Emergency and essential surgical services in Afghanistan: still a missing challenge.

BACKGROUND: In Afghanistan, the number of surgically amenable injuries related to civil unrest and ongoing conflict or consequent to road traffic accidents, trauma, or pregnancy-related complications is rising and becoming a major cause of death and disability. This study was designed to evaluate availability of basic lifesaving and disability-preventive emergency surgical and anesthesia interventions representing most of the country. METHODS: Evaluation was performed outside Kabul to represent a cross-section of the country. Data were collected from Afghanistan health facilities, using the WHO Tool for Situation Analysis to Assess Emergency and Essential Surgical Care, covering case volume, travel distances, infrastructures, human resources, supplies, equipment, and interventions characterizing basic trauma, surgery, and anesthesia capacities. RESULTS: In 30% of the 17 facilities examined, oxygen supply is limited and irregular; uninterrupted running water is not accessible in 40%; electrical power is not available continuously in 66%. Shortage of equipment and personnel is evident in peripheral health facilities: certified surgeons are present in 63.6% and certified anesthesiologists in 27.2%. Continuous 24 h surgical service is available in 29.4%. Lifesaving procedures are performed in 17-42% of peripheral hospitals; 23.5% are without emergency obstetric service. CONCLUSIONS: Limited access to surgery is highly remarkable in Afghanistan, with a severe shortage of emergency surgical capacities in provincial and district hospitals, where availability of basic and emergency surgical care is far from satisfactory. A comprehensive approach for strengthening basic surgical capacities at the primary health care level should be introduced.