Humanitarian Surgery Initiative

• Health systems in low resource settings are characteristically weakened, rendering them extremely vulnerable when a humanitarian crisis or major disaster occurs.
• A significant proportion of the health needs faced by vulnerable communities in low resource settings require emergency surgical (limb and life-saving) intervention. For example, UNOCHA reported that in 2020, over 10 million women and young people received life-saving sexual and reproductive health care and services to address gender-based violence and 2,412 health facilities in 52 countries provided emergency obstetric care*.
• Traditionally, the delivery of the ‘humanitarian surgical response’ in low resource settings has been through the recruitment and deployment of surgeons and surgical care teams from other countries, mainly as volunteers.
• Surgeons trained and working in high-income countries are becoming more specialised and technology-dependent. This has resulted in skills and knowledge gaps between their training, experience and the burden of injuries they treat in low resource settings. Dedicated training courses have been developed to upgrade the skills of surgical care teams willing to assist in humanitarian relief operations, but they are few, heavily dependent on face-to-face training and very expensive.
• There are questions about access to on-going learning and the continuing professional development of the surgical humanitarian workforce after their initial training and in-between deployments/ missions.
• As the unmet surgical need in low resource humanitarian settings continues to grow, the capacity to meet those needs has become constrained and exacerbated, not only by the recent challenges presented by Covid-19 on international mobility, but also by the lack of in-country surgical capacity at local, national and regional levels.
• Our knowledge and understanding of the global burden of surgically treatable conditions during humanitarian crises is hampered by a lack of systematic data collection and research in humanitarian surgery.

This collaboration aims to:

• Increase our understanding of the training and capacity development needs of the humanitarian surgery and surgical care sector.
• Scope the current use of existing digital platforms and technology in delivering surgical training and online learning in low resource settings.
• Assess the opportunities and challenges of introducing technology-enabled training as a sustainable solution for strengthening the humanitarian surgical capacity and preparedness of local and national staff in low resource settings.
• Identify, support and pilot novel ways to deliver high standards of training and capacity strengthening, with an emphasis on approaches already being utilised in low resource humanitarian settings for national and local health personnel.
• Identify and/or design innovative solutions for the systematic collection of data and the implementation of research in humanitarian surgery to inform learning and contribute to the collection of global surgery indicators.
• Make recommendations and develop an action plan based on the findings of this study.
• Establish a broad-based network/coalition focused on training, standards and capacity building in humanitarian surgery and surgical care.

• Medécins Sans Frontiers (MSF)
• Global Surgery Policy Unit (GSPU), London School of Economics & Political Science (LSE)
• Humanitarian and Conflict Response Institute (HCRI)

We want to engage with all parts of the humanitarian, global health, training and technology sectors in relation to this collaboration. We particularly welcome contributions and views from:

• Those with experience of delivering surgical care in humanitarian surge situations or austere environments. Surgery does not take place in a vacuum and the role of the surgical care team is vital. We are seeking contributions and insights from surgeons, nurses, anaesthetists/ anaesthesiologists, haematologists/ transfusion specialists, midwives, obstetricians and physicians.
  
• Trainers and training course providers. Those involved in designing or delivering courses, workshops and programmes that include a focus on knowledge and skills transfer on aspects of humanitarian surgical care. We also want to understand how far local postgraduate training programmes in low resource settings are able to prepare the health workforce in mobilising an adequate surgical response when a humanitarian situation occurs.
• Those who have attended or participated in courses, workshops and training events. We want to understand how useful, accessible and relevant humanitarian surgery-related training has been and whether participants have been able to apply their learning to real humanitarian situations.
• Diaspora health professionals who have migrated from countries affected by war, conflict, climate change, natural disasters and epidemics. We are keen to involve diaspora health professionals and organisations in this work as we want to understand how migration from low resource settings to other countries has impacted the resilience and recovery of the health systems and workforce in their ‘home’ countries. We would also like to develop a better understanding of the role that diaspora health professionals play in establishing sustainable models for building local humanitarian response preparedness and capacity. We are particularly interested in hearing from those who have sought or obtained refugee or asylum status in another country.
• Technology providers, online and digital platforms. This collaboration aims to identify and evaluate the use of existing digital platforms and technology being used to deliver surgical training, data collection and capacity development. How might these be used before, during and after humanitarian events?

We are adopting a broad and inclusive approach to this study. Our collaboration focuses on surgery as the starting point, but our approach seeks to engage wider surgical care stakeholders, medical specialties and interest groups.

Seven fully-funded innovation fellowships have been established to support this collaboration. 

Our Innovation Fellows played an integral role in this collaboration, worked with stakeholders, supported and contributed to the substantive development and implementation of the programme as well as carried out their own research, and shared their findings as part of the collaboration’s outputs, policy, and communications efforts.