M. W. El Hechi1, J. M. Khalifeh2, E. P. Ramly3,4, J. Abed Elahad1, A. I. Eid1, A. Bonde1, G. Velmahos1, J. Hoballah5, H. Kaafarani1 1Massachusetts General Hospital,Department Of Surgery,Boston, MA, USA 2Washington University,School Of Medicine,St. Louis, MO, USA 3New York University School Of Medicine,Hansjörg Wyss Department Of Plastic Surgery,New York, NY, USA 4Oregon Health And Science University,Department Of Surgery,Portland, OR, USA 5American University of Beirut Medical Center,Department Of General Surgery,Beirut, Lebanon
Introduction:
Lebanon, a country of 6 million people, hosts approximately one million Syrian refugees registered with the United Nations High Commissioner for Refugees (UNHCR). The UNHCR contracts with select hospitals throughout the country to facilitate the provision of affordable and accessible basic primary health and emergency care to refugees. We aimed to assess the surgical capabilities of UNHCR-covered hospitals in Lebanon.
Methods:
Cross-sectional data from the Surgical Capacity in Areas with Refugees (SCAR) study were combined with hospital affiliation data directly obtained from the UNHCR. The SCAR study evaluated surgical capacity in Lebanon by mapping all acute care hospitals in the country and administering the validated five domain Personnel, Infrastructure, Procedures, Equipment, and Supplies (PIPES) tool to each hospital. Surgical capacity, specifically overall and domain-specific PIPES indices and mean numbers of surgeons, anesthesiologists, and hospital beds, were compared between UNHCR affiliated and non-affiliated hospitals. In an effort to understand regional disparities, the geographic distribution of UNHCR-affiliated hospitals was cross-referenced with refugee population distributions across the country.
Results:
A total of 129 hospitals were included and the PIPES tool was successfully administered in all hospitals (100%) between 2014 and 2017. Out of the 35 hospitals affiliated with the UNHCR, 43% were public, while 57% were operated privately. The mean overall and domain-specific PIPES indices and the mean number of hospital beds were similar between the UNHCR affiliated and non-affiliated hospitals (Figure 1). The mean numbers of general surgeons and anesthesiologists per hospital were also similar between the two groups (7.94 vs. 7.52, p=0.64; 3.86 vs. 4.05, p=0.68, respectively). Upon geographical mapping of hospital coordinates and refugee populations across Lebanon, the greatest disparity was found in the Northeastern region of the country (Baalbeck-Hermel): that region had the highest number of refugees but lacked any UNHCR-coverage.
Conclusion:
Hospitals covered by the UNHCR performed similarly to non-affiliated hospitals with respect to all aspects of the PIPES surgical capacity tool. However, there is a concerning geographic mismatch between UNHCR hospital coverage and refugee density, specifically in the underserved Northeastern region of Lebanon.
