Academic Publication

Surgery for children in low-income countries affected by humanitarian emergencies from 2008 to 2014: The Médecins Sans Frontières Operations Centre Brussels experience

Katherine T. Flynn-O'Brien
Miguel Trelles
Lynette Dominguez
Ghulam Hiadar Hassani
Clemence Akemani
Aamer Naseer
Innocent Bagura Ntawukiruwabo
Adam L. Kushner
David H. Rothstein
Barclay T. Stewart
Journal of Pediatric Surgery
Publication Year:
April 29, 2020
  • SDG 3 - Good Health and Well-Being
  • SDG 16 - Peace, Justice and Strong Institutions

This article discusses the deficiency of pediatric surgical care in developing countries disrupted by crisis. The authors examine the pediatric surgical care at Médecins Sans Frontières-Brussels (MSF-OCB) projects in order to highlight the current resource allocation and the barriers faced in surgical care for children. The authors also describe the pediatric-specific skillset necessary for surgeons on humanitarian missions and advocate for the protection of vulnerable children during crisis.



Pediatric surgical care is deficient in developing countries disrupted by crisis. We aimed to describe pediatric surgical care at Médecins Sans Frontières-Brussels (MSF-OCB) projects to inform resource allocation and define the pediatric-specific skillset necessary for humanitarian surgical teams.


Procedures performed by MSF-OCB from July 2008 to December 2014 were reviewed. Project characteristics, patient demographics and clinical data were described. Multivariable logistic regression was performed to determine predictors of perioperative death.


Of 109,828 procedures, 26,284 were performed for 24,576 children (22% of all procedures). The most common pediatric operative indication was trauma (13,984; 57%). Nine percent of all surgical indications were due to violence (e.g., land mines, firearms, gender-based violence, etc.). The majority of procedures (19,582; 75%) were general surgical, followed by orthopedic (4350; 17%), and obstetric/gynecologic/urologic (2135; 8%). Perioperative death was low (42; 0.17%); independent predictors of death included age < 1 year, use of general anesthesia with a definitive airway, and operation during conflict.


Surgical care for children comprised nearly a quarter of all procedures performed by MSF-OCB between 2008 and 2014. Attention to trauma surgery and infant perioperative care is particularly needed. These findings are important when resourcing projects and training surgical staff for humanitarian missions.

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