Strengthening of EMERGENCY Surgical Activity in Afghanistan

Project location: AFGHANISTAN, Kabul; Lashkar-gah; Anabah
Project start date: December 2014 - Project end date: December 2013
Project number: 2014-015
Beneficiary: Emergency ONG ONLUS


Since 1999, EMERGENCY has been active in Afghanistan and has built and managed a Surgical and Medical Centre and a Maternity Centre in the Panjshir Valley, a Surgical Centre in Kabul, a Surgical Centre in Lashkar-gah, a network of First Aid Posts and Health Centres, a programme of medical assistance to the inmates of the largest prisons in the country.
The country has been ravaged over 40 years of war which has caused one and a half million dead, hundreds of thousands of wounded and disabled, in addition to more than four million displaced people.The most recent war began in October 2001 but many civilians continue to suffer the consequence of the previous conflicts as the territory is scattered of landmines and unexploded devices.
EMERGENCY began working in Afghanistan in 1999 in the Panjshir Valley, controlled by the Northern Alliance at the time time, where has been opened the Surgical Centre for war victims in Anabah.
Over the years, the admission criteria were extended to include emergency surgery, trauma and elective surgery. Since 2003, with the opening of the paediatric and internal medicine wards, the Surgical Centre for war victims has become a General Hospital for the inhabitants of the Valley.
In April 2001, EMERGENCY opened a second Surgical Centre in Kabul, the capital city, controlled by Taliban at the time.
In 2002, following a Memorandum of Understanding signed with the local Ministry of Health, hospital services were extended from war surgery to emergency surgery and trauma. In August 2003, a 6 bed state-of-the-art reanimation and intensive care unit was opened. In August 2005, due to the continuing increase of brain trauma patients, a CT Scan unit was installed, the only one available for free in all of Afghanistan.
At present EMERGENCY's hospital in Kabul is the most important Centre for war and trauma surgery in Afghanistan.
In September 2004, EMERGENCY opened a third Surgical Centre in Lashkar-gah, the capital city of Helmand province, Southern Afghanistan.
The Centre, offers high quality surgical assistance to the population of a vast area where free health care is completely lacking. The Southern regions of Afghanistan are theatre of intense fighting between Taliban, Afghan troops and foreign troops - the majority of victims are civilian, involved against their will in daily fire-fighting, suicide bombings, air bombings. At EMERGENCY's Surgical Centre in Lashkar-Gah, 40 percent of the admitted patients is under 14 years old.
The three Surgical Centres are also linked to a network of 31 First Aid Posts and Primary Health Clinics that EMERGENCY runs in the country to offer medical care to the inhabitants of isolated areas and to provide timely life-saving treatments to wounded patients to be transferred to EMERGENCY hospitals.
Since December 1999, EMERGENCY has treated over 3,940,000 people (as of December 31, 2013) in Afghanistan.
2013 was the worst year ever for the Afghan population since the beginning of the war, 13 years ago. EMERGENCY NGO Surgical Centres, especially in Kabul and Lashkar-gah, admitted 4,317 patients with war wounds (around 12 war casualties per day 365 days a year), a total of 38% more than in 2012 and 60% more than in 2011.
Of these, 2,183 had bullet wounds, 1,037 had been hit by shrapnel and 613 had wounds caused by landmines.
As usual, women and children account for more than a third of the casualties: in 2013, a total of 784 children and 668 women were admitted for medical care.
The situation has not improved with the start of 2014 and for the next months is expected a further escalation of the conflict.
The ongoing situation makes it necessary to respond promptly and effectively to the needs of the Afghan population in order to offer a surgical care of the highest quality and free of charge. The Nando Peretti Foundation has awarded a grant for this project.

Envisaging a possible escalation of the Afghan war EMERGENCY is committed to keeping its hospitals in perfect working order to face a potential further increase if the activity and in order to respond promptly and adequately to the needs of the local population.
In the pre proposal EMERGENCY also planned the purchase of new furnitures for the operating theatres of the three Centres and the renewal of the surgical instruments used during surgery for the Centre of Anabah. As anticipated on the pre-proposal these supplies have already been purchased and sent to Afghanistan at the beginning of 2014 to face in a timely manner the ongoing needs of surgical assistance.
In fact the rise of the number of war wounded patients creates a greater need for surgical material.
EMERGENCY has then planned to purchase supplies of orthopaedic external fixators, required for the reduction of fractures, and sutures used during surgeries for all its Surgical Centres.
These supplies will restore the stocks of the same materials already sent to Afghanistan at the beginning of the year so as to cover the last months of 2014.
The specific object of this project is indeed to respond promptly and effectively to the needs of the Afghan population of high-standard and free-charge surgical care.
Please find below a detailed description of the activities EMERGENCY performs in its tree Surgical Centres in Afghanistan:
- First-aid: patients in need for surgery are stabilized and transferred to the Operating Theatres. Less severe cases are medicated or treated in the dressing rooms
- Diagnostics: X-rays and Lab exams are available for further evaluation;
- Surgery: surgery for war injuries, emergency surgery, trauma and elective surgery;
- Postoperative hospitalization: patients are admitted in the surgical wards after the operation. Each morning a team composed of an international surgeon and national nurses and doctors visits the patients in order to assess their conditions. This is also an important opportunity for the training of local staff;
- Follow-up: visits are held for patients who have already been operated or treated to monitor their conditions;
- Physiotherapy: patients who underwent surgery or were treated for limb injuries receive physiotherapy treatments to facilitate their rehabilitation;
- Training on-the-job: local staff is constantly assisted by experienced international colleagues. EMERGENCY trains both medical personnel and administrative and technical staff.

To fulfil all the activities listed EMERGENCY will apply its standard operational procedures which consist in:
- provide assistance totally free of charge;
- guarantee treatment to anyone in need of assistance, without any sort of discrimination;
- practice high quality medicine and employs standardized therapeutic and working protocols already tested in emergency situations;
- train local staff thoroughly to foster their complete operational independence .
The actual forcefulness of these methods is proved by the mortality rate of the three Centres which is around 2% of the patients admitted.

The expected outcome of the project proposed is therefore the strengthening of the access to high quality and free of charge surgical treatments for the local population increasingly affected by the conflict in Afghanistan.
Final beneficiaries of the project proposed by EMERGENCY will be the patients, adults and children, which will be treated and operated free of charge in the EMERGENCY Surgical Centres in Afghanistan.
Each month on average 360 patients are treated for war injuries in the three Surgical Centresrun byEMERGENCY.
Furthermore the local medical staff will benefit from the strengthening of the surgical activity. During their professional training assisted by experienced colleagues the local staff will have the opportunity to further enhance, deepen and refresh their surgical skills.
EMERGENCY employs in its tree Surgical Centres in Afghanistan around 710 members of the local staff: around 350 are members of medical staff.

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