Working in a Warzone: The Challenges Faced by Medical Staff Working during the Troubles

By Ruth Coon, Queen’s University Belfast

The Troubles (1968-1998) created a complex work environment for healthcare staff in Northern Ireland. They experienced challenges to their neutrality and medical ethics, as well as threats and dangers at work. In my research, a number of medical staff who worked at various hospitals across Northern Ireland were interviewed about their experiences during the Troubles. Many of these staff spoke of the challenges of working in what they described as a ‘warzone.’[1]

Working at hospitals, such as the Royal Victoria Hospital in Belfast, could be dangerous. The Royal was located at a significant Protestant/Catholic interface which was a flashpoint for violence. Given this, security forces could often be found on the Royal site and were targeted by the republican paramilitaries, which placed staff and patients in danger. For instance, during a gun battle which raged between the IRA and the army at the site in August 1972, patients and staff were terrified as they became trapped in the crossfire. According to one report, a woman fainted as the bullets flew above her head.[2] Due to the stationing of soldiers on the Royal site, threats were issued by the IRA on several occasions during the 1970s which described the hospital as a ‘legitimate target’. Medical staff were also accused by the IRA of colluding with the security forces at the hospital, claiming that the staff allowed the security forces to use the premises for their military operations.[3] Despite the threat, the army would remain at the site and statements were issued denying IRA allegations that the army misused the hospital.[4] Regardless of the denial, security forces were stationed at the hospital, could be found inside the building itself and also in hospitals across the province throughout the conflict.[5]

The violence also made its way inside the hospital, threatening the safety of staff and patients. One surgeon interviewed spoke of having a gun pointed at his chest in a case of mistaken identity before it was turned on his friend next to him. His friend was shot twice and sadly died. A mortuary attendant from the Royal, Gerald Tucker, was targeted and killed on hospital grounds in 1977. His death brought together around 500 staff members, both Protestant and Catholic, in an interdenominational service of remembrance, united in their anger at the tragic killing. A strike of hospital staff demonstrating their outrage at his death was narrowly avoided. Such a strike, if it had occurred, would have had significant ramifications for patient services.[6]

Image: Grieving neighbours of Mr Robin Shields, an ambulance controller shot dead at the Royal Victoria Hospital, 1980. © National Museums NI.

In October 1980, an ambulance controller, Robin Shields was tragically shot and killed while at work. The IRA gunmen who carried out the killing disguised themselves as hospital workers – their actions revealing a lack of respect for healthcare workers and their position as neutrals in the conflict. Following his death, his ambulance colleagues decided they could only respond to emergency calls until after the funeral, and that they would require extra security to be provided on the site. This would have consequences for patients who required non-urgent transportation to the hospital.[7] Following the incident, there were reports that the ambulance drivers had received a telephone threat stating that any of them with a security forces connection would be shot. The IRA denied the threat and the drivers vowed to continue working but declared that if they were forced to stop it would be the IRA’s responsibility.[8] The Royal was not the only hospital in Belfast which witnessed such deadly violence. In 1991 Musgrave Park Hospital, Belfast was bombed, injuring ten and killing two people. Some of those injured in the incident were young children who were being treated on the orthopaedic ward.[9] 

Alongside the physical dangers, staff also faced emotional stresses and strains. At the time, it was generally assumed that medical staff were in some way immune to the effects of violent conflict and in consequence there was a woeful lack of support.[10] Yet, dealing with the seriously injured and the aftermath of major incidents in Northern Ireland undoubtedly took its toll on the medical personnel involved. Given the nature of the conflict in Northern Ireland, it was easy for those within the health service to experience trauma and loss. Medical staff were often placed in the horrifying situation of realising that they were identifying remains of people they actually knew. Furthermore, as Northern Ireland was a relatively small population which had a strong community emphasis. This meant that the possibility of treating someone you knew was very real. This was particularly the case when major incidents affected smaller towns across the province and local hospitals had to deal with the casualties.[11] In consequence, several interviewees spoke of these experiences and the effects that this had on them both personally and on their work. A doctor who was a final year student based at Altnagelvin Hospital in 1982 recalled the aftermath of the Droppin’ Well bomb, ‘I remember the nurses, many were in tears because they knew some of the casualties or the families of some of the casualties.’

Medical staff additionally faced challenges to their ethics and medical neutrality. Within hospitals in Northern Ireland during the conflict it was not unusual to have those from the different sides of the community, various paramilitary groups and the security forces being cared for in the same ward, and even side by side. All the medical staff interviewed stressed that they felt they did not provide different treatment no matter the background of the individuals or what they might have done. It appeared to be important to them to ensure that they made this point about their neutrality. However, despite this some difficulties were expressed by individuals such as encountering patients whom they would have preferred not to treat due to who they were or what they had done.[12] There were other issues too such as the obligation to disclose information to the security forces about patients who had been injured in the violence. This threatened the doctor-patient relationship and the confidence patients had in their doctors and could impact on their decision to attend hospital for treatment.[13]

Image: Kathleen Robb, matron of RVH 1966-1973 on her first day of work. She was awarded an OBE for her work during the early years of the Troubles. © National Museums NI.

Considering the physical and mental stresses brought by the conflict there was a significant lack of official support available to medical staff who worked during this period. At the time counselling wasn’t available to them and the idea of asking for help was often viewed as weak. There was a get on with the job attitude which prevailed and a sense that medical staff were viewed as being immune to the emotional effects of dealing with the often terrifying and heart-breaking aftermath of the violence. To say that they were immune would be incorrect. Some of the individuals who worked during that period have clearly been affected by what they dealt with. Studies after the Omagh bomb 1998 revealed burn out, a state of physical and emotional exhaustion as a consequence of being involved with long-term demanding situations, had increased among those who responded to the events aftermath. Other studies have revealed incidences of PTSD among medical staff.[14]

Due to the lack of official support, available medical staff had to find their own ways of coping. From the medical staff interviewed the common theme which emerged was the importance to them of camaraderie and teamwork. An unofficial system of support developed as they in some ways ‘counselled’ one another. They understood what each other was going through and could talk through experiences together. Strong bonds as teams developed and outside of work staff would spend social and recreational time together. Social events such as barbeques and meals out were organised. Many staff, particularly the nursing staff, lived together and this was pointed to as a way in which bonds between staff were strengthened. Another method of coping with the horrors of the time was the use of humour. That despite the dark circumstances they were able to find something to laugh about. One individual explained, ‘we managed to have some laughs too, usually at the antics of ourselves’.  Of course, this use of black humour as a coping mechanism is a common thread in Northern Irish society.[15]

Despite the obvious challenges faced by the medical staff many speak fondly of their time working in the health service. That despite the horrors of the conflict they enjoyed their work and the excitement that new medical challenges brought. As well as the feeling of camaraderie and teamwork that they developed.

© The Author(s) 2021. Published by the Epidemic Belfast team on behalf of Ulster University. Any unauthorised broadcasting, public performance, copying or re-recording will constitute an infringement of copyright.

[1] Interviews were carried out with twenty-nine former healthcare workers who worked at various hospitals and in community services across Northern Ireland. Staff interviewed included doctors, nurses and allied health professionals.

[2] ‘Big Belfast Gun Battle’, Reading Evening Post (29 August 1972).

[3] ‘IRA Plans to Attack Hospital’, Irish Independent (12 September 1972); ‘NIHA- Minutes of the Meeting of the Authority, September 14, 1972’, PRONI, HOS/1/3/1/9.

[4] ‘Army to Stay at Hospital despite IRA Warning’, Irish Press (13 September 1972).

[5] Nick Van der Bijl, Operation Banner: The British Army in Northern Ireland 1969-2007 (Barnsley: Pen and Sword Military, 2009), p. 116.

[6] ‘Heads Bowed at ‘Desecrated’ Hospital’, Irish Times (11 June 1977).

[7] ‘Hospital Row as Ambulance Man is Shot’, Irish Independent (1 October 1980).

[8] ‘IRA denies Hospital Drivers Threat,’ Irish Independent (2 October 1980).

[9] ‘Widespread Condemnation of IRA Bomb Attack on Hospital’, Irish Times (4 November 1991).

[10] Carol Acton and Jane Potter, Working in a World of Hurt: Trauma and Resilience in the Narratives of Medical Personnel in Warzones (Manchester: Manchester University Press, 2015), pp. 79-84. 

[11] M.G. Brown and S.G. Marshall, ‘The Enniskillen Bomb: A Disaster Plan’, British Medical Journal, 297 (29 October 1988); Sean Collins, ‘What About Us? The Psychological Implications of Dealing with Trauma following the Omagh Bomb’, Emergency Nurse, 8:10 (2001).

[12] Margaret Graham and Jean Orr (eds), Nurse’s Voices from the Northern Ireland Troubles (Middlesex: RCN Publishing, 2014).

[13] James McKenna, Farhat Manzoor and Greta Jones, Candles in the Dark: Medical Ethical Issues in Northern Ireland During the Troubles (London: Nuffield Trust, 2009), p. 22; Peter Pringle and Philip Jacobson, Those are Real Bullets, Aren’t They?: Bloody Sunday, Derry, 30 January 1972 (London: Fourth Estate, 2000), p. 66. Accessed 4 October 2021.

[14] Collins, ‘What about Us?’; A. Luce, J. Firth-Cozens, S. Midgley and C. Burges, ‘After the Omagh Bomb: Post-Traumatic Stress Disorder in Health Service Staff’, Journal of Traumatic Stress 15:1 (February 2002), pp. 27-30.