• Miguel Trelles, Barclay T Stewart, Hamayoun Hemat, Masood Naseem, Sattar Zaheer, Mutallib Zakir, Edris Adel, Catherine Van Overloop, and Adam L Kushner.
• Anaesthesia, Gynaecology, and Emergency Medicine Unit, Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium. Electronic address: miguel.trelles@brussels.msf.org.
• Surgery. 2016 Nov 1; 160 (5): 1414-1421.

BackgroundOn October 3, 2015, a United States airstrike hit Médecins Sans Frontières (Doctors Without Borders) Trauma Centre in Kunduz, Afghanistan. Our aim was to describe the care provided and estimate the health burden averted by surgical care at the hospital. We also report the benefit rendered by the Trauma Centre to the health of the local population prior to its destruction.MethodsAll operations performed in an operating theater at the Trauma Centre from its opening on August 30, 2011, to August 31, 2015, were described. Disability-adjusted life years averted by operative care over the same period were estimated.ResultsThe Trauma Centre performed 13,970 operations, which included 17,928 procedures for 6,685 patients. The median age of patients who required operative intervention was 21 years (interquartile range 12-34 years). More than 85% of patients were men (12,034 patients; 86%). Of the 6,685 patients who required operative care, 4,387 suffered unintentional, non-violence-related injuries (66%), while 2,276 suffered violence-related injuries (34%). The perioperative death rate at the facility decreased from 7.2 deaths per 1,000 operations in 2011 to 1.3 deaths in 2015 (P = .03). More than 154,250 disability-adjusted life years were averted by operative care (95% confidence interval 153,042-155,465).ConclusionThe health burden averted by the surgical care provided at the Trauma Centre was large; it is critically felt by those still living in the region. Access to essential trauma care for all victims of armed conflict is a human right; as directed by International Humanitarian Law, we must guarantee special protection for the wounded, sick, and medical personnel and facilities during war.Copyright © 2016 Elsevier Inc. All rights reserved.

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