Addressing the Burden of Surgical Disease: Post-Conflict Capacity Building in the North Caucasus

Background: Years after the terror attack on a school in Beslan, North Ossetia, Russian Federation, where more than 1,000 children with their families were taken hostage and 334 people killed, many survivors with complex blast ear injuries were left untreated, because no microsurgery services were available in the North Caucasus region. Our initial approach of treating victims abroad was costly and not sustainable.

Aim and Method:

Building on available structures and partnering international volunteers with local medical professionals, regional government, and academic institutions, in cooperation with victims' representatives and citizen groups, we created a partnership in North Ossetia to establish microsurgery services in a highly politicized environment.

Results:

At the Children's Hospital in Vladikavkaz, North Ossetia, local surgeons were trained in microsurgery, and all victims with ear trauma were successfully treated without adverse events. Our concerted strategy helped easing procedural hurdles and addressing security concerns in a highly politicized environment. In several instances, post-traumatic stress disorder among survivors impaired our access to victims.

Conclusions:

Building on existing secondary care in mid-income countries can address the burden of surgical disease beyond general surgery. Partnering international with local stakeholders, including citizen groups, can create a credible partnership to access vulnerable populations in a region of instable security conditions and can facilitate a meaningful transition from humanitarian aid to partnership for development. Mental health should be part of a comprehensive needs assessment when responding to the burden of surgical disease in conflict or post-conflict settings.