Severe War Injuries Research Articles

Analyzing the Capacity of the Healthcare System in Gaza to Address Gaza Residents Needs

The present humanitarian crisis in Gaza has resulted in the devastation of medical facilities and health infrastructure. As of January 2024, the World Health Organization reports that 78% of primary care clinics funded by the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA, 2024) have ceased operations, and hospitals’ bed capacity throughout Gaza has decreased by more than 59% (World Health Organization, 2024). Direct military attacks on medical facilities as well as the blockade of medical supplies and humanitarian aid pose the largest obstacles to greater healthcare attainment in Gaza (IRC, 2024). Over the course of the conflict, there has been a surge in the number of people suffering from war injuries, which now totals 71,377 (Shurafa, 2024). The rise in the number of patients who require access to medical services in combination with the limited hospital functionality in the Gaza Strip is putting a massive strain on their already limited healthcare system; before the over 6 month long duration of direct military attacks by the Israeli Defence Forces (IDF) on hospitals in Gaza, data indicated a maximum ratio of 1.55 hospital beds per 1000 individuals across the entire region of the Gaza Strip, while the ratio in the US is around 2.35 hospital beds per 1000 individuals (Taylor, 2024). The already poor living conditions of the demographic–most of whom are housed in temporary structures in severe weather conditions with a lack of access to food and water for sustenance or hygiene–signify a need for a more robust healthcare system. However, triage conditions prioritize treatment of the most severe war injuries, which has forced hospitals to abandon previously established vaccination projects and disease surveillance programs, leaving the remaining population to suffer from preventable diseases such as chickenpox, upper respiratory infections, scabies, and Hepatitis A (Soni, 2024). Individuals who do receive medical care face higher levels of infection due to a lack of adequate sanitation, waste management measures, and basic hygiene supplies (The Economist, 2024).

Approaches to surgical treatment and antibacterial therapy in patients with chronic infection after war injuries

Fracture-related infection following orthopedic surgery, especially in cases of war-related trauma, represents a grave complication. The injuries sustained in war often entail severe damage to soft tissues, including significant impairment of vessels, nerves, tendons, muscles, and result in substantial bone defects. Complicating matters further, these infections often involve multidrug-resistant pathogens, making effective treatment a significant challenge. Optimal management of patients with combat-related trauma and signs of infection necessitates specialized care in dedicated centers. The approach to treatment should be guided by a well-defined algorithm that incorporates appropriate surgical interventions alongside systemic and localized antibiotic administration. In instances where chronic infection manifests after war-related injuries and specific causative agents are not definitively identified, initiating empiric therapy is advisable. A combination of meropenem, colistin, and vancomycin can be a suitable choice for initial treatment. Subsequently, once the causative microbes are identified, targeted treatment can be prescribed based on the susceptibility patterns. This article delves into the primary pathogens commonly found in war-related wounds and provides effective antibiotic regimens based on the specific microorganisms. One promising approach for managing severe war injuries is suppressive antibiotic therapy, which enhances the prospects of successful treatment. The comprehensive strategy outlinedhere aims to mitigate the serious risks posed by fracture-related infections in the context of war-induced trauma, ultimately improving patient outcomes and prognosis.

Wives for the Wounded: Marriage Mediation for Japanese Disabled Veterans during World War II

Abstract Japan’s armed invasion of China in July 1937 catalyzed the creation of new welfare services for the rapidly escalating number of Japanese disabled veterans. Among those reforms was the emergence of public and private marriage mediation services that aimed to introduce potential brides to disabled veterans and create independent households for men with severe war injuries. Acting through the Greater Japan Disabled Veterans Association and Patriotic Women’s Association, the Japanese state established formal procedures for arranging such marriages. Concurrently, private matchmakers created marriage mediation services expressly for disabled veterans. Public and private marriage mediation efforts sought the multifaceted rehabilitation of disabled veterans and contributed to total war mobilization on the Japanese home front. In the process, wartime marriage mediation for disabled veterans reinforced contemporary social customs and gender norms by positioning women within married households to support their husbands. However, women possessed an extraordinary degree of personal agency because their consent was needed to produce marriages intended to benefit wounded servicemen and the war effort. This essay examines the origins of marriage mediation services for Japanese disabled veterans as well as popular wartime depictions of such endeavors and their female participants.

Functional limb salvage in severe war injuries to limbs

High-velocity weapons usually result in a great amount of tissue damage and represent a surgical challenge. We analyzed the results of the treatment of patients after severe war injuries to the limbs (limbs at risk), in whom functional restoration of the limbs was performed. Eighteen patients with severe high-energy limb fractures after blast injuries and high-velocity gunshots were treated from 1993 to 2006. Soft-tissue debridement followed by axial realigning and fracture stabilization using tubular external fixators was performed on admission day in most of the patients. The primary tubular fixators were exchanged 5–7 days later for minimally invasive methods of definitive skeletal fixation (mostly Ilizarov frames), and soft-tissue coverage using delayed primary sutures, skin grafts or flaps was accomplished. Post-traumatic bone defects in three patients were treated by gradual bone transport in the Ilizarov frames. The injured limbs were preserved in all the treated patients and most returned to active lives. Staged treatment including primary temporary unilateral tubular stabilization performed in damage control procedures followed by definitive minimally invasive fracture fixation methods was found to be an effective tool in the management of patients suffering from severe tissue damage due to high-energy war injuries, including limbs at risk.

A.369 Administration of hypertonic saline–dextran solutions for hospital treatment of severe war injuries

A.369 Administration of hypertonic saline–dextran solutions for hospital treatment of severe war injuries

Prevention of tongue prolapse by immediate stabilization in severely avulsed mandibular war injuries

A significantly successful procedure for tongue stabilization, used in six cases of severe war injuries to the mandible, which prevents the serious complications of tongue prolapse, is here presented. The procedure consists of a the insertion of horseshoe-shaped Kirschner wire, the ends of which are fixed to the posterior mandibular segments, thus acting as a scaffolding for the lacerated soft tissues of the anterior two-thirds of the tongue, floor of the mouth and the submandibular region. This technique provides an acceptable appearance and assists feeding, reduces dribbling and dryness of the tongue, limits the likelihood of infection of the soft tissues of the floor of the mouth with subsequent contracture, affords scaffolding for the soft tissues, foundation for bone grafts, and permits greater freedom in augmenting the vermilion of the lower lip.

Salah Eddin external fixation system: a bone slider and compressor.

This study involves 65 patients with severe war injuries to the extremities where all conventional and available lines of treatment have failed or a decision of amputation has been made. Twelve humeri, 45 tibiae and eight femura were studied. The sliding system was used on 39 patients and the compressor system on 26 patients. In the sliding system, gaps ranged from 2 cm to 12 cm. In the compressor system established nonunion, failed bone graft operations, infected pseudarthrosis and gaps less than 2 cm were studied. Salah Eddin external fixation systems, both sliding and compressor, were found to be efficient, biomechanically adequate, easy to apply and remove and able to replace considerable gaps with no risks of open surgery.

Dorsal silicone rods in the primary care of war injuries

During armed combat serious hand injuries are often neglected only to receive the attention they deserve far too late. The authors have employed a vigorous approach to the primary care of severe war injuries to dorsum of the hand introducing silicone rods where extensor tendons have been destroyed and where skin closure is obtained using inguinal skin flaps.