Before fitting an artificial limb, physiotherapists assess a woman from the Democratic Republic of the Congo seeking refuge in Sudan. ICRC/J Warren

Significant new guidance on physical therapists' responsibilities in emergency zones

What are the responsibilities of physical therapists involved in emergency zones? New plain-language guidance from the International Committee of the Red Cross sets out the rights and responsibilities of health personnel in conflict and other situations of danger. It has been welcomed by physical therapists who specialise in this area.

The document deals with some of the issues that arise when providing health care to people who are wounded or sick as a result of having been involved in armed conflicts or other emergencies. It covers

  • the protection of health personnel, the sick and the wounded
  • standards of practice
  • the health needs of particularly vulnerable people
  • health records
  • imported health care (including military health care)
  • data gathering and health personnel as witnesses to violations of international law
  • working with the media.

According to Pete Skelton, a British physiotherapist who has worked in emergency situations in Haiti, the Middle East and Africa, this is a significant update for physical therapists, because it is framed in the context of humanitarian law and human rights law, taking into consideration the UN Convention on the Rights of Persons with Disabilities.

“There is a move away from ‘medical ethics’ towards ‘health care ethics’ with specific references to physiotherapists and rehabilitation,” he says. 

Of particular relevance to physical therapists is a section on health care for people with particular vulnerabilities, which outlines the need to address access to health care and rehabilitation for people with disabilities, he says. The report also addresses issues around importing health care, which have relevance for physical therapists when considering the provision of locally appropriate wheelchairs or prosthetics. 

“It also addresses an issue which frequently proves challenging for physiotherapists during emergencies – the responsibility of all health professionals to keep accurate records,” says Pete Skelton. “Time and again rehabilitation in conflict and emergencies can be hindered either by a lack of appropriate medical records or by physiotherapists themselves failing to document interventions appropriately due to time constraints. Emphasising our responsibility to maintain appropriate records, even in an emergency, is invaluable.”

Barbara Rau, who is responsible for physical therapy within the physical rehabilitation department of the International Committee of the Red Cross (ICRC), said physical therapists should use such guidelines, and those published by organisations such as WCPT, the World Health Organization and Medecins sans Frontieres (MSF), and periodically review their performance to guarantee optimal quality of care. 

“Physical therapists and other health care professionals have important responsibilities in emergency situations while giving special attention to women, children, elderly people and people with disabilities – indeed, they are experts for these specific populations,” she said.

“They are delivering services within a team of health professionals whose structure and organisation might be more challenging than the usual hospital or rehabilitation-based interdisciplinary team.”

“In providing effective and impartial health care, physical therapists have rights (based on humanitarian rights law) and responsibilities, the first one being to look after oneself. Other responsibilities are that they offer, given constraints and if security is provided, an appropriate standard of care – meaning that they use adequate material and technology, and apply professional knowledge and expertise within a relationship of trust.”

WCPT provides a range of resources and guidance for physical therapists working in disaster zones or emergency situations. 

“Physical therapists working or interested in working in disaster zones should be aware of WCPT policy statements that apply to practice in emergency response situations, such as those on disaster management, ethical responsibilities, patients’/clients’ rights and the consequences of armed violence, landmines and other weapons of war,” said Catherine Sykes, WCPT’s Professional Policy Consultant.

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