrugs, they had nothing – and it was amajor problem,’ he said. Other units,however, were better off; for example,one had a paraffin-powered refrigerator

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In Afghanistan, a little money can go a long way: US$150 was enough toprovide new premises for oneveterinary field unit. The photographabove shows the old premises; theone on the left shows the new

Mr David Love describes work torebuild the veterinary infrastructure inAfghanistan

Photographs: D

avid Love

The Veterinary Record, May 14, 2005 627

and a cool box for transporting medi-cines. A relatively small amount ofmoney could make a huge differenceand he described one unit in Faizabadthat was moved into new premises thatwere refurbished and established as aveterinary unit for a total of US$150.

Some of the funding had been allo-cated to setting up a proper cold chainfacility and a veterinary drug wholesaleoperation. As in Iraq, a problem hadbeen encountered in ensuring that vet-erinary medicines were kept at theiroptimum temperatures. The aim was toset up a central store in Kabul and sevenregional stores. Each veterinary fieldunit would be supplied with a fridgeand a freezer, and six small, transit-sizedrefrigerated vehicles and one largerrefrigerated lorry would be purchasedto transport veterinary medicinesunder proper conditions. An agreementhad also been reached with an airline todistribute vaccines by air.

Natural disastersWhile many of the speakers concen-trated on the aftermath of conflicts,Mr Ray Butcher, a practitioner fromUxbridge, spoke about his experience inBanda Aceh in Indonesia following lastyear’s tsunami (VR, January 29, 2005,vol 156, pp 126-129). He was asked togo out to Banda Aceh by WSPA, whichalso sent teams out to Sri Lanka,Chennai in India and Thailand. Whilethese countries had been affected by thesame disaster, the needs in each countrywere very different as a result of differ-ences in culture and infrastructure, he

said. For example, while there were localsocieties for WSPA teams to liaise with inthese other countries, there was none inAceh.

Mr Butcher explained that, in othercountries he had visited previously onbehalf of WSPA, he had encountered themoral dilemma of weighing humansuffering against animal suffering. Hehad overcome this by saying that caringfor the animals was also caring forhumanity. However, in Aceh, the scaleof the human tragedy far outweighedthe animal welfare problems.

Any disaster relief operation had tohave short- and longer-term aims, hesaid. The short-term aim was to provide

aid to restore the situation to a pre-disaster state. There was also the poten-tial to improve conditions. However, itwas not possible to impose a differentculture on an existing one without edu-cating the people and being accepted bythem. ‘There is no magic wand in suchsituations,’ he said.

Effects on peopleThe fate of animals in a disaster willhave other impacts on the human pop-ulation in addition to the loss of foodsources, transport and livelihood, saidColonel Simon Miller of the ArmyMedical Directorate. There was also thepotential for zoonoses. In a presenta-tion that considered the epidemiologyof disasters, he introduced a number ofprinciples that were applied to evaluatehow disasters might affect the health ofpeople, with the aim that the veterinarysurgeons present could then apply themto animals. It was important to applythe principles in order to ensure that asecond disaster – an outbreak of infec-tious disease – did not result in furtherdeaths. It was not possible to apply ablanket approach to every disaster;instead, thought was required aboutwhat action was appropriate.

A disaster was, he said, a disruptionof the human ecology that exceeded thecapacity of a community to cope. Theeffects of a disaster on human popula-tions ranged from death and injurythrough psychological trauma to envi-ronmental exposure and the spread ofcommunicable diseases. Outbreaks ofcommunicable diseases were notinevitable following a disaster, but wereactually more of an exception – in thelast 25 years of the 20th century therehad been 14 major flood disasters, butonly one subsequent major outbreak ofdisease (Sudan in 1980, where an out-break of gastrointestinal disease fol-lowed the flood). However, outbreakswere more likely in certain situations,such as overcrowding following popu-lation displacement, or after environ-mental collapse, particularly whenwater became contaminated withsewage. One of the top priorities in any disaster situation was to producepotable water, he said.

Another important risk factor thatimpacted on disease in the human pop-ulation in the aftermath of a disasterwas a loss of control of disease vectors.In some parts of the world, ColonelMiller said, there was a precarious con-trol of vectors. A disaster distractedattention away from measures to con-trol vectors of diseases such as malariaand dengue.

A further principle to bear in mindwas that disease outbreaks might notoccur until some time after the disaster.There was the incubation period for the

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VETAID – yesterday and todayTHE charity VETAID had begun life as ‘VetsWithout Borders’, explained Mr MartynEdelsten (right). Mr Edelsten, a consul-tant to the charity, said that, in its earlyyears, it had always worked in conflict sit-uations. Its activities had been restrictedby the security situation in each country.The relief it had provided had often beenshort term, and it had been impossibleto monitor the impact of its work.

Mr Edelsten described some of thefirst projects carried out by Vets WithoutBorders in Mozambique, Afghanistanand Sudan, where the charity had begunits now well established programme totrain community animal health officers totreat basic problems.

VETAID had subsequently been devel-oped, focusing on work in poor commu-nities reliant on livestock, with theemphasis being placed on sustainability.It used local staff, and had become amuch stronger organisation. Areas of theworld in which it was currently working

included Somalia and Mozambique, andit was moving away from its traditionallivestock activities into areas such asadvocacy. VETAID was now very experi-enced – although it had learned the hardway!

Colonel Simon Miller discusses some ofthe principles applied when dealingwith the human side of disasters

628 The Veterinary Record, May 14, 2005

disease to consider, as well as a possibledelayed impact of environmental healtheffects and ecological changes.

‘Diseases don’t just happen,’ he said,and it was important to be aware ofwhich diseases were endemic in an areaand which might be imported. Healthsurveillance was critical.

Colonel Miller described some ofthe impacts of the Asian tsunami on thepeople affected. ‘Interestingly,’ he said,‘dead bodies have not posed a majorrisk to health. It is always thought thatthey do or that they will, but it is a factof the matter that they are pretty lowrisk . . . the risks to health posed by theliving greatly outweigh the risks tohealth posed by the dead.’ There hadbeen relatively few cases of gastroin-testinal disease but lots of cases ofrespiratory disease caused by near-drowning, and many of the woundscaused by being in the water hadbecome contaminated and there hadbeen over 60 cases of tetanus inIndonesia.

The one zoonotic disease that wasassessed by the World Health Organi-zation to be a real risk was leptospiro-sis. There were fears that, following thefloods, a proliferation of rats wouldcause pollution of the water.

Two other military speakers alsogave presentations at the seminar.Brigadier Alan Hawley, Director, BritishForces Germany Health Services, wascommander medical of the third divi-sion during the Gulf War, and was in

charge of the British military hospitals.He discussed some of the problemsencountered and said that one of thedistinguishing characteristics of a con-flict situation was that difficult deci-sions were often required on both apersonal and other levels. Medicine, hesuggested, could be an effective meansof winning over the local populationquickly. It provided a ‘high-impact,quick hit’ in the battle for hearts andminds, he said.

Major Suzy Read explained the roleof the organisation Civil MilitaryCooperation (CIMIC), which had been

established in 1997 to provide the mil-itary with an interface between thecivilian and military populations inmilitary operations. Military operationsnowadays, she said, always had a civildimension, and the civil sector wasinevitably part of both the problem and the solution to any crisis. The pur-pose of CIMIC was to establish andmaintain the full cooperation of thecivil population and agencies within anarea of operations in order to createconditions that offered support to thecommander of those operations, andthat would support a lasting solution tothe crisis. CIMIC was not, she said, ‘anoptional extra’ or ‘a way of passing thetime’.

Validity in the veterinary fieldSumming up the seminar, BrigadierAndrew Warde, director of the ArmyVeterinary and Remount Services, saidthat the meeting had generated muchfood for thought: each of the presenta-tions had given a different insight intothe problems that arose after conflictsand disasters and some of the solutions.There were a number of importantlessons, and many of the broad medicalprinciples that were used as a frame-work to approach human disaster situ-ations should be analysed by vets andtested for their validity in the veterinaryfield. There was also a need for trainingin applying the principles. Every situa-tion was different and a blanketapproach was not appropriate.

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Brigadier Andrew Warde: many of thebroad medical principles applied tohumans should be tested for theirvalidity in the veterinary field

ELISA detection of antibodies to Alternaria in cats

THE saprophytic fungus Alternaria is anopportunistic pathogen that can infecthuman beings and animals and has alsobeen associated with atopic disease. On p 633, Mrs Charlotte Dye and colleaguesdescribe an indirect ELISA to detect anti-Alternaria immunoglobulin G (IgG) in theserum of cats. Samples were obtained from63 cats, including 12 specific pathogen-free(SPF) cats and kittens and four cats withconfirmed Alternaria infections. SpecificIgG was detected in the serum of 52 (82 percent) of the cats; those under two years ofage had significantly lower IgG concentra-tions than older animals. The cats’ sex,access to the outdoors, environment andbreed had no significant effect. The catswith confirmed infections did not have significantly higher antibody levels. All theadult SPF cats were positive; the authorsnote that it was difficult to obtain a nega-tive control serum because Alternaria is socommon in the environment.

Establishment of biochemicalreference ranges in ewes of various ages

REFERENCE biochemical ranges areimportant for the interpretation ofdata. They can be influenced by variousfactors, and it is thus important to estab-lish reference ranges for different groups of animals. On p 636, Dr Pascal Dubreuiland colleagues establish reference rangesfor mid-gestation ewes of different ages. Ewes in the last two months ofpregnancy were sampled from flocks inQuébec, Canada, and the samples fromeach flock were pooled into those fromewes one, two to three, or four or moreyears of age. The pools were analysed for electrolytes, chemistry and enzymes andthe values were compared with publishedreference ranges. In total, 83 pools, con-taining 750 individual samples, wereanalysed. All the values obtained werewithin published ranges, and there wereslight changes in some parameters withincreasing age.

Lidocaine and bupivacaine forbrachial plexus block in dogs

A BRACHIAL plexus block is used rou-tinely to provide anaesthesia and analgesiain arm surgery on humans, but there arefew reports of its use in veterinary medi-cine. On p 639, Dr Sandra Wenger and colleagues evaluate the intra- and postoper-ative analgesic effect of a brachial plexusblock induced in dogs undergoing forelimbsurgery under general anaesthesia. Tendogs received a mixture of lidocaine andbupivacaine, injected into the region of thebrachial plexus; 10 control dogs received aninjection of saline at the same site. Theblock was induced successfully in all thedogs and there were no adverse effects. Thecontrol group received significantly moreanalgesia, intraoperatively with fentanyland postoperatively with methadone,because of their signs of pain. The authorsconclude that the low dose of local anaes-thetic used resulted in a significant reduc-tion in the need for analgesia and carried alow risk of systemic toxicity.

Papers in this week’s Veterinary Record