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From Mosul to Taiz: Surgery on the Frontlines

Orthopaedic Surgeon and UK-Med Surgical Lead Andy Kent has extensive military and humanitarian experience, with over 30 years of surgical experience and 17 years’ service in the Royal Army Medical Corps. His international responses include Mosul, Beirut and Eswatini.

He shares his insight into providing surgical support in areas affected by conflict, and why UK-Med is urgently fundraising to provide this support in Yemen:

Life-saving training for surgeons treated patients with trauma injuries

“In 2017, I spent 2 months working in Iraq during the battle to retake Mosul from DAESH (also known as ISIL, Islamic State or ISIS). Nearly all local healthcare infrastructure had collapsed – often literally – and huge numbers of people sadly required urgent trauma surgery.

In conflict settings like Mosul and Yemen, we often see children, women and men of all ages with musculoskeletal trauma from IEDs (improvised explosive device) and air strike fragments as well as gunshot trauma.

Andy removing an external fixator (a stabilising frame to hold the broken bones in proper position) from a young girl’s femur in Mosul. (Photo credit: Andy Kent)

Even in warzones, babies are still being born

Given the risks of complications during childbirth, a lack of surgical training has a huge impact on mothers and babies. No matter where there is conflict, women will continue to have babies.

Yemen has one of the highest maternal mortality rates in the world. One woman and six newborns die every two hours from complications during pregnancy or childbirth[1]. For young women in areas devastated by conflict – like Ta’iz – giving birth can be a death sentence. The ability for surgeons to offer safe delivery and or C-sections is essential – including the facility to offer blood transfusion.

A mother holding her child waiting to receive treatment from a mobile clinic in Sa'dah, north Yemen. There is a desperate need to provide maternal and neonatal care in Yemen, which has some of the world’s highest maternal mortality rates. (Photo credit: Julien Harneis / Shutterstock)

High impact training can improve the quality of life for patients living through incredible hardships

Unfortunately, most conflict zones are in poor regions that are already suffering with the effects of chronic-ill health. More than 80% of Yemen’s population currently lacks food, fuel, drinking water and access to health care services [2]. Diseases and conditions that are eradicated or curable in other parts of the world wreak havoc on communities. Life for someone with chronic health conditions like unmanaged diabetes is disproportionately difficult.

One of the major issues in conflict areas I’ve found is the location of the surgical team. If they’re to provide life and limb-saving surgery, this needs to be as close to the front lines as possible. But this does place everyone – both medical staff and patients – at risk.

Almost two thirds of the population in Yemen live more than an hour from comprehensive emergency obstetric and surgical care[3]. With significant road and travel blocks throughout Yemen, the closure of its main airport – Sana’a Airport – and a shortage of paramedics for ambulances, healthcare facilities are incredibly stretched.

Here in the UK, we’ve seen the waiting times for surgical procedures rise exponentially because of COVID-19, but in countries like Yemen, COVID-19 is just another crisis on top of so many others.

The difference you can make

“Give a man a fish and he’ll eat for a day. Teach him to fish and he’ll eat for a lifetime.” In Mosul we were able to empower the local surgical teams to deliver life and limb-saving treatment, which involved a combination of ‘hands on’ surgery and training.

This was the most rewarding part of my role in Mosul – engaging and bonding with the local medical teams and giving them the confidence to act independently. The satisfaction came both from the patients we treated and the legacy we left behind. A combination of hands-on support and training is something that UK-Med need to bring to Yemen.

Left: Andy training surgeons in Mosul. Right: Andy with one of the local surgeons that he worked with.

One of the major problems we face is that surgical (and anaesthetic) training is becoming so sub-specialised. It is proving increasingly difficult to recruit Surgical Teams with the appropriate skill set to deliver a wide range of emergency surgical procedures in austere or conflict settings. But UK-Med is unique in that it has access to such specialisms, which can make a fundamental difference in Yemen and the many other contexts they work in.

With your help, we can bring in a team of highly experienced NHS surgeons, anaesthetists and nursing staff to Yemen to provide trauma training and support surgical services.”

Please donate to UK-Med’s Yemen Appeal today to bring together the best of the NHS, humanitarian and local health expertise and save lives on the Yemen frontlines.

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