Surgery in low‐income countries during crisis: experience at Médecins Sans Frontières facilities in 20 countries between 2008 and 2014

Abstract

The global burden of trauma and surgical conditions fall disproportionately on lowand middle-income countries (LMICs) [1, 2]. Inopportunely, developing countries are least equipped to provide essential surgical care [3]. As a result, LMICs have a significant burden of unmet surgical needs [4]. When these fragile health systems are disrupted by conflict, a natural disaster or an epidemic the capacity for and quality of surgical care decreases even further [5]. In response, M edecins Sans Fronti eres (MSF) provides surgical humanitarian assistance in countries affected by crisis through one of the five operation centres; one of these is Operations Centre Brussels (OCB). Describing the epidemiology of surgical care at MSFOCB projects improves planning for humanitarian assistance and provides a unique opportunity to examine surgical needs that were otherwise unmet by national healthcare systems [6]. From 2008 through 2014, MSFOCB performed 119 524 operations at 45 projects in 20 countries. The majority of operations were obstetric (range 28–42% of operations by year), general surgical (e.g. hernias, appendicitis; range 15–49%) and unintentional trauma-related (e.g. road traffic crash, burn; range 10– 42%). Violence was also a common cause of surgical need (e.g. land mine or bomb injury, gunshot wound; range 7– 15%) (Table 1). MSF-OCB teams provided safe anaesthesia, often by task sharing, in the face of complex care needs evidenced by low perioperative death rates (i.e. death from time of anaesthesia care to discharge from the recovery ward; 0.2–0.3% of operations). From 2008 through 2014, the orthopaedic care capacity was deliberately improved to meet the needs of conflict-related projects (Figure 1). This was done by developing fracture care guidelines for nonorthopaedists, as well as recruiting expatriate orthopaedic surgeons. More detailed operative epidemiology of these sites has been reported previously [6–8].