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