Surgical Needs at the End of the Battle of Mosul: Results from Mosul General Hospital

Abstract

Purpose The aim of the study was to analyze the surgical needs of patients seeking emergency care at the Mosul General Hospital in the final phase of the battle of Mosul in northern Iraq between an international military coalition and rebel forces. During the conflict, the International Red Committee of the Red Cross (ICRC) supported the hospital with staff and resources. Ceasefire in the conflict was declared at the end of July 2017. Methods Routinely collected hospital data from the ICRC-supported Mosul General Hospital from June 6, 2017, to October 1, 2017 were collected and analyzed retrospectively. All patients with weapon-related injuries as well as all patients with other types of injuries or acute surgical illness were included. Results Some 265 patients were admitted during the study period. Non-weapon-related conditions were more common than weapon-related (55.1%). The most common non-weapon-related condition was appendicitis followed by hernia and soft tissue wounds. Blast/fragment was the most frequent weapon-related injury mechanism followed by gunshot. The most commonly injured body regions were chest and abdomen. Children accounted for 35.3% of all weapon-related injuries. Patients presented at the hospital with weapon-related injuries more than 2 months after the official declaration of ceasefire. A majority of the non-weapon-related, as well as the weapon-related conditions, needed surgery (88.1% and 87.6%, respectively). Few postoperative complications were reported. Conclusions The number of children affected by the fighting seems to be higher in this cohort compared to previous reports. Even several months after the fighting officially ceased, patients with weapon-related injuries were presenting. Everyday illnesses or non-weapon-related injuries dominated. This finding underlines the importance of providing victims of conflicts with surgery for life-threatening conditions, whether weapon related or not.

Exploratory laparotomy during the battle of Mosul, 2016–2017: results from a tertiary civilian hospital in Erbil, Iraqi Kurdistan

“…The small number of patients with abdominal injuries requiring surgical intervention makes it difficult to generalize the results from this study. The findings in regards to patient characteristics and injury patterns are however similar to those found in previous studies of the same conflict [ 6 , 14 , 28 ]. Additionally, the overall rates of abdominal injury within our population are similar to reports from the International Committee of the Red Cross regarding burden of abdominal injury at their various conflict-affiliated hospitals [ 5 ].…”

“…The impact of the trauma pathway as suggested by the WHO is difficult to assess. Our demographic data are similar to data from all patients presenting to Mosul General Hospital, one of the field hospitals in the conflict [ 27 , 28 ]. Additionally, many patients in our study were transferred directly from TSPs to EMC, thus bypassing the field hospitals.…”

Exploratory Laparotomy During the Battle of Mosul, 2016–2017: Results from a Tertiary Civilian Hospital in Erbil, Iraqi Kurdistan

“…The small number of patients with abdominal injuries requiring surgical intervention makes it di cult to generalize the results from this study. The ndings in regards to patient characteristics and injury patterns are however similar to those found in previous studies of the same con ict (5,14,27). Additionally, the overall rates of abdominal injury within our population are similar to reports from the International Committee of the Red Cross regarding burden of abdominal injury at their various con ict-a liated hospitals (6).…”

“…The impact of the trauma pathway as suggested by the WHO is di cult to assess. Our demographic data are similar to data from all patients presenting to Mosul General Hospital, one of the eld hospitals in the con ict (26,27). Additionally, many patients in our study were transferred directly from TSPs to EMC, thus bypassing the eld hospitals.…”

“…Median ISS was 13 (IQR 9-18) and median NISS was 18 (IQR [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. The mean difference between ISS and NISS for individual patients was 7.3 (p<0.001).…”