Gaza Strip: Hand surgeon reports on burns surgery program

Médecins Sans Frontières supports a surgery program in Nasser Hospital in Khan Younis. © Isabelle Merny/MSF

Hand surgeon Dr. Stefan Krieger went on a Médecins Sans Frontières mission to the Gaza Strip, spending three weeks (November 21 – December 8, 2011) at the Nasser hospital in Khan Yunis. 35 patients underwent surgery for sequels related to severe burns. Four to five operations were performed each day in collaboration with local surgical teams.

In July 2010, Médecins Sans Frontières signed an agreement with local health authorities and opened a specialized surgery program in the Nasser hospital in Khan Yunis, in southern Gaza Strip.  Several times a year, Médecins Sans Frontières teams - composed of surgeons, operating room nurses and anaesthetists – carry out missions, working closely with Nasser teams.  As with Médecins Sans Frontières’ other activities in Gaza, the goal of our surgical program is to alleviate the medical impacts that wounded patients experience and to allow them to regain optimal use of their limbs.

For Dr. Krieger, this mission provided an opportunity to address the lack of specialized medical care in the Gaza Strip. “The Médecins Sans Frontières team is operating in the Médecins Sans Frontières mobile field hospital assigned last August to face lack of space available at Nasser hospital due to its ongoing rehabilitation. Due to heavy rain in the precedent week, the Médecins Sans Frontières inflatable hospital had to be reconstructed and the ground of the tent elevated by using a wood construction. A further hygienically and noisy challenge was the fact that just aside of our tent the hospital road was rebuilt with a lot of dust and construction machines passing by every 5 minutes. But all the material I needed was available. Hygiene and sterilization were also highly satisfying.  

220 patients had been identified in advance by the teams. Consultations started on the 23rd of November and were undertaken together with Dr. Hassan HAMDAN, the head of the burn unit of Nasser Hospital. Out of these 220 patients, and according the inclusion criteria, we chose 56 for surgery: 80% of the cases were post burn constructions, followed by congenital deformities in hands and one tumour case; 89% of the patients who had been operated are children under 18 years old; 36% were females.

We had in total 9 days to operate. We could undertake 4 to 5 operations per day, ending up with 35 operations in total. The Médecins Sans Frontières anaesthetist was very experienced even anaesthesia on very young children was possible. Organization of the daily logistics and communication with the patients were very well managed by local staff, all the operation theatre (OT) logistics were done by the Médecins Sans Frontières OT nurse in a highly qualified way. The functional results we have followed up so far were fully satisfying. Furthermore we had no infection, hygiene protocols are strictly followed and the preparation and cleaning of the patients by the team is of high standard. Hand surgical cases we mostly followed up in the Médecins Sans Frontières Gaza rehabilitation clinic: dressing and physiotherapy including splinting are provided under the supervision of doctors and physiotherapists.

I think there is future surgical work for Médecins Sans Frontières especially in hand surgery and flap coverage of burn sequelae. The team spirit was very motivating. In between the operations we could frequently do dressings or consultations of new cases.  Cooperation with Dr. HAMDAM of Nasser Hospital is very good as he is interested in gaining new techniques. We had very good surgical discussions and I left him my textbooks electronically for further reading. Security was fine during my whole mission, we could move and work every day, still there were incidents reported during the night. This never affected our own security”.

“I had a very good and challenging mission in this field” concludes Dr Krieger who was very satisfied with his mission and who is willing to come back or to recommend it to other surgeons. Three more surgeons are expected to arrive before the end of the year to finish the rest of the planned surgeries. Such operations provide an opportunity for Médecins Sans Frontières and Palestinian experts to exchange about medical techniques and surgical procedure related to elective reconstructive hand surgery and anaesthetic procedures including those of young children.