Development of a Multinational Collaboration Supporting Reconstructive Surgery in Response to the 2023-2025 War in...

The escalation of conflict in Gaza since October 2023 has devastated an already fragile healthcare system and generated an overwhelming civilian need for reconstructive surgical care. Traditional humanitarian approaches often defer reconstructive planning until conflict resolution, which delays care and worsens morbidity. The global plastic and reconstructive surgery community has extensive experience in collaboration, but few published models exist for the proactive formation of ethically grounded, multidisciplinary teams during active conflict.

We used a community-based participatory research framework to establish a multinational, multidisciplinary team focused on reconstructive surgical planning in Gaza. The team included academic plastic surgeons, clinicians with relevant geographic experience, implementation scientists, and regional scholars. We prioritized early engagement of Gaza-based partners and institutional review board approvals from relevant Palestinian entities to ensure contextual relevance.

Within 1 year, we established a functional, ethically approved collaboration with institutional funding and administrative support. Key lessons included the importance of early stakeholder engagement, leveraging short-term goals for long-term progress, adapting to dynamic conflict conditions, establishing internal infrastructure, and maintaining flexible communication channels. The first wave of initiatives focused on actionable outputs is underway, including estimating reconstructive surgical need, conducting capacity evaluations, and documenting current care delivery.

Our approach offers a replicable, ethical framework for context-sensitive collaboration in conflict zones. It enables plastic surgeons to engage proactively in humanitarian crises beyond direct care. Actionable outputs can be used by local leaders, organizations, and policymakers to reduce delays between conflict resolution and delivery of reconstructive care.