Burn wound care of civilians in Sahel region by French military surgical teams: ethical challenges and future training requirements.

The primary mission of the French military surgical teams deployed in external operations in the Sahel is to provide support for combatants. However, many of their activities and of the limited human and material resources allocated to them are devoted to providing free medical assistance to the local population. The French military surgical teams are very often expected to take care of serious burns for the benefit of civil populations because of the absence of dedicated civilian medical structures. Surgical teams are faced with a necessary triage of patients to be taken care of because of the discrepancy between the high demand for care and the means at their disposal. But the triage can lead to ethical dilemmas when the values that come into play in the decision contradict each other or when they run up against the quota of available human and material resources, as well as the interests of the military institution. The challenge is then to become aware of these dilemmas in this particular context. A discussion of these ethical dilemmas would help carers to avoid developing fatalistic attitudes or developing chronic pathologies due to unresolved or unconscious predicaments. Solutions are proposed that place ethical reflection at the heart of the practices during external operations by the French surgical teams. The ethics of discussion must bring together all players in care management and also the military authorities, before, during and after the missions. Training programmes for ethical reflection would benefit surgical teams and help them approach and become aware of the dilemmas they will necessarily face.