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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
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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
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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
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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
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MSF activities
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MSF OCBJabal al-Akrad
•Close to Turkey•Mountainous North •Population: 150.000•Internally displaced•Frequent bombing
•OCB: Field hospital with surgical center
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Emergency surgeryessential
requirements
Infrastructure
& Electricity
Water & Sanitation
Infection control
Waste management
Sterilisation
Blood transfusion
Supply
Human resources
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….to chicken farm
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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)
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Violent trauma cases (by week)
Evacuation
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Indications for surgery
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Type of surgery
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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%)
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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.
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Compressed Humanitarian space Clandestine Cave Chicken farm Several evacuations Kidnapping Project closure
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Thank you