In a decade of war, U.S. military surgeons provided more than 6,000 humanitarian surgical procedures to Afghan adults

A male in military uniform holds a stethoscope to a traditionally dressed Afghan man. KHOWST PROVINCE, Afghanistan- U.S. Army Spc. Spencer Smith, a medic with Team Delaware, 1st Battalion, 501st Infantry Regiment, 4th Brigade Combat Team (Airborne), 25th Infantry Brigade, Task Force 4-25, checks out a local villager who complained of chest pain. Smith performs minor medical treatment as a courtesy to the villagers who have to travel many miles to the nearest medical facility. (Image credit: U.S. Army Sgt. William Begley, 11th Public Affairs Detachment)

 By Sarah Marshall

Two surgeons observe a screen displaying the view of a camera being used to see inside the patient on the operating table
KANDAHAR AIRFIELD, AGHANISTAN- Lt. Cmdr. Jack Brandau, a general surgeon
and Lt. Cmdr. Matthew Bradley, a trauma surgeon, perform laparoscopic surgery on
a patient at the NATO Role 3 Multinational Medical Unit in Kandahar, Afghanistan.
(Image credit: Lt. Cmdr. Jesse Ehrenfeld)
In addition to caring for U.S. troops and coalition forces during conflicts in the Middle East, U.S. military surgeons also provided humanitarian surgical care to nearly 6,000 local national Afghan adult patients over the course of a decade, according to a USU study published Sept. 13 in JAMA Surgery.

The retrospective study, “Surgical humanitarian care in Unites States military treatment facilities in Afghanistan: 2002 to 2013,” is the largest, most comprehensive review of adult humanitarian surgical care provided by the U.S. military in Afghanistan, and was led by the Uniformed Services University (USU) and Walter Reed National Military Medical Center (WRNMMC), including U.S. Navy Capt. (Dr.) Eric Elster, chair of the USU/WRNMMC Department of Surgery, Air Force Lt. Col. (Dr.) Peter Learn, associate chair of Surgery for Quality and Patient Outcomes in the USU/WRNNMC Department of Surgery, and Dr. Sharon Weeks, a General Surgery resident at WRNMMC.

With the help of a linguist, Maj. (Dr.) Shane McCauley and Maj.
(Dr.) Tracy Bozung document a patient's injuries at Forward
Operating Base Smart before he is medically evacuated
after a bus rollover on Highway 1, Zabul province, Afghanistan.
Eleven patients were medically evacuated for further care.
Doctors McCauley and Bozung are assigned to Provincial
Reconstruction Team Zabul. (Image credit: SSG Brian Ferguson)
For more than 15 years, U.S. military surgeons have been providing humanitarian surgical care to local national civilians throughout the conflict in Afghanistan. Until now, large reports on this data have focused on children. Therefore, the researchers sought to review and better understand humanitarian surgical care provided during this time to local civilian adults.

The team queried a military medicine administrative database, looking at data for adult patients (over age 15) who underwent at least one surgical procedure in military treatment facilities in Afghanistan from January 2002 to March 2013.  During that time, 5,786 local adult civilians underwent more than 9,400 surgical procedures, accounting for more than 37,100 inpatient days.  More than a third of these procedures – about 3,300 total – were considered essential surgical procedures for developing countries, according to the World Health Organization’s Disease Control Priorities. War-related patients and non-war related trauma patients underwent procedures at similar rates, and the most commonly performed procedures involved treating fractures and conditions related to soft tissue and the nervous system.

Two surgeons in an operating room observe a screen displaying the view from a camera inside the patient
KANDAHAR AIRFIELD, AGHANISTAN- Hospital Corpsman 3rd Class Najii Thomas assists
Lt. Cmdr. Matthew Bradley, Chief of Trauma at the NATO Role 3 Multinational Medical Unit
in Kandahar, Afghanistan. Together they performed laparoscopic surgery on a patient.
(Image credit: Lt. Cmdr. Jesse Ehrenfeld)
The study illustrates the level of commitment, resources, and expertise provided by U.S. military surgeons in a country with one of the lowest estimates of access to safe, timely surgical care, according to Learn.

“These findings also demonstrate the willingness of military surgical units to commit their time, energy, and resources to helping patients in need, regardless of circumstance,” Learn said. “It’s also a reminder that in order to serve these units and patients well, now and in future conflicts, we must continue to provide careful guidance and training on the ethical, cultural, and long-term medical implications of delivering this care.”