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European Association for Health Information and Libraries
Association Européenne pour I'Information et les Bibliothèques de Santé


"Days of danger, nights of waking"*

* Sir Walter Scott, The Lady of the Lake

To organise the efficient work of a medical library in a state of emergency is not an easy task. One has to be prepared for very complicated consumer needs and for extraordinary efforts in their fulfilment.

At the beginning of the nineties Croatia was faced with problems similar to those in other countries of the Central and Eastern Europe (CEE) caused by the transition from a one-party system to pluralistic democracy and the introduction of a free market economy. The domains of health care, medical education, and scientific research, from where medical information consumers mainly come, were undergoing at that time the process of restructuring. Medical libraries had began to modernise their services and re-train their librarians for new challenges. But then, Croatia was affected by an unexpected and painful event - military aggression on its proclaimed independence, which very soon developed into serious armed conflict. The physical, psychological, and social consequences of that war have already been remarkably well presented by Richard Horton, editor of "The Lancet", in his two-part reportage from Croatia and Bosnia (1,2).

Jelka Petrak

The war imposed very serious and difficult tasks upon all sorts of medical professionals. There were numerous obstacles, such as the lack of equipment, the shortage of qualified military medical professionals, and subsequently experience in the organisation and functioning of an army medical corps (3). More personally there was the lack of experience in coping with stressful events (loss of homes, separation from family members, loss of all personal belongings and memorabilia) etc. The Faculty of Medicine at Zagreb University, the principal national centre for medical science and practice, was suddenly put in charge of various medical, organisational and technical matters of war. This responsibility was also to be borne its library staff!

The first wartime task of the Central Medical Library in the July of 1991 was to find documents containing the basic ius in bello principles, i.e. international treaties and conventions on the conduct of combat and the protection of victims of combat. The law of war grants a particular protection to specific categories of persons and objects, and among these are also military and civilian medical personnel and objects. On the other hand, international humanitarian law, as well as human rights, provide the context for those who try to deliver medical and emergency relief in war zones (4). During that time Croatia was experiencing violations of human rights which often resulted in serious medical consequences (5). By searching our catalogues we found the Croatian translation of the Geneva Convention. But, at the same time we became very much aware of our serious lack of literature in the field of war medicine. In our collection, for example, we only had an old handbook on war surgery, published in 1953. We found also a few older journal titles (e.g. War Medicine) and some special issues (e.g. Israel Journal of Medical Sciences, Surgical Clinics of North America). But it was not nearly enough! Technology of warfare had completely changed and its medical consequences too. So we decided to apply for help to the International Committee of the Red Cross (ICRC) and to the colleagues from other libraries with a letter published in the EAHIL Newsletter (6).

In the autumn of 1991 hostilities became stronger. Some parts of the country were completely cut off, and their Croatian inhabitants expelled. We heard the sounds of the first air raid alarms. The number of refugees and injured increased. As the Library Director I was appointed to the Information Division of the Medical Corps Headquarters. The priorities for the provision of medical information were determined by the current situation, but first of all the Library had to give full information support to:

- all divisions of the Medical Corps Headquarters,

- the public health services (biological-chemical protection, preventive health, sanitary control etc. which also included refugee problems),

- all regional medical services if their information needs could not be satisfied by their local libraries (e.g. unknown or complex problems of the care of traumatised patients ).

The daily library grind became packed, tense and excited. The number of staff decreased. Our male colleagues volunteered or were drafted, and mothers of small children were very often understandably absent. The store area of the library was transformed into an improvised bomb shelter. Everyone who in the moment of an air alarm found himself in the central Faculty building hurried to the library. The store took on the mantel of a large reading-room: the journals were taken out from the shelves and browsed by people standing or sitting on the floor. The Managing Faculty Board also used to come to the library area in those moments, with all phone calls redirected to our extensions. I often had the impression that the Library was a real focus of the entire Faculty.

The lecturing timetable was unchanged and the teaching process uninterrupted (7). All the seats in the student reading-rooms were generally occupied. Current journals continued to arrive regularly as well as the CD-ROM version of Medline. We searched the printed version of Index Medicus from 1943, as well as the available Medline, for all descriptors covering medical aspects of warfare. We classified the references in three groups:

- organisational aspects of warfare (including the problems of displaced persons),

- psychological trauma,

- wounds and injuries

All available articles were copied and put on the information desk. We offered help in information searching and document supplying to all medical institutions and services on the front-line. Their requests had absolute priority of processing and, of course, were free of charge.

It was frequently difficult to decide on a proper search strategy and to find appropriate references. The references on medical consequences of warfare are not so numerous in periodicals. In the American journals, for example, PTSD is very widely described as well as all other psychological and social problems of veterans. But these are mainly the aftermath problems. Our burning issues were: war surgery (wounds and their complications), health care of displaced persons and organisational aspects of the developing medical corps. Some of these problems were very specifically connected to local circumstances, and our librarians did their best in critically reviewing the available literature, comparing the information with local data.

During this period aid began to arrive. The contents of the shipment sent by ICRC included documents on the international humanitarian law, as well as the Red Cross wound classification and a videocassette on wartime surgery, both badly needed by our doctors in the field. The British Library sent us their bibliographies produced in the context of the Gulf War. Several European and American medical libraries sent us related books and photocopies and offered every kind of assistance. The Croatian Fraternal Union of America donated several hundreds of medical books and they were immediately distributed to all Croatian medical libraries. Various means, private cars and military vehicles transported the books. We were very happy to learn that books reached their destination and were of some use.

All members of the library staff worked with an incredible enthusiasm even dealing with problems in which we had not any experience at all. We helped, for example, in the language editing of the manuscript of the handbook on war surgery as well as preparing papers for international medical journals. When the first articles on the war in Croatia appeared we started to collect and index them. Today our database contains over 700 items and we are preparing its web version. In our departmental clinical library we even managed to organise a collection of fiction books (a loan from a city library). The books were intended for the injured in hospital care. We compiled a list of them and the nurses assisted in their circulation to the patients.

The intensive period lasted for almost three years. When I recall today those "days of danger, nights of waking" I still am aware of the sudden feeling of the importance of our profession and what we daily encountered. It was a precious and deeply moving experience I never want to repeat, but also never to forget.


1. Horton R. Croatia and Bosnia: the imprints of war. I. Consequences. Lancet 1999;353:2139-44.

2. Horton R. Croatia and Bosnia: the imprints of war. II. Restoration. Lancet 1999;353:2223-28.

3. Puntaric D, Brkic K. Formation and organization of military medical service at the east Slavonia front in the 1991/1992 war in Croatia. Milit Med 1995;168:412-6.

4. Leaning J. Medicine and international humanitarian law. BMJ 1999;319:393-4.

5. Kostovic I, Judas M, eds. Mass killing and genocide in Croatia 1991/92: a book of evidence. Zagreb: Hrvatska sveucilisna naklada, 1992.

6. Shaw J. Stop-Press from Zagreb. EAHIL Newsletter 1991; (17): 13

7. Marusic M. War and medical education in Croatia. Acad Med 1994;69:111-3.

Jelka Petrak

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Contents No. 49


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