Surgical Care of Pediatric Patients in the Humanitarian Setting

Abstract

When examining surgical interventions in a population of pediatric patients cared for in the specialized setting of humanitarian aid and conflict zones, burns, other accidental injuries, and infection composed the bulk of indications in the preteen group; interventions in the teenage group were principally caused by trauma-related injuries. Crude perioperative case mortality rates in the preteen group were significantly lower than in the adult group. Further work is needed to examine long-term outcomes of pediatric operations in these settings and to guide context-specific surgical program development.

Anaesthesia care providers employed in humanitarian settings by Médecins Sans Frontières: a retrospective observational study of 173 084 surgical cases over 10 years

“…In this study, we report briefly on intraoperative mortality. Rates are comparable across the different lead providers and similar to other observational data from LMICs17–21 and some humanitarian organisations (including other MSF operational centres),4 22 23 while higher than other humanitarian organisations 24 25. Such data must be interpreted cautiously as they should ideally be adjusted more fully for case-mix and severity.…”

“…There is an increasing body of literature outlining the surgical needs of populations in humanitarian settings 3–6. The recognition that the humanitarian sector is not immune from the need to demonstrate safe surgical care has led to calls for more robust outcome data and clearer accountability 7–9.…”

Global surgery for paediatric casualties in armed conflict

“…In conflict, the paediatric workload in military hospitals is 6% of all patients[5–10], and an even greater portion of paediatric patients (18%) is treated in humanitarian hospitals [11, 12]. Additionally, the percentage of paediatric patients is markedly higher among the surgical patient population in military hospitals (16%) [13, 14] as well as in humanitarian efforts (30%) [15–19], which again emphasizes that war-wounded children demand extensive care and resources [5, 8–10, 13, 20–24]. Additionally, younger age (≤ 8 years) has been independently associated with mortality in trauma patients admitted to combat support hospitals in Iraq and Afghanistan [9, 10, 22].…”

Surgical Outreach for Children by International Humanitarian Organizations: A Review

“…In crisis situations, an important proportion of their services are directed toward children. An analysis of surgical care delivered at MSF facilities in 21 countries showed that 21% of patients were younger than 18 years old and concluded that the “aspiring humanitarian surgeon must consequently be familiar with the management of pediatric patients and be comfortable with performing common pediatric surgical procedures” [ 18 , 19 ]. An example of disaster relief provided not by international non-governmental organizations but by a national government is the US Naval Ship Comfort, which provided surgical care to 237 pediatric patients over 37 days after the January, 2010, earthquake in Haiti [ 20 ].…”