Post-traumatic stress disorder in the context of terrorism and other civil conflict in Northern Ireland: randomised controlled trial

Sir-

After the peace accord in November 2006, approximately 35,000 Maoist
combatants, People’s Liberation Army (PLA) in Nepal have been disarmed and

settled into seven cantonments in seven rural districts in Southwest Nepal

under the supervision of United Nations. Each cantonment accommodates
approximately 5,000 PLA soldiers.

Kinderberg International, e.V., a German humanitarian NGO under
contract
with GTZ, a German foreign aid agency has been conducting surgical camps
for resettled combatants in the past 6 months to provide reconstructive
surgery service for combatants treated in the field during the war.

From October 29th to November 6th 2007, we provided the surgical camp
to
the 7th battalion division in Talband, Kailali district. The team
consisted of
four surgeons and physicians and six nurses and three logistic staffs. We
provided free medical consultation and reconstructive surgery for
combatants
in this cantonment. We stayed in the camp 24 hours for 7 days and provided

as much surgery and medical consultation as possible for the soldiers.
We examined 622 patients during 7 consecutive days and we conducted all
together 74 operations including stump revision, bullet removal. Average
age
of patients was 23.4 years old and predominantly male (79.7%). The high
demand of surgical intervention was expected considering the nature of the

camp as post-conflict disarmed military encampments.
The most striking finding of this camp was stunningly high prevalence of
chronic pain syndrome developed after bullet and shrapnel wounds (27.7%).
This high prevalence of chronic pain and emotional scars to these young
military recruits urges us the need for comprehensive intervention other
than
surgery. High prevalence of depression and PTSD are reported among victims

of recent conflicts . And somatization as primary symptoms of depression
is
also well known fact in many communities . Considering these trends of
high musculoskeletal pain syndrome several years after active fighting,
the
international relief community should be ready to provide psychosocial
interventions for disarmed combatants.

Masahiro J Morikawa, MD, MPH
Kinderberg International, e.V. Stuttgart, Germany
Case Western Reserve University, Cleveland, OH, USA

Andreas Settje, MD
Kinderberg International, e. V. Kathmandu, Nepal
SKM hospital for reconstructive surgery, Sankhu, Nepal

Competing interests:
None declared