The Defence Medical Services are neither the most visible nor glamorous element of current military operations in Iraq. Indeed, their work, like other logistical support to the fighting force, often passes unnoticed and may be easily overlooked by the casual observer.

Medical support is nevertheless as vital to operations as bombs and bullets, and the efforts and achievements of health professionals and the servicemen who support them, are remarkable.

Iraq is a dangerous place to be at the moment. In the last six months, the Army has used more ammunition than in 30 years of conflict in Northern Ireland. Some units have come under some of the heaviest fire since the Korean War. The IED (Improvised Explosive Device) threat has never been worse and the tactics and techniques employed by insurgents display a sophistication and expertise that could only be achievable with outside help.

Medics see the worst of war and are left to deal with the consequences of combat: between August and November 2004, the Field Hospital at Shaiba Logistic Base outside Basra admitted approximately 700 patients. These included 50 casualties resulting from hostile action with a variety of gunshot wounds, fragmentation and blast injuries. Despite this, combat casualties are still in the minority; disease and non-battle injury (DNBI) accounts for the majority of the workload. In the same period there were more than 5,000 primary healthcare attendances.

What makes the work of the UK Medical Group so remarkable is that it delivers a standard of care that is not only comparable to the NHS, but in many cases significantly better. For instance, how many NHS hospitals could routinely “field” three trauma teams, each staffed with the pinnacle of professional expertise, to simultaneously manage a major incident? Where else could you find a service without waiting lists and appointment times?
Providing world-class healthcare in tents, in one of the most hostile environments on earth, poses enormous challenges. In the extreme environment and operating conditions in Iraq, one might be forgiven for thinking that we were making the best of a bad job. However, all this activity is subject to the same standards of clinical governance and identical governance structures as the NHS.

The UK Medical Group comprises a tented 75- bed field hospital at the Shaiba Logistic Base outside Basra. The tented hospital covers an area of approximately one square kilometre and when packed for transportation fills approximately 100 Iso-containers. The hospital uses large amounts of power and water – problematic resources at the best of times in a desert environment. It is the job of the Med Group’s support squadron to maintain life-support and essential supplies to the hospital, as well as maintaining its infrastructure.
The hospital’s capability is impressive.

It provides crisis expansion to 150 beds for up to 72 hours. In addition to managing trauma, the hospital provides a full range of services, including elective medicine and surgery, a four-bed intensive care unit, an infectious disease ward and assessment unit, a mental health team, physiotherapy, x-rays, pathology departments and a primary healthcare centre. Health promotion is also important business and there are highly successful smoking cessation and sexual health clinics.  The hospital is currently being rebuilt. A CT scanner will be installed shortly, and although the new hospital will remain in tents, the operating theatres and ICU will be rebuilt in hardened buildings.

In addition to the hospital, the UK Med Group also includes a squadron of a close support medical regiment responsible for primary care, dentistry, and the provision of an emergency resuscitation capability throughout the UK area of operations. The “blue light matrix” is more than a comprehensive ambulance service. It must possess the capability to get the patient from the point of injury to skilled resuscitation within the “golden hour” – a critical clinical time-line that must be observed if life threatening injuries are to be successfully treated.

Impressive though the performance of the Med Group may be, the most remarkable asset is its staff. Like so many others, I have just returned from my second operational tour in Iraq in the last 12 months. Like nearly 20 per cent of the 9,000 strong force, I am a Territorial Officer. Many of us are now on our second or even third operational tour. Within the medical services the proportion is even greater, with Territorials making up 50 per cent of the 400 strong UK Medical Group on OP TELIC 4a.

The 1996 Reserve Forces Act (RFA 96) enables the compulsory mobilisation of TA and Reservists. Although RFA 96 compensates employers for additional costs incurred as a result of employee mobilisation, the inconvenience and disruption that inevitably occurs (particularly when an NHS Trust looses highly qualified professional staff), means that successful mobilisation also depends upon the continuing good will and support on the part of employer. This support may begin to wear somewhat thin in some cases where individuals have been repeatedly mobilised.

It is unlikely that the current sustained level of TA mobilisation was ever envisaged when RFA 96 was enacted and perhaps with the prospect of operations in Iraq continuing for the foreseeable future, it is time for an imaginative rethink of the relationship that exists between military and civilian employers. Without doubt, operational experience brings added value to the civilian workplace. However, a more formal contract is perhaps now required with civilian employers; one that assists with medium-term workforce planning and reduces the uncertainties of unpredictable mobilisation at short notice.

Although politically controversial, OP TELIC has been an unprecedented success for the Defence Medical Services and the Territorial Army. Both have been severely tested and have not been found wanting. We have successfully risen to meet an extraordinary challenge. Every patient brought to the UK Med Group on OP TELIC 4a with any chance of survival, was saved. Many servicemen owe their limbs and, indeed, their very lives to the skill and efforts of “weekend soldiers” and their long-suffering employers.