Transcript Conducting Emergency War Surgery : the case

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
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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

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Radicalization of the North
Phases with HR difficulties
Supply
Distance support to unaccessible
areas
SECURITY
MSF activities
MSF OCB
Jabal al-Akrad
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•
•
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•
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Close to Turkey
Mountainous North
Population: 150.000
Internally displaced
Frequent bombing
OCB: Field hospital
with surgical center
Infrastructure
& Electricity
Human
resources
Supply
Water &
Sanitation
Emergency surgery
essential
requirements
Blood
transfusion
Infection
control
Waste
management
Sterilisation
….to chicken farm
RESULTS
(Period: 5/09/12 – 1/1/2014)
Total patients
 Female
 Civilians
 Age in years, median (range)
578
248
381
25
(43%)
(66%)
(1-90)
Total Procedures
 Operating theater occupancy
in minutes per day, median (range)
712
120
(16-790)
Violent trauma cases (by week)
Evacuation
Indications for surgery
Other
13%
Violence
44%
Obstetrics
33%
Accident
10%
Type of surgery
specialized
surgery
8%
visceral
surgery
14%
minor
wound
51%
Caesarean
section
22%
other
5%
Operation Theatre Mortality
Total patients
Intra-operative mortality
•
•
•
•
578
4 (0.6%)
Multiple severe blast trauma
Hip fracture
Lung laceration
Vena-cava tear
Total No newborns
• Stillbirths
1
1
1
1
154
6 (4%)
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
Conclusions

In a conflict affected and dangerous context, MSF
adapted its modus-operandi and managed to offer
emergency surgery
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A standardized approach, adapting to local realities,
and using experienced expatriates and Syrian staff
were key factors
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Despite difficult conditions, low intra-operative
mortality could be achieved.
Compressed Humanitarian space
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Clandestine
Cave  Chicken farm
Several evacuations
Kidnapping
Project closure
Thank you