World Journal of Surgery

, Volume 40, Issue 11, pp 2628–2634 | Cite as

Global Estimation of Surgical Procedures Needed for Forcibly Displaced Persons

  • Yuanting ZhaEmail author
  • Barclay Stewart
  • Eugenia Lee
  • Kyle N. Remick
  • David H. Rothstein
  • Reinou S. Groen
  • Gilbert Burnham
  • David K. Imagawa
  • Adam L. Kushner
Original Scientific Report



Sixty million people were displaced from their homes due to conflict, persecution, or human rights violations at the end of 2014. This vulnerable population bears a disproportionate burden of disease, much of which is surgically treatable. We sought to estimate the surgical needs for forcibly displaced persons globally to inform humanitarian assistance initiatives.


Data regarding forcibly displaced persons, including refugees, internally displaced persons (IDPs), and asylum seekers were extracted from United Nations databases. Using the minimum proposed surgical rate of 4669 procedures per 100,000 persons annually, global, regional, and country-specific estimates were calculated. The prevalence of pregnancy and obstetric complications were used to estimate obstetric surgical needs.


At least 2.78 million surgical procedures (IQR 2.58–3.15 million) were needed for 59.5 million displaced persons. Of these, 1.06 million procedures were required in North Africa and the Middle East, representing an increase of 50 % from current unmet surgical need in the region. Host countries with the highest surgical burden for the displaced included Syria (388,000 procedures), Colombia (282,000 procedures), and Iraq (187,000). Between 4 and 10 % of required procedures were obstetric surgical procedures. Children aged <18 years made up 52 % of the displaced, portending a substantial demand for pediatric surgical care.


Approximately three million procedures annually are required to meet the surgical needs of refugees, IDPs, and asylum seekers. Most displaced persons are hosted in countries with inadequate surgical care capacity. These figures should be considered when planning humanitarian assistance and targeted surgical capacity improvements.


Host Country Asylum Seeker Surgical Care Displace Person Surgical Capacity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This study was funded in part by Grant R25-TW009345 from the Fogarty International Center, US National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


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Copyright information

© Société Internationale de Chirurgie 2016

Authors and Affiliations

  • Yuanting Zha
    • 1
    • 2
    Email author
  • Barclay Stewart
    • 3
    • 4
    • 5
  • Eugenia Lee
    • 1
    • 6
  • Kyle N. Remick
    • 7
    • 8
  • David H. Rothstein
    • 9
    • 10
  • Reinou S. Groen
    • 11
  • Gilbert Burnham
    • 1
  • David K. Imagawa
    • 2
  • Adam L. Kushner
    • 1
    • 12
    • 13
  1. 1.Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.University of California, Irvine School of MedicineIrvineUSA
  3. 3.Department of SurgeryUniversity of WashingtonSeattleUSA
  4. 4.School of Medical SciencesKwame Nkrumah UniversityKumasiGhana
  5. 5.Department of Interdisciplinary Health SciencesStellenbosch UniversityCape TownSouth Africa
  6. 6.Department of SurgeryUniversity of Southern CaliforniaLos AngelesUSA
  7. 7.Department of SurgeryUniformed Services University of the Health SciencesBethesdaUSA
  8. 8.Military DeputyCombat Casualty Care Research ProgramFort DetrickUSA
  9. 9.Department of Pediatric SurgeryWomen and Children’s Hospital of BuffaloBuffaloUSA
  10. 10.Department of SurgeryState University of New York at BuffaloBuffaloUSA
  11. 11.Department of Gynecology & ObstetricsJohns Hopkins HospitalBaltimoreUSA
  12. 12.Department of SurgeryColumbia UniversityNew YorkUSA
  13. 13.Surgeons OverSeasNew YorkUSA

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