Turning off the lights in Northern IrelandBMJ 1997; 314 doi: http://dx.doi.org/10.1136/bmj.314.7079.524a (Published 15 February 1997) Cite this as: BMJ 1997;314:524
At Christmas the lights in Belfast were switched on by bubbly children's television presenter Zoe Ball. This was in stark contrast to the celebrity in 1995–the president of the United States, Bill Clinton. Having the leader of the most powerful nation in the world to switch on the Christmas lights is a great honour for a small country like ours and a difficult act to follow. It was inevitable that last year's guest would appear lightweight in comparison, but surely this difference in status mirrors the change in fortune of Ulster itself over the intervening 12 months. One year ago the mood of the city in the pre-Christmas shopping frenzy was optimistic, and spirits were high—higher than elsewhere in the United Kingdom. Since then we have witnessed the failure of a peace process, terrorist explosions in London and Manchester, and an attack on an army base near Belfast. So a shadow was cast over Christmas 1996.
People from both communities reacted to each setback with shock, disbelief, and then resignation as the usual factions attacked each other backed by the same tired old rhetoric. Within the hospital these events have had a significant effect. In the early part of the year when there was a veneer of peace we had to treat only the victims of punishment beatings. To avoid the spotlight of international criticism the terrorists swapped their guns for less emotive devices: baseball bats for the loyalists and hurley sticks in the case of nationalists. Ironically the injuries produced by these weapons sometimes proved more destructive and difficult to treat than a simple kneecapping.
As the marching and rioting season progressed tempers frayed, fuelled on one side by lack of progress in talks and on the other by the provocation of a renewed bombing campaign. Violence returned to the streets, injuries became more frequent, and beds were occupied in the intensive care unit. As summer turned to autumn the tension seemed to be dying down. Arguments about the right to march along traditional routes and parity of esteem were abandoned until the following year. Folk turned their attention to more important, more practical concerns like Christmas. Then the broken ceasefire was forcefully brought to the attention of the province by a carefully planned and executed attack on army headquarters.
The health service responded in the same way as it has done over the past 25 years. In this hospital all emergency operations were postponed, and theatre teams, worked late into the night treating the injured. The intensive care unit spilled over into a cardiac surgery ward. By the next morning a strange transformation had taken place. As a heavy fall of snow changes a landscape this act of terrorism had changed the hospital. Security cameras had returned to the corridors, plain clothed police officers guarded the intensive care unit inside their long abandoned observation post, and soldiers in combat gear patrolled the public areas. No one seemed to notice. Visitors and staff alike went about their business without so much as a second glance. The changes were invisible and the local policy of not seeing the security forces was in force. It must seem odd to outsiders to have armed troops on duty in a hospital, odder still that everyone ignores them. After 25 years of the troubles it is a sad fact that it is the unguarded ward or the unpatrolled corridor that causes surprise. Life in Belfast was truly back to normal.
There was one change: doctors spoke at a news conference and for the first time explained the effect that the explosion was having on health care in the province. Very simply they outlined how emergency cases were delayed, major cancer and cardiac surgery postponed, intensive care facilities overstretched, and scarce resources consumed. It was clear that an intolerable burden was being placed on a struggling health service, and for once it was not the fault of government underfunding.
I doubt that their words had much impact; certainly not with the terrorists. But they reminded me that our local difficulties are an expensive luxury. The cost to the NHS has been borne not just by the taxpayer but by those awaiting medical care. The additional cost of damage to vehicles, buildings, businesses, and investment, plus the cost of policing the province has been borne by the nation and must be greater than the gross national product of many countries. No outcome to the position in Ulster justifies this expense but there is an even greater cost involved.
I started to write this article on Remembrance Sunday because, despite our efforts, a man died as a result of the explosion. A new name was added to a regimental role of honour, to be saluted on this day by future generations. Another widow has been made, more children are fatherless. Unlike the rioters, this man had no choice to make. He was doing his duty—serving in Ulster to prevent an “acceptable level of violence” from becoming civil war. The price of his death we will never be able to pay. Be it president or media darling, it matters little who switches on the lights in Northern Ireland. The problem is that someone keeps extinguishing them.
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