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Conducting Emergency War Surgery: the case-study of Syria

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:

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Conducting Emergency War Surgery: the case-study of Syria

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  1. 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

  2. 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

  3. 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

  4. 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

  5. MSF activities

  6. MSF OCB Jabal al-Akrad • Close to Turkey • Mountainous North • Population: 150.000 • Internally displaced • Frequent bombing • OCB: Field hospital with surgical center

  7. Infrastructure & Electricity Emergency surgeryessential requirements Human resources Water & Sanitation Supply Infection control Blood transfusion Waste management Sterilisation

  8. ….to chicken farm Movie

  9. RESULTS(Period: 5/09/12 – 1/1/2014) Total patients 578 • Female 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)

  10. Violent trauma cases (by week) Evacuation

  11. Indications for surgery

  12. Type of surgery

  13. 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

  14. 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.

  15. Compressed Humanitarian space • Clandestine • Cave  Chicken farm • Several evacuations • Kidnapping • Project closure

  16. Thank you

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