Conducting Emergency War Surgery: the case-study of Syria
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Transcript of Conducting Emergency War Surgery: the case-study of Syria
Conducting Emergency War Surgery: the case-study of Syria
Miguel Trelles, Lynette Dominguez, Katrin Kisswani, Marie-Christine Ferir, Rosa Crestani, Alberto Zerboni, Thierry Vandenborre, Aloa Rahmein, Tom Decroo, Rony Zachariah
Objectives:
In the conflict setting of Syria, to report on:
Preconditions to establish surgical activities within field hospital
Types of surgical morbidity, surgical procedures performed and outcomes
Syria: 3 years of civil war Of 23 million Syrians
7 million internally displaced
2.7 million refugees Deaths – > 150.000 (vast
majority civilians) 10 million in urgent need 250.000 under siege
Contextual challenges Clandestine activities;
Not authorized by government No registration in Turkey Cross border activity
Rapidly changing context Radicalization of the North
Phases with HR difficulties Supply
Distance support to unaccessible areas
SECURITY
MSF activities
MSF OCBJabal al-Akrad
•Close to Turkey•Mountainous North •Population: 150.000•Internally displaced•Frequent bombing
•OCB: Field hospital with surgical center
Emergency surgeryessential
requirements
Infrastructure
& Electricity
Water & Sanitation
Infection control
Waste management
Sterilisation
Blood transfusion
Supply
Human resources
….to chicken farm
RESULTS(Period: 5/09/12 – 1/1/2014)
Total patients 578Female 248 (43%) Civilians 381 (66%)Age in years, median (range) 25 (1-90)
Total Procedures 712 Operating theater occupancy 120 (16-790) in minutes per day, median (range)
Violent trauma cases (by week)
Evacuation
Indications for surgery
Type of surgery
Operation Theatre Mortality
Remark: patients with a very bad prognosis didn’t pass triage, and didn’t make it to the operating theater, or were referred to Turkey
Total patients 578Intra-operative mortality 4 (0.6%)• Multiple severe blast trauma • Hip fracture• Lung laceration• Vena-cava tear
1111
Total No newborns 154• Stillbirths 6 (4%)
Conclusions In a conflict affected and dangerous context, MSF
adapted its modus-operandi and managed to offer emergency surgery
A standardized approach, adapting to local realities, and using experienced expatriates and Syrian staff were key factors
Despite difficult conditions, low intra-operative mortality could be achieved.
Compressed Humanitarian space Clandestine Cave Chicken farm Several evacuations Kidnapping Project closure
Thank you