Y. A. Zha1,2, E. Lee1,3, K. N. Remick4,5, D. H. Rothstein6,7, D. Guha-Sapir8, R. S. Groen9, D. K. Imagawa2, G. Burnham1, A. L. Kushner1,10,11 8Centre For Research On The Epidemiology Of Disasters – Université Catholique De Louvain,Brussels, , Belgium 9Johns Hopkins Hospital,Department Of Gynecology & Obstetrics,Baltimore, MD, USA 10Columbia University College Of Physicians And Surgeons,Department Of Surgery,New York, NY, USA 11Surgeons OverSeas,New York, NY, USA 1Johns Hopkins Bloomberg School Of Public Health,Department Of International Health,Baltimore, MD, USA 2University Of California – Irvine School Of Medicine,Department Of Surgery,Irvine, CA, USA 3University Of Southern California,Department Of Surgery,Los Angeles, CA, USA 4Uniformed Services University Of The Health Sciences,Department Of Surgery,Bethesda, MD, USA 5Combat Casualty Care Research Program,Ft. Detrick, MD, USA 6Women And Children’s Hospital Of Buffalo,Department Of Pediatric Surgery,Buffalo, NY, USA 7State University Of New York At Buffalo,Department Of Surgery,Buffalo, NY, USA
Introduction:
According to United Nations High Commissioner for Refugees (UNHCR), 59.5 million people worldwide were displaced from their homes due to conflict, persecution, violence, and human rights violations at the end of 2014. This vulnerable population suffers from poor health conditions, many of which are surgically treatable. The recently released Lancet Commission on Global Surgery proposed a target capacity of 5,000 operations per 100,000 people annually by 2030 to meet the demands of the global burden of surgical disease. Based on this value, we sought to estimate the minimum surgical needs of refugees, internally displaced persons (IDPs), and asylum seekers.
Methods:
Using the UNHCR database, the numbers of refugees, IDPs, and asylum seekers at the end of 2014 were identified. Data on the age and gender distribution of this population were also recorded. The numbers of displaced persons were categorized by the top countries of residence. Using the proposed annual minimum target of 5,000 operations per 100,000 population, the numbers of major surgical procedures needed per year were calculated.
Results:
For the 59.5 million displaced persons, we calculated that at least 2.98 million operations are needed each year. The minimum numbers of surgeries required per year for the countries with the largest populations of displaced individuals include: Syria (397,000 surgeries), Colombia (302,000 surgeries), Iraq (201,000 surgeries), Democratic Republic of Congo (181,000 surgeries), and Pakistan (148,000 surgeries). The numbers of displaced persons and estimated operations needed annually by category are shown in Table 1. Gender distribution for displaced individuals shows a nearly equal breakdown of males (50.2%) and females (49.8%). Additionally, 51% of refugees were children (age less than 18 years).
Conclusion:
An estimated minimum of nearly 3 million operations are required each year to meet the large surgical needs of refugees, IDPs, and asylum seekers. Obstetrical/gynecological and pediatric surgical expertise will likely be in high demand due to the large proportion of women and children among those displaced. Most displaced persons are hosted in countries with inadequate healthcare infrastructure and where surgical care is likely to fall short of the need. We recommend governments and non-governmental organizations consider these figures when providing humanitarian assistance and allocating resources. In addition, including surgical need with data collected on displaced persons can help the implementation, monitoring, and evaluation of humanitarian surgery programs.
