Surgical Care for the Direct and Indirect Victims of Violence in the Eastern Democratic Republic Of Congo

Background:The provision of surgical assistance in conflict is often associated with care for victims of violence.However, there is an increasing appreciation that surgical care is needed for non-traumatic morbidities. In this paperwe report on surgical interventions carried out by Médecins sans Frontières in Masisi, North Kivu, Democratic Republicof Congo to contribute to the scarce evidence base on surgical needs in conflict.Methods: We analysed data on all surgical interventions done at Masisi district hospital between September 2007 andDecember 2009. Types of interventions are described, and logistic regression used to model associations withviolence-related injury.Results:2869 operations were performed on 2441 patients. Obstetric emergencies accounted for over half (675, 57%)of all surgical pathology and infections for another quarter (160, 14%). Trauma-related injuries accounted for only onequarter (681, 24%) of all interventions; among these, 363 (13%) were violence-related. Male gender (adjusted odds ratio(AOR) = 20.0, p < 0.001), military status (AOR = 4.1, p < 0.001), and age less than 20 years (AOR = 2.1, p < 0.001) wereassociated with violence-related injury. Immediate peri-operative mortality was 0.2%.Conclusions:In this study, most surgical interventions were unrelated to violent trauma and rather reflected thegeneral surgical needs of a low-income tropical country. Programs in conflict zones in low-income countries need tobe prepared to treat both the war-wounded and non-trauma related life-threatening surgical needs of the generalpopulation. Given the limited surgical workforce in these areas, training of local staff and task shifting is recommendedto support broad availability of essential surgical care. Further studies into the surgical needs of the population arewarranted, including population-based surveys, to improve program planning and resource allocation and theeffectiveness of the humanitarian response.