Post-surgical scar management and rehabilitation in burn patients: Insights from Gaza's challenging context - A...

Burn injuries represent a challenge in the Gaza Strip, where access to rehabilitation services is constrained by ongoing conflict and limited healthcare resources. This study describes the implementation and outcomes of rehabilitation and physiotherapy services for patients with post-surgical skin grafts (SSG) scars treated in Médecins Sans Frontières (MSF) outpatient clinics in Gaza. We conducted a retrospective descriptive study using routinely collected programmatic data from patients with SSG scars enrolled in MSF post-operative outpatient clinics in the Gaza Strip (Gaza City, Beit Lahia, and Khan Younis), between January 2018 and December 2020. Outcomes were assessed using five measures: reducibility score, Functional Activity for Burn (FAB) score, Vancouver Scar Scale (VSS), Visual Analogue Scale (VAS) for pain, and an itching score. A total of 177 patient records were included. Most patients were children under 18 years (n = 136, 76.8%), and scald burns were the most common injury mechanism (n = 119, 67.6%). Improvements were observed across several clinical and patient-reported outcomes during follow-up. Mean pain scores decreased from 5.3 (SD: 2.5) to 1.4 (SD: 1.8), itching scores from 3.7 (SD: 2.7) to 2.7 (SD: 2.2), and VSS scores from 7.1 (SD: 1.8) to 5.7 (SD: 1.7). Functional outcomes improved, with mean FAB scores increasing from 25.6 (SD: 7.1) to 34.6 (SD: 2.3), while reducibility scores decreased from 2.3 (SD: 1.4) to 0.8 (SD: 0.9). Our findings describe the implementation of rehabilitation and physiotherapy services and document improvements observed during follow-up among burn patients in the Gaza Strip. Despite the challenging environment, MSF's clinic in Gaza demonstrated the feasibility of delivering rehabilitation care to burn survivors in a conflict-affected area. Further research is needed to refine and validate best practices in rehabilitation interventions tailored to the specific needs of patients in conflict-affected and resource-constrained settings and to continue improving the quality of care for burn survivors.