The Complexities of Managing Surgical Disease in Refugee & Vulnerable Populations.
A little girl with her father at the patient screening at Zheen International Hospital, Erbil. June 2024.
Surgical disease is any intervention, which requires some form of localized procedure such as surgery or any other invasive technique. Managing surgical disease in refugee and vulnerable populations can present a complex array of challenges including medical, logistical, resource and socio-economic.
Swisscross and its global specialists have a deep history in working with refugee, displaced and vulnerable populations across low-and-middle-income countries (LMICs), many of which have faced war, conflict and climate crisis.
In the years of providing care and treatment, Swisscross has observed that the global burden of surgical disease has increased and it is a significant public health issue. This burden has disproportionately affected persons with lack of access to specialists, availability of surgery in their communities and those unable to afford sometimes life-changing interventions. Many of the challenges are linked and need a holistic approach by humanitarian actors to address them.
SOME OF THE CHALLENGES OBSERVED
Swisscross on a visit to Kawergosk Refugee Camp in Falahat, Iraq, where the majority of refugees are from Syria. September 2023.
1. Resource Limitations
Lack of Infrastructure & Equipment: Many persons affected by war and conflict including refugees and IDPs often lack the necessary infrastructure for performing surgeries, including functioning and sterile operating rooms. You also find a lack of essential surgical tools, medications, and post-operative care supplies, which are often scarce and expensive.
Limited Personnel: There is frequently a shortage of trained surgeons, anesthetists, and supporting medical staff in LMICs and especially across conflict and fragile settings - where many medical professionals have also left due to safetyee.
2. Access to Care
Geographic Barriers: Refugees and vulnerable persons may be in remote or inaccessible locations, making it difficult to transport patients to and from medical facilities.
Security Issues: Ongoing conflict or instability can pose significant risks for both patients and healthcare providers.
3. Pre-existing Health Conditions
Chronic Illnesses: Many refugee and displaced persons suffer from chronic and neglected conditions including infection and post cancer treatments, such as breast reconstruction which need surgical interventions.
Malnutrition and Infection: Poor nutritional status and high rates of infectious diseases can increase surgical risks and slow recovery.
4. Psychological Trauma
Mental Health Issues: Refugees often experience high levels of psychological trauma and stress, which can affect their overall health and complicate surgical care.
Trust Issues: Past experiences with violence or inadequate healthcare can lead to mistrust of medical services. To build trust it is important to work with local healthcare professionals to navigate communication, language and cultural sensitivities.
5. Funding and Sustainability
Limited Funding: Humanitarian aid for surgical care is often unmet and insufficient. Funding can be unpredictable, affecting the availability and continuity of services for thousands of people in need.
Sustainability Concerns: Establishing and maintaining surgical programs in refugee settings require long-term commitment, resource allocation and collaborative approaches with local and international actors.
6. Follow-Up and Rehabilitation
Continuity of Care: Ensuring consistent follow-up and post-operative care can be difficult, especially if refugees are mobile, relocated frequently or unable/afford to travel to clinics and hospitals.
Rehabilitation Services: Access to rehabilitation and physical therapy is often limited, which can impact recovery and long-term outcomes.
Swisscross training session with residents at Rizgary Teaching Hospital. November 2023.
HOW SWISSCROSS IS MEETING THE CHALLENGES
To effectively manage surgical disease in refugee and vulnerable populations, Swisscross believes comprehensive strategies are needed, which bring many sides together with the ultimate goal - to provide the best surgical interventions to the most vulnerable and in need
Strengthening Infrastructure: We are investing in building up and equipping Zheen International Hospital in Erbil, working closely with local actors, healthcare professionals from across Iraq, so together we can share the burden and provide surgery to patients.
Training and Support: Swisscross works with a team of global specialists and experts in the field of surgery, who are not only a part of humanitarian surgical missions in Iraq, but provide local healthcare workers, medical students and universities with training and mentorship with the aim to impart knowledge and strengthen medicine in the country.
Transport to Swisscross Clinics: Working closely with local government and local NGOs, we have been able to get patients to our complex care program in Erbil from remote or underserved areas.
Technology: In 2022, Swisscross rolled-out the Electronic Triage Tool - a multi-language, scalable application that allows healthcare workers to send details for patient referrals and triaging. The app has allowed our partners in the field to refer thousands of patients in a secure and efficient manner.
Cultural Competence: Working with local medical professionals and hiring two local doctors in Erbil has allowed us to breakthrough cultural sensitivities and improve communication and trust with patients and partners.
Integrated Care: Wherever it is feasible, Swisscross ensures integrated approaches that combine surgical care with primary healthcare, and rehabilitation. Our integrated approaches understand that we have to work together with different organizations, with multifaceted skills to create the best outcomes for patients.
By addressing these challenges holistically, we can improve the surgical care available to refugees and vulnerable people to enhance their overall health outcomes.
In building the complex care program in Kurdistan, Iraq, Swisscross has set itself apart by understanding and integrating care for vulnerable populations which includes working closely with and collaborating with local healthcare actors and NGOs, strengthening healthcare infrastructure and training local healthcare providers to build up “a community of specialists” to treat and care for local and regional patients in need of surgery.
