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By Marie Smyth, Mike Morrissey, Jennifer Hamilton
North and West Belfast Health and Social Services Trust
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The Troubles in Northern Ireland have found resonance in images of burnt-out houses and schoolchildren cowering behind their mothers on their way to school. But what does living in an environment of violence, tribal conflict and acute urban deprivation do to people and their physical and emotional health?

This study does not provide a definitive answer. It explores the impact of sudden bereavement, paramilitary control and forced displacement in destroying communities. It notes the overall poorer health of residents in North and West Belfast, but is not able to distinguish the Troubles-related causes from those related to deprivation. However, it shows most graphically the pressures on staff working in these areas - the personal risks, caution in sharing information and mistrust even of some colleagues - and yet a stoicism and determination to maintain a service in the face of impossible odds. This has enabled services to be delivered in health and social care across the religious and political fault lines.

Using the words of those living and working in North and West Belfast, the authors present a vivid and moving account of the realities of working life in a conflict-torn area.

Terry Bamford is a member of the General Social Care Council and a former director of social services at Kensington and Chelsea Council, London.