Surgical Equity for the Forcibly Displaced

Every minute, 20 people are displaced due to humanitarian emergencies. Forced to flee their homes and everything they know, the displaced population is in a constant state of transience - typically characterized by uncertainty and dread. Their statelessness denies them the right to employment, mobility, and education, but most perilously, it denies them access to adequate health care. The deficit in health services for refugees is significant on the primary and secondary level, but the shortfall is principally felt on the tertiary level - meaning that access to basic health care is limited but access to surgical care is close to impossible.

According to a 2016 study conducted by the John Hopkins Bloomberg School of Public Health, we are currently facing the largest refugee crisis since the second World War. And within the crisis exists a devastating surgical shortfall. The study notes that at the end of 2014, 59.5 million people had been forced out of their homes due to humanitarian emergencies. At least 2.78 million
surgeries are needed annually for all the refugees worldwide - with children making up 52% of the demand. The study was the first of its kind to estimate the surgical needs of displaced persons, and only used the data of registered asylum seekers. As such, these numbers reflect the absolute minimum estimate of required surgeries. The actual sum is undoubtedly much more significant.

The target proposed by the Lancet Commission on Global Surgery states that the surgical volume should be 5,000 procedures per 100,000 population or higher. Only 15% of the world has met this target. The dismal percentage is reflective of the lack of surgical care globally, but also reflects the refugee population, whose surgical conditions are more often neglected than corrected. Refugees generally reside in countries with critically limited health care availability and, to add further difficulty, the first evacuated from conflict zones are generally the ill and injured. As such, the refugee population has a higher proportion of surgically disabled individuals and significantly lower chances of receiving the necessary referral or treatment. Thus, for refugees, the surgical shortfall is often felt two-fold and the unmet demand tragically culminates in unnecessary morbidity and premature mortality.

Despite the current shortfall, studies have demonstrated that the introduction of surgical care in refugee camps is both economically beneficial and realistically achievable. One such study, conducted in 2013 by Dan Poenaru and Victor K. Wu, examined the burden of surgically correctable disabilities among children in the Dadaab Refugee camp. By determining the cost-effectiveness ratio of the Disability Adjusted Life Years (DALYs) of each patient treated, divided by the aggregate cost of all surgical admissions, the study found the cost per surgically averted DALY to be $40 -$88. The values derived from the study reveal that surgery is both a “feasible and cost effective” intervention in refugee camps. Poenaru and Wu assert that this study, along with others conducted previously, reveal that surgical intervention often costs less in $/DALY than other medical treatments that are generally pursued within healthcare systems.

Refugee Stats II (2).png

Considering the high number of surgically neglected refugees and the feasibility of improving access to surgical care, there is no excuse for the perpetuation of surgical disability within the migrant population. Over the past two decades, the global population of forcibly displaced people has grown substantially from 33.9 million in 1997 to 65.6 million in 2016, and it remains at a record high. As such, it is increasingly important for national healthcare systems and humanitarian assistance organizations to include surgical care for refugees in their assistance planning, resource allocation, and strategic improvements. The void in tertiary care for displaced persons runs at a high cost. Without improvements to surgical capacity for this vulnerable population, lives will continue to be lost and destroyed.

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For further reading on the topic please refer to the two studies linked below:

Global Estimation of Surgical Procedures Needed for Forcibly Displaced Person:

https://www.ncbi.nlm.nih.gov/pubmed/27225996

Burden of surgically correctable disabilities among children in the Dadaab Refugee Camp.

https://www.ncbi.nlm.nih.gov/pubmed/23283220