Trauma Systems in Conflict Zones: A Qualitative Study of Field Operational Requirements in Humanitarian Care

Trauma care is a central component of humanitarian medical response in conflict zones. However, essential operational knowledge-referral pathways, triage practices, logistical coordination, and team leadership-remains largely undocumented and inconsistently applied. The absence of structured learning mechanisms perpetuates fragmentation and impedes quality improvement across missions. Our study aimed to capture and analyze the field-based experiences of humanitarian health professionals to define practical, system-oriented requirements for effective trauma care in conflict settings.

We conducted a qualitative, exploratory study grounded in 19 in-depth, semi-structured interviews with experienced humanitarian health professionals. Participants were purposively sampled for their experience across prehospital care, hospital-based trauma response, and humanitarian coordination. Thematic analysis was used to identify structural patterns, operational challenges, and field-informed strategies that shape trauma care delivery in conflict-affected contexts. Reporting of this study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Participants described trauma care in conflict settings as dependent on interlocking requirements of six interdependent domains. Effective coordination was portrayed not as a technical function but as a relational one, built on trust, preparedness, and shared ownership across agencies and communities. Information exchange needed to be ethically governed, technically reliable, and tailored to fragile environments, relying on simplicity, redundancy, and low-tech tools co-developed with local actors. Prehospital care and transport systems were seen as decisive and in need of deliberate design, rooted in safety mapping, role-adapted responder models, and integration with local infrastructure. Workforce competence extended beyond clinical skills to include cross-functional agility, cultural literacy, and ethical resilience. Education and training were considered incomplete unless they prepared staff with conflict-specific competencies, supported by structured, simulation-based training for both expatriate and local staff. Finally, the absence of embedded operational research was viewed as a critical gap, with respondents calling for real-time learning systems that inform both frontline response and long-term planning.

Trauma care in modern conflict cannot rely on improvisation or technical skill alone. It must be underpinned by ethical, resilient and locally grounded systems. Our study highlights the operational knowledge of field practitioners, offering a foundation for building trauma care systems that are integrated, resilient, locally anchored, and worthy of the people they aim to serve.