Notes from the field: A GP details his work in conflict zones

Lines are drawn on a map to denote where you are and who owns the land you step foot on. You carry a book that allows you to enter and leave a country when you choose to. For me, I have this safety blanket of having a passport that allows me to move freely amongst almost all the countries in the world and to come back to a country to live that is not at war. For the past 5 years I have been travelling to countries at war and working as a clinician and now as a team lead. I started this work after I qualified as a GP in 2020 and then completed a master’s in public health at The University of Sheffield, and here I developed my love of global health and specifically emergency response and disaster relief. 

Providing general practice in conflict zones around the world

In my experience, the skills of a GP are almost always downplayed as being useful in these contexts, but 74% of deaths worldwide, approximately 41 million deaths, are caused by non-communicable diseases - and GPs are the most appropriate healthcare professionals to manage NCDs and especially in these contexts. We have a unique set of skills that allow us to work with limited resources and manage conditions outside strict protocols, such as utilising second or third line medication when we are restricted on availability or managing various drug interactions. Humanitarian emergencies are becoming more complex and interconnected with other issues such as hunger, conflict, climate change and geopolitics. We may not manage these things in practice back in the UK, but we manage complexity every day and should not be made to think that we are unable to work in these contexts. Over the years I have worked in Greece, Iraq, Syria, Ukraine and most recently in 2024 - Gaza. Managing risk, dwindling resources and complexity was what was required in Gaza, especially when I was responsible for the project running on the ground for my German organisation CADUS. 

When I started working, I was offering basic general practice and then was promoted to medical coordinator, which involved managing the inventory and ordering of supplies. One aspect of GP work that came into very good use was the ability to rationalise the medication that was ordered, making sure that medication was ordered that needed minimal blood test monitoring in resource poor settings and which were widely available and cheap. These are done daily as a GP managing our practice prescribing budgets as well as rationalising medication prescribed to patients making sure we use the least to give the maximum effort. 

Dr De Silva at a camp in rural Rukka, Syria.
Dr De Silva at a camp in rural Rukka, Syria Credit: Moritz Matakas

Teaching and teamwork to overcome challenges 

In my time in Iraq and Syria I was involved in training of the healthcare staff, and this was something that I had learned with teaching medical students as well as GP registrars when I was a salaried GP. I utilised these skills in East Ukraine teaching civilian organisations a modified battlefield trauma stabilisation course. 

My biggest challenge came when I was managing a team of 15 people in Gaza offering trauma stabilisation and medical evacuations from the North to the South. This was one of my proudest achievements in my career being involved with CADUS and being a direct implementing partner of the World Health Organization. I realised my communication skills were the most important tool there, managing a team in a high-risk unsafe environment as well as speaking to other organisations to offer the best care that we could in a low resource setting alongside our partners. When you are responsible for the lives of 15 people you must be able to manage the ideas, expectations and concerns of your team as well as being able to accept risk and stratify it to make decisions under pressure. 

Who better than a GP to do all that...

More information

Find out more about Hareen De Silva's work as a volunteer around the world. 

About the writers

Hareen qualified as a GP in 2015 and spent five years working in Doncaster, South Yorkshire. He was involved in the RCGP as the First5 rep for South Yorkshire and North Trent. He became the youngest faculty chair in RCGP history before a career in humanitarian assistance in Greece, Iraq, Northeast Syria, Ukraine and most recently Gaza. He worked as a clinician initially but now works in management and leadership and was the Head of Mission for his organisation CADUS in Gaza. He currently lectures for World Extreme Medicine in Humanitarian Medicine and works as a locum GP in the UK.