Cardiac surgery for children in war and disaster zones: global experiences and lessons

The 2025 Global Peace Index highlights that there are now 59 active state-based conflicts, the highest number since the Second World War, and overall levels of peacefulness are at their lowest since the index began. For children with CHD, this escalation means that more regions face disruption of surgical services, growing backlogs of untreated cases, and greater risks of displacement and loss to follow-up.

We aimed to conduct a narrative review mapping existing evidence on the provision, models, outcomes, barriers, and enablers of paediatric cardiac surgery in conflict-affected and disaster settings while identifying gaps to inform future research and practice.

Conflicts and disasters amplify the burden of both congenital and acquired paediatric heart disease, worsened by late presentation and progressive loss of operability. The collapse of hospital infrastructure, targeting of health workers, interruption of supply chains, and diversion of resources to trauma care severely limit the feasibility of surgery. Perioperative challenges, including the absence of paediatric intensive care, infection control difficulties, and disrupted follow-up, frequently compromise outcomes.

Conflict and disaster settings significantly exacerbate existing structural weaknesses in congenital cardiac care and may introduce additional system shocks that disrupt infrastructure, workforce stability, supply chains, and continuity of care. Future humanitarian health frameworks should explicitly include congenital and paediatric cardiac care within non-communicable disease response, supported by pre-positioned critical equipment, telemedicine, and long-term partnerships.