Pain control often neglected in war areasBMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7453.1398-a (Published 10 June 2004) Cite this as: BMJ 2004;328:1398
All rapid responses
1999-2000 I was involved in the medical care in Kosovo, working with MSF.
The availability of peripheral analgesics and opioids was on an acceptable
level both due to the rest supplies of the Yugoslav health system (where
not looted) and donations of the NGOs. The local medical staff usually
used opioids reasonably, although a bit more restrictive then in Europe.
While the supply for acute care, e.g. emrgencies and short term clinical
treatment rearly was a problem, difficulties arose for supplying chronic
patients, espercially those, living in remote areas. I can recall cases of
withdrawal because somebody (usually mobile unit)put the chronic pain
patients on opioids and let the further supply to be organised by
themselves. The same is applicable for all CNS-active drugs, especially
antidepressants and anxiolytics which are widely used in the conflict
Concerning the reasons of low opioid availability it is important to
differentiate between the restrictive state policy and insufficient or no
supply due to economical reasons, especially grave in the conflict areas.
In the last case the involved organisations should seek the ways to ensure
continuous supply from the very beginning. Here it may be helpfull to
establish a dialogue between the NGOs, the local medical workers and the
authorities at an early stage.
Dr. Andrej Andrejew
Competing interests: No competing interests