Conducting Emergency War Surgery : the case
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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
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 OCB
Jabal al-Akrad
•
•
•
•
•
•
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
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