Report of the 3rd ICMM Course for Health Support in Saharan Environment
 This course, which has become an annual event for military medical experts from most parts of the world, was organized from 13 to 19 November in Tozeur by Tunisian General Directorate of Military Health under the patronage of Tunisian Minister of Defense and the aegis of International Committee of Military Medicine.
The Course Director was Brigadier General (MD) M. Kamel CHEBBI Surgeon General of Tunisia and Honorary President of ICMM. The Course Coordinator was Senior Colonel (MD) Mustapha FERJANI, also in charge of the scientific aspects. For logistics and appraisal aspects, Colonel (MD) Mounir CHIBBANI and Colonel (MD) Fethi BAYOUDH were respectively in charge.
 The success of this international scientific event is largely due to the contribution of various partners. To cite a few: Pasteur Institute of Tunis, Faculty of Medicine of Tunis, Faculty of Medicine of Monastir, the pharmaceutical laboratories and various Headquarters and structures emanating from the Tunisian Ministry of Defense.
The program, which is by now well established, will continue to be developed. Practice was afforded the prime position; two thirds of course time was devoted to it. New subjects were developed, such as importance of water management and general survival in the desert environment, the experience of the Tunisian Military Health Service during the humanitarian mission to aid the refugees of the Libyan crisis, etc.
Lectures were given in French or in English, with efficient simultaneous translation in both languages.
 The scientific program was centred on 5 modules as follow:
1. Diseases linked to heat
This module comprises some conferences and clinical case presentations on the topic “traditional and following exercise heat strokes” and highlighted prevention means. It comprises also practical workshops regarding to “strategy of acclimatization before deployment in Saharan environment” and “evaluation means of the heat risk”.
The participants are equipped with calculation formulas of heat stroke rank of risk, according to the climatic conditions: “temperature, percentage of moisture, wind speed and solar radiations”. They acquired the capacity to calculate the daily combatant water needs as well as estimating the cycles work/rest according to the climate.
Recommendations were given to include a salted food to replace salt lost. Also techniques of water treatment and monitoring of drinking water on ground were presented.
 2. Diseases linked to the environment
This module treats in addition to the parasitic diseases “Bilharziose and Paludism” and Saharan environment diseases like the environmental silicosis, the management of water and water treatment experiences during United Nation missions to ensure a drinking water supply to troops deployed in arid climates.
3. Poisoning by scorpion sting or snake bite
Practical conferences and workshops stressed the prevention means, distinction between poisonous snake and grass snakes, and the recognition of the dangerous scorpions, the cleansing procedures of a risky environment, as well as the bites management and treatment. The place of the serotherapy and the reanimation means were approached.
 4. Missions of the health service in the desert environment
This module deal with theoretical aspects of health support in Saharan environment and include practical aspects treating about battalion aid station, ground and air medical evacuation and survival exercise in Saharan environment.
It also comprises workshops that stressed on the characteristics of the aid station deployment and troops conditioning in Saharan environment. Workshops highlighted the specifities of the medical supply as well as the characteristics of drug conditioning, filling aqueous solutions and medical plan in this environment.
5. Training certificate and introduction to cutaneous leishmaniasis
Theoretical presentations and practical workshops are developed in connection with an endemic disease (200 millions people at the risk and 2 million new cases per annum, a neglected disease).
At the end of the course, the participants get the opportunity to have an update on clinical, epidemiologic knowledge and methods of fight against the leishmaniasis. They were equipped to recognize the disease and to make a fast diagnosis of this parasitosis.
 This training is carried out in collaboration with Pasteur institute of Tunis. It should be noted that the team of this institute contributed to discover and develop a new drug “ointment” for cutaneous leishmaniasis which is very effective and without side effects (WR279396: Paromomycine 15% + Gentamycine 0,5%) to replace old injectable drugs used since about fifty years and having many side effects (a derivative of antimony: glucantime and pentostam). This discovery was carried out thanks to collaboration between Tunisian competences and Walter Reed Army Institute of Research (USA).
The participants were civilian and military personnel and came from Algeria, Germany, Saudi Arabia, Burkina Faso, China, France, Ghana, Qatar, the Sudan, Sweden, Switzerland, Tunisia and the USA.
The instructors came from Saudi Arabia, France, Morocco, Tunisia and USA.
 The course was perfectly organized and the organizers did not spare their efforts to facilitate the arrival of the participants, the lecturers and the representative of ICMM Secretary General to this remote region of Tunisia. From the moment of their arrival on Tunisian soil to their departure the guests were given any possible assistance by their Tunisian hosts.
The quality of the programme content was extremely high and there were many opportunities for the audience to become actively involved, thanks to the excellent instructional technique of the instructors and the practical exercises.
Appraisal forms were distributed at every lecture and practical session, covering all aspects of the course. These forms have been examined by a commission with the aim of improving the quality of future course sessions.
The organization committee hope that the participants will pass on the most important lessons learned as well as their experience gained from the practical exercises to their hierarchies and that they will recommend this course to other military or civilian health professionals in their own countries.
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