Module 6: Emergency and Essential Surgical Care

Countries that have suffered from natural disasters, or are in the midst of a war or conflict, have great surgical needs. Emergency aid and emergency surgical care aims to provide immediate life-saving assistance and address acute needs. In countries plagued by war, however, war-wounds actually represent a minority of surgical needs. Injury during conflict contributes to mortality, but most causes of mortality are secondary, such as cholera and malnutrition.(1) Though the type of necessary surgical assistance for countries in conflict is often associated with care for victims of violence, there is an increasing appreciation and awareness that surgical care is also needed for non-traumatic morbidities. This is because often armed conflict occurs in low-income countries where fragile health care systems become overwhelmed, and the population becomes even more vulnerable to malnutrition, infectious diseases, rape and poor antenatal care.  It is also important to remember that while military patients have a greater relative risk of violence-related injuries, civilians still make up the majority of violence-affected cases in terms of absolute numbers.  A study on surgical interventions performed at Masisi district hospital in the Democratic Republic of Congo between 2007 and 2009 revealed that obstetric emergencies accounted for over half of all surgical pathology, while infections accounted for another quarter. Contrary to popular belief, trauma-related injuries accounted only for one quarter of all interventions, while 13% were specifically violence related.  Similarly, a review of  Médecins Sans Frontières (MSF) services in Chad, Somalia, South Sudan, the Democratic Republic of Congo, the Central African Republic and Pakistan found that only 22% of surgical interventions were due to violent injury, while obstetric emergencies accounted for 30% of interventions. “Most of the emergency procedures performed were similar to those performed in hospitals in low-income countries not in conflict.” (2) These findings are consistent from program audits in other conflict zones. Therefore, since most surgical interventions were unrelated to violent trauma and instead reflected the general surgical needs of a low income country, “programs in conflict zones… need to be prepared to treat both the war-wounded and non-trauma related life-threatening surgical needs of the general population.” (3)

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(1) Chu, K., Trelles, M., and Ford, N. “Rethinking surgical care in conflict.” The Lancet. 375. (2010).

(2) Chu, K., Havet, P, Ford, N., and Trelles, M. “Surgical care for the direct and indirect victims of violence in the eastern Democratic Republic of Congo.” Confl Health. 4.6 (2010).

(3) Ibid.