* 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).
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
- 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
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
- 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.
2. Horton R. Croatia and Bosnia: the imprints of war. II. Restoration.
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
4. Leaning J. Medicine and international humanitarian law. BMJ
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
Contents No. 49