Northern Ireland today is viewed as a haven of peace and reconciliation. Yet all you have to do is scrape the surface of our history, politics, even day to day life such as housing, education and even health provision and you’ll find a different story.

 A story of sectarian division that stretches back centuries that affected all aspects of life for most of the population… and is still very much evident today both physically through our Peacewalls, and also politically by the never ending point scoring against each other by most of the political parties in this country at both local and national levels.

 Of course the ‘Troubles’ as I remember them are over as there is no appetite in any community for the terrorism that Northern Ireland was once famous for but an ideological war of words and ideas continues.  I call that legacy issue history wars or historiography and I’ll be returning to that and other history related themes and issues in future podcasts.

 In our podcast I wanted to explore how the Troubles affected people, communities and services that survived the conflict and how the Troubles affected work and day to day life and will concentrate not only on the terrible headlines that flashed across TV screens worldwide but the personal stories of people who got on with their jobs and lives in the most demanding of circumstances.

 In Today’s podcast I’m focusing on the health and ambulance services who adapted to meet the needs of a country that was tearing its self apart including anyone or institution that got in its way even the National Health Service including front line staff such as nurses, doctors and ambulance staff and paramedics.

But first of all how did our hospitals and services begin and then evolve in the first place?

The NHS came into being on the 5^th July 1948 and a separate act was passed for Northern Ireland to create a new managing entity the Northern Ireland Hospitals Authority to oversee health care including the ambulance service and hospitals. It remained that way until direct rule was imposed on Northern Ireland by the British Government in March 1972 with a new body called the Department of Health and Social Services (DHSS)  created in 1973.

As in almost all things in Northern Ireland the DHSS although totally neutral in the divided sectarian politics that led to the Troubles also became caught up in events simply due to the location of hospitals in areas that were perceived as Loyalist or Republican. For example although the Royal Victoria Hospital (RVH) was designated at the main accident centre for Belfast as early as 1963, by 1971/72 at the height of the Troubles when over 450 people were murdered and lots more were mutilated by terrorist attacks the hospitals location in West Belfast meant that medical staff including doctors, nurses and ambulance staff had to cross areas that were defacto war zones to reach the RVH in fact some staff began to stay their rather than risk returning home .The Belfast City Hospital was seen as neutral as it stood also on a peaceline between the Donegal and Lisburn Roads.

Musgrave Park Hospital was perceived as military by the IRA and Republicans and did have a British Army  medical unit there since the Second World War even though it treated Kneecappings carried out by both Loyalists and Republicans and was a former boys reformatory school taken over by the army.

The Mater on the Crumlin Road was a voluntary status hospital until 1972 due to its Catholic ethos and had to self-fund itself until then yet it also was responsible for a number of Troubles related ‘firsts’. The first to care for injured British Soldiers in 1969 when they were attacked from both Loyalist and Nationalist mobs and the first hospital where a patient was murdered in bed (Moira Drumm but more about that in another podcast.) Of course there were other hospitals in Northern Ireland that dealt with Troubles casualties such as Altnagelvin in Derry and Tyrone County Hospital but it’s the Belfast hospitals I want to concentrate on in this podcast.

To begin with Northern Ireland was not a very healthy place to live in especially in working class areas where, after all, the majority of riots, murders and maiming’s happened during the Troubles.  37% of Catholic Homes and 28% of Protestant homes had no hot running water, a bath or inside toilet (Duffy, 2024) with 38% of houses requiring repair or demolition (Housing Executive, 1974).  My street was a prime example with houses that were rat and cockroach infested and located in blind alleys.,,,, In fact Refuse bins had to be carried through the houses to be emptied.  We had no bath or inside toilet until I was 11 years old and you got washed in a kitchen sink and bathed occasionally in a tin bath in the tiny living room.  I’m not complaining but I think it worth pointing out that poverty and illness knew no religious bounds.  The chronic mismanagement of the economy by the Unionist Government and party were partly to blame for this but that’s the subject of a future podcast.  To simplify things:

 Irish Males

– Typically experienced better mortality relative to Northern Ireland

and England and Wales in the 1st half of 20th century

– Relative mortality dis-improved in 2nd half of 20th century

• Irish Females

– Experienced consistently worse mortality relative to England and

Wales in the 20th Century (Hall, 2011)

In other words our health nosedived from the end of the second world war compared to the rest of the United Kingdom.

My point is that the NHS and hospitals in Northern Ireland were having it tough long before the latest Troubles broke out in earnest in 1969.  And then the Troubles broke out. There was some preplanning for major accidents in 1963 including the possibility of attacks on Belfast during the Cold War but some of the findings were not implemented.  For example it was envisaged that large scale civilian casualties would result in the telephone system being overawed by people calling hospitals yet no separate system was set up so during the Troubles Ambulance and medical staff didn’t wait to be called in for duty when they heard of a terrorist attack on the news.  They described going to their duty stations and hospitals without being called as an ‘unwritten law’ (Duffy, 2024).  This plan also decided not to send medical personnel to incident locations and use ambulances to transport the wounded to hospitals and also issue electronic pagers to alert medical staff (Andress, 1971). Triage was considered critical in such situations as based on wartime experiences where those crying out for help would be treated at the expense of those most in need, the ‘silent ones’ who were unable to cry out for help due to their injuries (IBID)p32

So when the Troubles did erupt on the streets of Belfast and Derry the NHS had to react and that reaction came with its consequences. For example what was their status in the conflict, as impartial witnesses that had immunity from violence or as agents of the British State that treated British Soldiers to get them back into the fight once again?

According to the Geneva Convention and the International Committee of the Red Cross, medical staff are considered neutral in a conflict zone and must be impartial when treating wounded.  However in the Troubles the lines between combatant and non-combatant could become blurred especially as injured terrorists could find themselves in the same ward as injured policemen of the Royal Ulster Constabulary.

The British Army didn’t help this issue much by building a fortified outpost called a ‘sanger’ at the back of the RVH hospital on Broadway that pushed the neutrality of the hospital to its limit.  That led to the IRA declaring the RVH a ‘legitimate target’  Ibid (Duffy, 2024) leading to the sanger and hospital coming under attack (Post, 1972)

In 1980 Robin Shields (McKitterick, 1999) an ambulance controller was murdered at his desk in the RVH by IRA men dressed in hospital overalls. He was a former police reserve constable who had left the police a year earlier and was totally unarmed. His funeral was delayed by widespread bomb scares that prevented some colleagues from attending his funeral.

That’s not the first time terrorists used medical overalls or laboratory coats to murder in hospitals. At the Mater hospital in 1976 Maire Drumm the vice president of Sinn Fein and a prominent Republican activist was shot dead in her hospital bed by members of the Ulster Defence Association/Ulster Freedom Fighters.  The Secretary of State at the time Merlyn Rees commented on Drumm ‘One exception (to condemning killings) is Mrs Maire Drumm who not long ago boasted of sending British soldiers home in their coffins’ (McKitterick, 1999) in 1976 a 20lb bomb was planted at the RVH probably in retaliation for Drumm’s murder Ibid (Duffy, 2024) and the hospital was bombed again using a booby trap device in a refuse bin when three RUC officers were injured.  All during this violent period ambulance and medical staff were expected to be at their duty stations on time no matter what bombs, barriers and circumstances faced them (Orr, 2013). Even when the RVH did lay on transport for their staff with a bus taking staff and passengers to and from Belfast City Centre using the Grosvenor Road the bus was a shot at by Republicans and a RVH biochemist injured [1]

Politics also invaded the hospital space as well. When hospital porters were injured by accidental discharges from soldiers weapons as they stood guard the RVH union leader Brian Sullivan called for a strike to demand that the army leave the hospital entirely. 1200 workers walked out but the regional secretary John Coultard denounced the strike as ‘apolitical sectarian strike’ Ibid (Duffy, 2024) that seen hospital management smuggle bread and milk for patients into the RVH.  Senior consultants took on menial jobs to keep the RVH open and neutral on what was perceived as an overtly political industrial action.  Sullivan and other union members were involved in ‘Smash the Prevention of Terrorism Act’ to oppose ‘military occupation[2]’ and Protestant hospital workers from BCH refused to be involved. When the hospital tried to build a security wall around the hospital in 1977 the bricklayers were threatened by the IRA[3].  Eventually more murders followed with an IRA attack on Musgrave Park Hospital.

In the House of Commons the Secretary of State Peter Brooke stated “The bomb which the IRA left in the hospital is estimated to have contained 20 lb of Semtex. …..  I must stress the fact that this building is not, as the IRA has callously and cynically claimed, an operational military base….. it is purely and simply a hospital dedicated to healing and the relief of suffering. The nearest security force base is more than a quarter of a mile away and was manifestly not the target of the attack. (Hansard, 1991)

By then, the early 1990’s the Troubles seemed never ending yet things had to begun to change even at what seemed our darkest hours the Hunger Strikes, the Enniskillen Remembrance Day and the Shankill Fish Shop bombing.  IRA volunteers had already died on hunger strikes and hunger strikers had been inhumanly force fed by prison authorities such as the Old Bailey Bombers Dolours and Marian Price.  Of course the Price sisters are now better know through the Patrick Radden Keefe book ‘Say Nothing’ and their 200 day hunger protest did eventually see them transported back to Northern Ireland to serve their remaining jail sentences in the province.  But at what cost?  IRA man Michael Caughan died on hunger strike in June 1974  followed by Frank Stagg in 1976.  After  Caughan’s death the World Medical Association’s Declaration of Tokyo raised the hunger strike stakes rather than lowering them as now there would be no force feeding and hunger strike would mean a long slow death.

Once again the prison medical profession was placed at an ethical dilemma.  To save preventable deaths or to adhere to the Declaration and treat hunger strikers without intervening in this deadly political act.  One doctor who worked at Long Kesh/Maze was shot at as he left the prison in 1991 (James mckenna, 2011) whilst another, Dr Ross was believed to be so traumatised by the hunger strikes that saw the death of Bobby Sands and nine others he committed suicide eventually dying at the RVH in 1986.

But it was real people who worked on the wards, treating the injured and real people who transported the injured to those wards through the bombs, bullets and barricades.

Those people were the ambulance service. I talked to two of those very people Lorraine and Stephen Walsh about their time in the ambulance service during the troubles in our podcast and also after the Troubles as Lorraine is still an ambulance controller in the NHS.

So to conclude, the NHS in Northern Ireland set up in the wake of WWII had to adapt to meet the needs of a sustained terrorism campaign that ‘officially’ lasted 30 years but in reality the conflict lasted much longer and there are still some who foolishly believe that terrorism is the answer to a disunited Ireland.  For my generation the Troubles was very, very real and deadly and some still suffer both physically and mentally.

In the case of ambulance staff, memories of horrible atrocities such as the Shankill Bomb still haunt them.  No less haunting is the terrible effects of covid when mandatory isolation meant once again the NHS struggled to cope with mass deaths with insufficient protective equipment.  According to the Office of National Statistics “healthcare workers – including occupations such as doctors, nurses and midwives, nurse assistants, paramedics and ambulance staff, and hospital porters … had a statistically significant higher rate of death involving COVID-19[4].

However even these cold hard statistics hide the aftereffects of such trauma on people who dedicated their lives to healing others.  Some dying trying to save others and some could only watch and listen helplessly as their patients and charges died a lonely death.  We owe them a great deal, a debt that can never fully be repaid but at least we can recognise their service which was the purpose of this podcast and Blog Post which I hope you have enjoyed.

[1] “Terrorists fire at hospital man,” Daily Telegraph, 29 December 1977, 1

[2] “NUPE workers against the British Army in Belfast,” Smash the Prevention of terrorism Act Campaign, PRONI, D3957/7/1

[3] “Work on RVH wall stops,” Belfast Telegraph, 25 August 1977

[4] Office of National Statistic Accessed 14-12-25 – https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/bulletins/coronaviruscovid19relateddeathsbyoccupationenglandandwales/deathsregisteredbetween9marchand28december2020