Conducting Emergency War Surgery the casestudy of Syria

Conducting Emergency War Surgery: the casestudy 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: n n Preconditions to establish surgical activities within field hospital Types of surgical morbidity, surgical procedures performed and outcomes

Syria: 3 years of civil war n n Of 23 million Syrians q 7 million internally displaced q 2. 7 million refugees Deaths – > 150. 000 (vast majority civilians) 10 million in urgent need 250. 000 under siege

Contextual challenges n n Clandestine activities; q Not authorized by government q No registration in Turkey q Cross border activity Rapidly changing context q n n n Radicalization of the North Phases with HR difficulties Supply Distance support to unaccessible areas SECURITY

MSF activities

MSF OCB Jabal al-Akrad • • • Close to Turkey Mountainous North Population: 150. 000 Internally displaced Frequent bombing OCB: Field hospital with surgical center

Infrastructure & Electricity Human resources Supply Water & Sanitation Emergency surgery essential requirements Blood transfusion Infection control Waste management Sterilisation

…. to chicken farm Movie

RESULTS (Period: 5/09/12 – 1/1/2014) Total patients n Female n Civilians n Age in years, median (range) 578 248 381 25 (43%) (66%) (1 -90) Total Procedures n Operating theater occupancy in minutes per day, median (range) 712 120 (16 -790)

Violent trauma cases (by week) Evacuation

Indications for surgery

Type of surgery specialized surgery 8% visceral surgery 14% minor wound 51% Caesarean section 21% other 5%

Operation Theatre Mortality Total patients Intra-operative mortality • • 578 4 (0. 6%) Multiple severe blast trauma Hip fracture Lung laceration Vena-cava tear Total No newborns • Stillbirths 1 1 154 6 (4%) 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

Conclusions n n n 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.

Compressed Humanitarian space n n n Clandestine Cave Chicken farm Several evacuations Kidnapping Project closure

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