As of the end of 2017, 68.5 million people worldwide had been forcibly displaced from their homes largely as a result of conflict or violence. Of these people, 25.4 million people were refugees and the remaining 43.1 million people were internally displaced people1. These are numbers that are growing at an alarming rate (estimated at 1 person every 2 seconds). As a result of their statelessness refugees are typically denied rights to education, employment, mobility and, arguably most importantly, healthcare.
To further compound the issue of the rising number of forcibly displaced persons worldwide, the WHO also estimates that 86% of those that are forcibly displaced are hosted in developing countries2. Two significant examples of this estimate are the crises in South Sudan and Syria. In Syria, 12 million people had been forcibly displaced by the end of 2016 (more than half the country’s population) with the majority of refugees fleeing to Lebanon, Turkey and Jordan. Whereas in South Sudan (the fastest growing refugee crisis globally), 3.3 million people have been forcibly displaced since the end of 2013 with the majority of refugees fleeing to Uganda1.
With such a large proportion of refugees migrating to developing countries this situation then adds further strain on healthcare systems that are already under resourced and lacking in infrastructure. This means that for those that require healthcare provision on a tertiary level, particularly with regards to surgical procedures, their chances of receiving such healthcare are almost impossible.
In 2016, a study conducted at the John Hopkins Bloomberg School of Public Health3 was designed to highlight the surgical need of refugees worldwide. Using the minimum proposed surgical rate of 4669 procedures per 100000 people annually they calculated that, over that year, 2.78 million surgical procedures were needed. To fully appreciate the extent of this problem it is also worth noting that despite the fact that the number of refugees keeps rising, these figures are only based on recorded refugees. This figure, therefore, is likely to represent a minimum number of necessary procedures.
These statistics are mirrored by the targets set by the Lancet Commission on global surgery4 whereby it is stated that we should aim for 5000 procedures per 100000 population annually by 2030. Data compiled by the World Bank in 20135 showed that only 62 of 183 countries were meeting this target, of which more than 80% were developed countries. More significantly LMICs were averaging 2296 procedures per 100000 population annually, less than half of the target set by the Lancet Commission on global surgery. If we are going to be able to reach these targets in the areas most affected by forcibly displaced refugees then we will need a significant overhaul with regards to surgical workforce, access, resources, infrastructure and education in developing countries. A notion that is also supported by the UN Sustainable Development Goal 3 which states that we should aim to “achieve universal health coverage, including financial risk protection, access to quality essential health-care services” by 20306.
Given the statistics quoted and the rate at which these numbers are increasing there is a sense of urgency within which we need to intervene. To provide equitable surgical care at the rate specified by the Lancet Commission within the next 11 years is a significant challenge. If we are to attempt to combat this issue it is vitally important that national healthcare systems and humanitarian organisations specifically incorporate surgical care within their funding models, resource allocation and allotted workforce schemes.
Simon Lambracos
References:
3. “Global Estimation of Surgical Procedures Needed for Forcibly Displaced Persons.” Zha Y et al. World J Surg. 2016 Nov;40(11):2628-2634.
4. The Lancet Commission on Global Surgery 2030
5. https://time.graphics/statistic/wb115196
6. UN Sustainable Development Goals