Abstract
BackgroundPublished literature on surgical care in refugees tends to focus on the acute (‘emergent’) phase of crisis situations. Here we posit that there is a substantial burden of non-acute morbidity amenable to surgical intervention among refugees in the ‘chronic’ phase of crisis situations. We describe surgery for non-acute conditions undertaken at Mae La Refugee Camp, Thailand over a two year period.MethodsSurgery was performed by a general surgeon in a dedicated room of Mae La Refugee Camp over May 2005 to April 2007 with minimal instruments and staff. We obtained the equivalent costs for these procedures if they were done at the local Thai District General Hospital. We also acquired the list (and costs) of acute surgical referrals to the District General Hospital over September 2006 to December 2007.Results855 operations were performed on 847 patients in Mae La Refugee Camp (60.1% sterilizations, 13.3% ‘general surgery’, 5.6% ‘gynaecological surgery’, 17.4% ‘mass excisions’, 3.5% ‘other’). These procedures were worth 2,207,500 THB (75,683.33 USD) at costs quoted by the District General Hospital. Total cost encountered for these operations (including staff costs, consumables, anaesthesia and capital costs such as construction) equaled 1,280,000 THB (42,666 USD). Pertaining to acute surgical referrals to District General hospital: we estimate that 356,411.96 THB (11,880.40 USD) worth of operations over 14 months were potentially preventable if these cases had been operated at an earlier, non-acute state in Mae La Refugee Camp.ConclusionsA considerable burden of non-acute surgical morbidity exists in ‘chronic’ refugee situations. An in-house general surgical service is found to be cost-effective in relieving some of this burden and should be considered by policy makers as a viable intervention.
Highlights
Published literature on surgical care in refugees tends to focus on the acute (‘emergent’) phase of crisis situations
The published literature on surgery in refugee situations is concentrated on acute trauma in conflict situations [1,2,3,4] and reproductive health, the latter including female genital mutilation, refugee rights to abortion and family planning [5,6,7,8,9]
Health care in Mae La is provided by NonGovernmental Organisations (NGOs) – initially by Médecins Sans Frontières and subsequently by Aide Médicale Internationale (AMI)
Summary
Published literature on surgical care in refugees tends to focus on the acute (‘emergent’) phase of crisis situations. We posit that there is a substantial burden of non-acute morbidity amenable to surgical intervention among refugees in the ‘chronic’ phase of crisis situations. We describe surgery for non-acute conditions undertaken at Mae La Refugee Camp, Thailand over a two year period. The published literature on surgery in refugee situations is concentrated on acute trauma in conflict situations [1,2,3,4] and reproductive health, the latter including female genital mutilation, refugee rights to abortion and family planning [5,6,7,8,9]. The refugee situation in Mae La Camp is stable and the majority of morbidity is associated with infectious and chronic diseases; while war trauma and reproductive health problems exist, these are comparatively minor. One of the principle health issues is multi-drug resistant Plasmodium falciparum malaria – significant improvements in this area have been made due to both early detection and control with mefloquine and artesunate combination therapy [12]
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