World's forcibly displaced people need millions of surgeries each year

In 2014 alone, the nearly 60 million refugees, internally displaced persons and asylum seekers in the world needed nearly 3 million surgeries, according to a new analysis.

Over a third of those procedures were needed by forcibly displaced people in North Africa and the Middle East, where many health systems are already strained.

Surgical needs in this population are often not considered, the senior author told Reuters Health. "We know the refugee populations are going to develop pneumonia, need vaccinations and develop diarrhea because there is risk of cholera in the camps, but you don’t often hear about the surgical component," said Dr. Adam Kushner, of the Johns Hopkins Bloomberg School of Public Health in Baltimore.

"This needs to be part of the conversation," he said. The United Nations High Commissioner for Refugees (UNHCR) reported that 59.5 million people around the world were living as forcibly displaced people in 2014. That includes refugees, people forced to flee to other parts of their country and people seeking asylum in another country.

The number of forcibly displaced people continues to increase, the research team said May 25 in the World Journal of Surgery. An estimated 218,000 people entered Europe by sea just in October 2015, which is equal to the number of people who entered the continent by sea for all of 2014.

Understanding the surgical needs of forcibly displaced people can help inform planning, resource allocation and improvements in healthcare systems, Kushner and colleagues write. Using UNHCR data on forcibly displaced people, the researchers estimated the number of surgeries that would be needed by people in the various sub-populations.

An estimated 38.2 million people were internally displaced, that is, they were forced to flee to another area of the country. There were also an estimated 19.5 million refugees and 1.8 million asylum seekers.

More than half of forcibly displaced people in 2014 were under age 18, and almost all were under 60. Previous research suggests that for every 100,000 people, countries can expect to perform about 4,669 surgeries, Kushner said, although the number varies by country.

Overall, an estimated 2.78 million surgical procedures would have been needed for all forcibly displaced people in 2014. "It doesn’t include just simple suturing or simple burn care or splinting of fractures, which doesn’t need a formal operation," said Kushner.

Internally displaced people needed the largest proportion of surgeries: an estimated 1.78 million procedures. They were followed by refugees, who needed an estimated 910,000 surgeries. Asylum seekers were estimated to need 84,000 surgeries.

The largest number of procedures was required in North Africa and the Middle East, in Syria, Colombia, Iraq, Pakistan and the Democratic Republic of the Congo.

While the new study can't say what procedures were most needed, the researchers estimate that about 7 percent of all procedures were obstetric surgeries. Those include treatments for protracted labor, preeclampsia and ectopic pregnancy.

Past research from one refugee camp suggests emergency general surgeries are most common. Those include surgeries for hernias, chronic bone inflammation and growths on the uterus.

While a lot of people view surgery as being complex, Kushner said, "there is really a lot that can be done that’s low cost and effective that is simple to do and simple to teach."

"The more we try to address this situation the more we can prevent disability and death," he said.