Fragmented geographies and trauma pathways in the Middle East

Enduring and interlocking conflicts across the Middle East over the last 25 years have generated injuries on a large scale. While civilian injuries in the region have been widely documented, very little is known about civilian trauma pathways-the system designed to manage patients from the moment of injury through to rehabilitation. Military trauma pathways are premised on rapid evacuation, coordinated referral and timely access to treatment, but replicating these systems for civilians, under conditions of active and ongoing conflict, presents many challenges. Civilians can be injured almost anywhere-far away from hospitals, without access to ambulances, emergency and other services-and in absence of a clear trauma pathway, their care trajectory in the weeks and years after sustaining injury is highly inequitable and geographically fragmented. This analysis examines some of the problems posed by the geographical fragmentation of civilian trauma pathways and reflects on what might be done to rebuild and improve them.