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World J Surg. 2016 Nov;40(11):2628-2634.

Global Estimation of Surgical Procedures Needed for Forcibly Displaced Persons.

Author information

1
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. yzha1@jhu.edu.
2
University of California, Irvine School of Medicine, Irvine, CA, USA. yzha1@jhu.edu.
3
Department of Surgery, University of Washington, Seattle, WA, USA.
4
School of Medical Sciences, Kwame Nkrumah University, Kumasi, Ghana.
5
Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa.
6
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
7
Department of Surgery, University of Southern California, Los Angeles, CA, USA.
8
Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
9
Military Deputy, Combat Casualty Care Research Program, Fort Detrick, MD, USA.
10
Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, NY, USA.
11
Department of Surgery, State University of New York at Buffalo, Buffalo,  NY, USA.
12
Department of Gynecology & Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA.
13
University of California, Irvine School of Medicine, Irvine, CA, USA.
14
Department of Surgery, Columbia University, New York, NY, USA.
15
Surgeons OverSeas, New York, NY, USA.

Abstract

INTRODUCTION:

Sixty million people were displaced from their homes due to conflict, persecution, or human rights violations at the end of 2014. This vulnerable population bears a disproportionate burden of disease, much of which is surgically treatable. We sought to estimate the surgical needs for forcibly displaced persons globally to inform humanitarian assistance initiatives.

METHODS:

Data regarding forcibly displaced persons, including refugees, internally displaced persons (IDPs), and asylum seekers were extracted from United Nations databases. Using the minimum proposed surgical rate of 4669 procedures per 100,000 persons annually, global, regional, and country-specific estimates were calculated. The prevalence of pregnancy and obstetric complications were used to estimate obstetric surgical needs.

RESULTS:

At least 2.78 million surgical procedures (IQR 2.58-3.15 million) were needed for 59.5 million displaced persons. Of these, 1.06 million procedures were required in North Africa and the Middle East, representing an increase of 50 % from current unmet surgical need in the region. Host countries with the highest surgical burden for the displaced included Syria (388,000 procedures), Colombia (282,000 procedures), and Iraq (187,000). Between 4 and 10 % of required procedures were obstetric surgical procedures. Children aged <18 years made up 52 % of the displaced, portending a substantial demand for pediatric surgical care.

CONCLUSION:

Approximately three million procedures annually are required to meet the surgical needs of refugees, IDPs, and asylum seekers. Most displaced persons are hosted in countries with inadequate surgical care capacity. These figures should be considered when planning humanitarian assistance and targeted surgical capacity improvements.

PMID:
27225996
DOI:
10.1007/s00268-016-3579-x
[Indexed for MEDLINE]

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