EHJ January 2004, pages 4-5
Tracey Khanna reports from the third tri-service conference on environmental health in the armed forces

Within the profession there is currently much debate about the role and focus of the environmental health officer in the public sector versus that of the environmental health practitioner in the private sector. But there is a third sphere, albeit one that is often overlooked, where environmental health also has a critical role. The armed forces recognises that health is not simply a medical responsibility and that the preventive nature of environmental health is at the heart of ensuring healthy, fit, deployable personnel - both at home and abroad. Primarily tasked with the promotion of and maintenance of health and the prevention of disease, environmental health staff advise on all aspects of environmental health and occupational hygiene including basic sanitation, control of infectious disease, water quality, food hygiene, pest control and toxic chemical hazards.

The third armed forces environmental health conference, held at RAF Innsworth in Gloucester in November, brought together environmental health personnel from all three services to discuss these issues and, not surprisingly, to examine some of the challenges experienced during the second Gulf War in Iraq (Operation TELIC) and currently being encountered in the post-conflict reconstruction phase.

The speed and size of the British deployment and the rapid transition from fighting to the humanitarian aid effort created many planning problems for the environmental health effort and, as Major James Fletcher of 1 (UK) Armoured Division explained, not least in terms of readiness (this issue, page 6). One of the main deployment issues for the environmental health cadre was that the logistics support was unable to keep pace with the troop deployment, leaving thousands of troops to arrive in theatre with none of the basic equipment required being in place. Under such field conditions, it was stressed, there are huge benefits to having sufficient environmental health personnel deployed early enough and for units to deploy fully briefed on health threats and defences.

Captain Gareth Moore, of HQ 3rd Division, outlined the provision of environmental health support to units and prisoners of war during the early phases of OP TELIC. Following commencement of the conflict, a "temporary" PoW camp was required at Umm Qasr to hold, potentially, up to 30,000 people. The camp
had to be up and running within 12 hours of the start of the conflict, he said, and there were a number of potential environmental health issues, including: infectious disease spread and parasites; the provision of safe food and water; sanitation and personal hygiene; as well as overcrowding and camp routine. In the event, the main health issue was poor site selection by the prisoner of war holding unit, he admitted, because the camp was sited on an old refuse tip, as personal health and hygiene among prisoners was better than expected.

Camp sanitation was a health issue that cropped up throughout a number of the presentations given to delegates. Lieutenant Alister Witt, of the Royal Navy, was deployed to provide environmental health support to 3 Commando Brigade units (this issue, page 10). "The brigade was the first to deploy and there was
little time to input environmental health information to the initial reconnaissance to Kuwait and few personnel trained in environmental health duties at unit level," he told delegates. One of the problems with such a rapid deployment was the poor siting and construction of deep trench latrines (DTLs), which were the source of considerable nuisance. As was the poor hygiene management of some locations.

While the issue of equipment and training plagued the majority of environmental health personnel throughout their deployment, the most positive message came from Major Phil Wright, of HQ 4th Division, who discussed the successful integration of regular army, Territorial Army (TA) and Royal Air Force staff during the second phase of operations, where the main objective is to ensure a healthy, safe environment and the reconstruction of utilities.

From the RAF perspective, integration into a joint operation was not pre-planned, but the potential for such a move became clear once its junior environmental health technician arrived in Basra. Corporal Tierney of RAF CAM was based at Basra International Airport, with 1,800 to 2,000 on-site personnel - a large area of responsibility for what was initially perceived as an isolated post. However, the environmental health links were facilitated by a common goal and chain of command, bi-service training and the holistic concept of medical force protection, he explained.

This commonality was the driving force behind the integration of a number of TA environmental health staff into the team. The initial perception that the TA had a skills gap, lack of training and would prove to be a burden was overcome due to the commitment and vision to "seize the opportunities", explained Captain Liam Howley, TA EHO with 201 Field Hospital (V) RAMC and principle EHO at Chester le Street BC. "We should concentrate on the similarities that exist; the core skills that are exercised on a day-to-day basis in our civilian jobs," he said." What the TA has is an additional 25 to 30 people who can be used successfully for operational deployments."

"The time is right to look at a more integrated approach, using the TA and RAF in a joined-up approach," stressed Major Wright. "The manpower and resources were available to us to put people into different positions and see what they could do."

In a move away from the traditional environmental health role, Staff Sergeant Wood, of HQ 3rd Division, outlined his job embedded with the recently-formed Joint Nuclear Biological Chemical (NBC) Regiment, which was set up after the Strategic Defence Review and based at RAF Honington, Suffolk. The regiment - which is composed of two RAF squadrons plus supporting staff from other army units - fields specialist NBC defence equipment and is an essential element of joint force operations where there is an NBC threat, enhancing the integral NBC defence capabilities of the remainder of the force.

As a trained environmental health professional, SSgt Woods could provide informed health-focused advice to the regiment on the potential impact of specific chemicals and substances, occupational exposure issues, biological warfare agents and assist other environmental health technicians in identifying chemical agents found on the ground. "Having an EHO in division at the 'bird table' briefings each day had a positive impact on both the coalition forces and the Iraqi population," he concluded.

Drawing the conference to a close, Major Andy Buxton, currently the officer commanding of the department of environmental and occupational health defence medical services training centre, stressed that education and training is "key to everything". While the right approach to environmental health training in the military environment should be to analyse the job specification, write the training objectives, deliver the training and then have a feedback process, he told delegates that this is not always the case.

For the future, he said, important issues include a review of partnerships with academic institutions that can deliver parts of the training required, as well as a move to encourage more people with lower level qualifications onto higher qualifications, such as a special postgraduate diploma or masters degrees.

The next tri-service environmental health conference will be hosted in 2005 by the Royal Navy.