The changing role of civilian surgeons in conflicts: a meta-analysis of epidemiological data

Surgical activities in recent conflicts were reviewed based on the published epidemiological data. Ten articles on seven conflicts were identified and reviewed. The surgical activities in these articles were classified into three categories based on their activities: type 1, civilian border camp surgical activities; type 2, military hospitals in military deployment; type 3, civilian hospitals in former Yugoslavia or Palestine camp (most recent conflicts). Comparison of injuries in ratios of head-to-extremities, and critical part-to-extremities, among these three different types of surgical activity showed that type 3 hospitals had a statistically higher number of critical part injuries compared to the other two types of hospital. Type 3 hospitals represent the most recent endemic, regional and indiscriminate killing experiences. The high rates of critical part trauma in studies of recent conflicts show the increasing importance of trauma management skills by civilian surgeons in recent conflicts. Exchange of information among civilian surgeons serving in these difficult and dangerous conditions should be encouraged.