|Affiliation(s):||1Health Unit, ICRC, Geneva, Switzerland|
|Key messages:||1 – ‘If the patient cannot go to the hospital, the hospital goes to the patient’.
2 – In conflict situations, access to health care often implies innovative operations.
3 – Health care to war wounded persons opens the door to other humanitarian actions and protection to the population.
|Summary (max 100 words):||
Background: In some war contexts, the traditional approach of humanitarian assistance with support to established referral hospitals does not work and alternative solutions need to be identified. This has been the case for the ICRC support to war wounded patients in Darfur where distance, insecurity and costs of the health care prevented part of the population from accessing even basic health care. Based on previous experiences the ICRC has set up a mobile, light (400 kgs of equipment and supplies) surgical team of 4, able to deploy around the Darfur and operate independently on up to 30 patients in basic buildings or in the open, without laboratory, blood bank, x-ray unit, electricity and running water. The team, based in Nyala, city capital of Southern Darfur State is always ready to move by car, truck, airplane, helicopter. Results: during the last 3 years this team has treated more than 1200 patients, the majority in opposition controlled areas that would have no alternative hospital access. An analysis of the first 2 years of activity shows that 83% of patients were war wounded and penetrating central wounds were present in 9.4% of them. The team had 85 deployments with an average of 10 operations per mission (range 2-48). The role of the team has been defined as “critical” in 13% and “beneficial” in 75% of cases. The wounded have always been reached in less than 48 hours from the moment of call. The delay from injury to treatment has been of less than 24 hours in 26% of cases and between 1 day and 1 week in 43% of cases. In 10% it has been longer than 1 month. Strengths: patients from opposition controlled areas could access essential surgical care; ICRC independence and neutrality; ability to deploy almost everywhere and operate on patients even under a tent; flexibility, exit strategy made easier. Weaknesses: focus on war injuries; poor post-operative follow up, patients left in the hands of staff with only basic health education; costs. Opportunities: activity of the field surgical team has increased enormously the ICRC credibility among armed groups, opening doors to other ICRC activities like dissemination of humanitarian law, tracing of missing persons and protection of the population. Threats: security concerns related to working in a volatile environment; irregular level of activity with the team either bored or burn out; poor post-op follow up, which, in case of patients complications or mismanagement, may cause loss of confidence and blame on the team; difficulty to manage 2 calls at the same time.
|Conclusion (max 400 words):||
The mobile surgical team in Darfur provides access to emergency surgery to groups of population with no possible alternative. It is an approach to be considered when distance, insecurity, lack of access for tribal/group affiliation prevents patients’ access to established functioning hospitals.