GLOBAL SURGERY

Whilst there is no clear definition of exactly what defines ‘war surgery’, ICRC has been at the forefront of managing patients injured in conflict for over a century and a half.

However, in our context, the epidemiology of injuries has evolved, and we must adapt to provide necessary care, achieve optimal outcomes, and reduce complications and long-term disability. We must go beyond life and limb saving emergency frontline surgery towards a comprehensive, integrated patient-centred approach focused on the five pillars of resuscitation, repair, reconstruction, rehabilitation, and reintegration.

Fundamentals of War Surgery has been developed as an online self-paced course and pre-learning part of the ICRC’s blended Surgical Teams in War course. This training includes three online courses (Fundamentals of War Surgery, Anaesthesia in War, Nursing Care in War) and an interactive face to face session. The full course has been designed with common core components relevant to surgeons, anaesthetists, and nurses, as well as specific components addressing each specialty. Its main objective is to enable multidisciplinary surgical teams to respond together to the daily situations encountered in surgical settings.

Specialty: Surgery
Subspecialty: War & Humanitarian Surgery, Orthopaedic and Trauma Surgery, Basic Surgery,
Critical Care Surgery, Emergency Medicine, Wound Care, Plastic & Reconstructive Surgery, Major
Haemorrhage & Transfusion, Nursing, Disaster Management & Triaging a Surgical Patient,
Non-Technical Skills
Target audience: Surgeons, Emergency Medicine Doctors, Trauma Care & Post-Operative Nurses,
Burns Care Teams, Plastic Surgeon
Level: Basic, Intermediate
Language: English

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Adapt the professional practice and knowledge to the humanitarian contexts with limited resources, to provide quality surgical care to the wounded and sick,
Provide safe surgery for weapon-wounded patients in the context of limited resources of armed conflict and other situations of violence in different contexts,
Implement a comprehensive, integrated and patient-centred approach to the management of weapon wound patients,
Collaborate with multidisciplinary teams and strengthen technical and interpersonal skills.

What Learners Are Saying

“The teaching method, the videos, notes and illustrations as these helped greatly in grasping the entire concept around the fundamentals of war surgery.”

Practicing General Surgeon, Sierra Leone

"Very interesting and full of new concepts."

Specialist Surgeon, Ethiopia

“An excellent overview of War Surgery.”

Medical Technician, Canada

"Very good and comprehensive course!"

Physician, Mexico

"ALL ASPECTS OF THIS COURSE WERE INTERESTING."

Specialist Surgeon, Pakistan

"This course is perfect."

Postgraduate Anaesthesiologist, USA

International Committee of the Red Cross

The International Committee of the Red Cross (ICRC) is an impartial, neutral and independent organization whose mandate under the Geneva Conventions is to provide humanitarian assistance to people affected by armed conflict and other violence and promote the laws that protect victims of war.

The ICRC’s Health Unit plays a crucial role in providing medical assistance in conflict zones and areas affected by violence. Our teams work to meet the health needs of people affected by conflict and other violence by providing quality health care that is people-centric and follows an integrated public health and continuum of care approach with the aim of preventing and alleviating suffering and protecting life and dignity.

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Fundamentals of War Surgery

What's in this course?

This course enables multidisciplinary surgical teams to respond together to the daily situations encountered in surgical settings.

Surgery

War Surgery

Target Audience

This course has been specifically designed for early career surgeons in any specialty that may be confronted with dealing with weapon wounded patients in a conflict scenario. More experienced surgeons who have no or very limited experience of managing weapon wounded patients.

Varied activities

Lectures, Videos, Interactive Activities and Assessments

Duration

20 hours 40 minutes

Level

Basic

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Participate in the course discussion, share your thoughts and ask questions.

Whilst there is no clear definition of exactly what defines ‘war surgery’, ICRC has been at the forefront of managing patients injured in conflict for over a century and a half.
However, the context in which we work and the epidemiology of injuries has evolved, and we must adapt to this evolution, if we are to provide the necessary care, to achieve optimal outcomes for those patients injured in conflict, and reduce complications and long-term disability.

We must go beyond life and limb saving emergency front line surgery towards a comprehensive integrated patient-centred approach that focuses on the five pillars of resuscitation, repair, reconstruction, rehabilitation and reintegration.

By the end of this training programme, you will be able to:

Adapt the professional practice and knowledge to the humanitarian and contexts with limited resources, to provide quality surgical care to the wounded and sick.
Provide safe surgery for weapon-wounded patients in the context of limited resources of armed conflict and other situations of violence in different contexts.
Implement a comprehensive, integrated and patient-centred approach to the management of weapon wound patients.
Collaborate with multidisciplinary teams and strengthen technical and interpersonal skills.

The Fundamentals of War Surgery has been developed as a flexible, blended course with a compulsory eLearning format followed by an interactive and participatory face to face programme.

It has been designed with common core components that are relevant to surgeons, anaesthetists and nurses, as well as specific components which address the particular needs of each specialty within the surgical team.

The online activities are composed of the following modules:

Introduction to the International Red Cross and Red Crescent Movement and the ICRC
International Humanitarian Law
Violence Against Healthcare and the Health Care in Danger Initiative
Conflicts and Civilian Trauma: The Differences
Surgical Teams: Non-technical Skills
Ballistics: Bullets and Fragments
Ballistics: Explosions and Blasts
Burns in Conflict
Damage Control Resuscitation (DCR)
Mass Casualty Incidents
Introduction to Chemical, Biological, Radiological and Nuclear Materials & HAZardous MATerial
Nutrition for Hospitalised Patients: Nutritional Care for Adult and Paediatric Patients
Early Rehabilitation within Hospital Setting

For the surgery specific online learning, selected modules of the Military Clinical Readiness Curriculum are recommended reading. This curriculum, produced by the American College of Surgeons (ACS) and the Uniformed Services University of the Health Sciences (USU) is available with an open access on their website. It is a free resource and although developed with military surgeons in mind, the core clinical principles of weapon wounded management described in the curriculum are in accordance with ICRC teachings. The reader’s attention is drawn to the fact that the patient care approaches described in the curriculum reflect standards of care of a well-resourced military trauma system and certain resources such as evacuation to higher echelons, airlift medevac, serial debridement, etc may not be applicable in limited resources settings. However, the basic surgical science and knowledge remains the same and bulk of the surgical practices described in the curriculum are applicable in any scenario and context.

The curriculum is exhaustive, and the following modules of the curriculum are recommended for the purpose of Fundamentals of War Surgery reading.

Wounds, Amputations and Fractures

Management of war wounds
Compartment syndrome and Fasciotomy
Amputation
Burn care
Management of High Bilateral Amputations
Extremity Trauma: Hands and Feet

Torso Trauma

Pelvic Fracture Care
Blunt Abdominal Trauma
Damage Control Surgery
Thoracic trauma
Wartime vascular Surgery

For any content related enquiries, please contact the ICRC focal point of the training Rahul Shankar Koti, Chief Surgeon, at rkoti@icrc.org.

The International Committee of the Red Cross (ICRC) is an impartial, neutral and independent organization whose mandate under the Geneva Conventions is to provide humanitarian assistance to people affected by armed conflict and other violence and promote the laws that protect victims of war.

The ICRC’s Health Unit plays a crucial role in providing medical assistance in conflict zones and areas affected by violence. Our teams work to meet the health needs of people affected by conflict and other violence by providing quality health care that is people-centric and follows an integrated public health and continuum of care approach with the aim of preventing and alleviating suffering and protecting life and dignity.

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SURGhub is designed primarily for healthcare professionals. Previous medical knowledge is required to understand the contents.The use of any information on this site is undertaken solely at your own risk, and the creators and hosts of this site shall not be liable for any damages, losses, or other injury caused by the use of any information on this site, nor for any reliance on the accuracy or reliability of such information.

Professor Emmanuel Malabo Makasa is a Global Health/Global Surgery Consultant, an Academician, a Researcher and an experianced Clinician. He is the founding Executive Director of the Southern Africa Development Community’s University of Witwatersrand based regional-hub and collaboration Centre for Surgical Healthcare Improvement (WITSSURG) and its spoke, the Centre for Surgical Hdealthcare Research (CSHR) in the Republic of Zambia. He chairs SADC’s Technical Experts Working Group on surgical healthcare, the Partnerships Subcommittee of the Pan-African Surgical Health Forum (PASHeF) and he is the current Secretary General of the International Federation of Surgical Colleges (IFSC). Professor Makasa is a member of the Medical Education and Research Board of the Zambia Medical Association (ZMA MERB), he is a committee member of the Zambia Orthopaedics and Trauma Association (ZOTA) and he also on the board of Trustee for the Lusaka Orthopaedics Research and Education Trust (LORET), Community Without Boarders – Zambian Chapter and Africa Directions (AD).

Professor Emmanuel M Makasa has extensive experience in global health diplomacy, in regional and national surgical (peri-operative) health policy formulation and implementation and he has worked as a senior health systems manager, as honourary lecturer and as a specialist clinician in orthopaedics and Trauma Surgery. He is passionate about improving surgical healthcare in LMIC and has a track record of mobilising and coordinating multiple state and none-state actor stakeholders and partners within the United Nations Systems, in the Global Health/Global Surgery community, health professional groups and within clinical care around surgical systems and service delivery improvement. He has presented on and he has published on safe, timely, equitable, appropriate and affordable universal access to surgical (peri-operative) healthcare in Africa and beyond.

John G. Meara is the Kletjian Professor of Global Surgery, Director of the Program in Global Surgery and Social Change, and Professor of Surgery in the Department of Surgery at Harvard Medical School. Dr. Meara serves as the Plastic Surgeon-in-Chief of the Department of Plastic & Oral Surgery at Boston Children's Hospital. He was Co-Chair for the Lancet Commission on Global Surgery and was a commissioner on the Lancet Global Health Commission on High Quality Health Systems in the SDG Era and the Lancet Oncology Commission. In 2008 he created the Paul Farmer Global Surgery Fellowship program. He is also interested in value-based health care and implementation science research, including time driven activity-based cost research and outcomes research. Dr. Meara has led several ICHOM projects focusing on outcomes reporting and international benchmarking.

Dr. Meara's interests and innovation activities lie in the areas of craniofacial anomalies, cleft lip and cleft palate, but he has a particular interest in augmenting the delivery of quality surgical and anesthesia care in low-resource settings through long term capacity building. He is involved in multiple global surgery projects looking at the burden of surgical disease, the surgical capacity and health systems building in low-resource environments, surgical education and the economic impact of untreated surgical disease. He is also interested in value based health care and implementation science research, including time driven activity based cost research and outcomes research. Dr. Meara has led several ICHOM projects focusing on outcomes reporting and international benchmarking. Since 2008, he has directed the Paul Farmer Global Surgery Fellowship program in collaboration with Partners In Health. Its purpose is to strengthen global surgical systems through a combination of research, advocacy, and implementation science as well as train leaders who will further promote surgical care, education, and research pertinent to global surgery.

Dr. Atun is Professor of Global Health Systems at Harvard University and the Faculty Chair of the Harvard Ministerial Leadership Program. In 2008-12 he served as a member of the Executive Management Team of the Global Fund as Director of Strategy, Performance and Evaluation where he chaired the panel that oversaw annual investments of ~US$4 billion each year.

In 2006-2013 Dr. Atun was a Professor of International Health Management at Imperial College London, where he led the Centre for Health Management and was involved as founder, adviser and investor in biotech and health technology companies. He is a visiting professor at University of Kyoto, Japan.

Professor Atun’s research focuses on health system transformation, and innovation. He has published more than 350 papers in leading journals such as NEJM, Lancet, JAMA, Academy of Management Journal, Lancet Oncology, Lancet Global Health and Science Translational Medicine.

Prof Atun has advised more than 30 governments on health policy, strategy and health system reform, and has consulted for the World Bank, WHO and leading organizations such as Medtronic, Merck & Co, Novartis, Hoffman-La Roche. In 2019-20 he was a senior advisor to the G20 Presidency.

Professor Atun served as a member of the U.S. National Academy of Medicine Committee on Health Systems. He also served on the Advisory Boards of WHO Research Centre for Health Development in Japan and the Norwegian Research Council’s Programme for Global Health Research. He Chaired the STOP TB Partnership Coordinating Board in 2009-2011, and was as a member of the UK Medical Research Council’s Global Health Group. He is a member of the Longitude Prize Committee – the largest science prize in the world.

Professor Atun studied medicine at University of London as a Commonwealth Scholar and subsequently completed his postgraduate training in family medicine and public health. He obtained a Masters in Business Administration at University of London and Imperial College London. He is a Fellow of the Royal College of Physicians, the Faculty of Public Health, and the Royal College of General Practitioners.

Professor Atun was appointed President of the GSF Foundation Board in October 2021.

Professor Mark G. Shrime, MD, MPH, PhD, FACS previously served as the O’Brien Chair of Global Surgery at the Royal College of Surgeons in Ireland, as the founder and Director of the Center for Global Surgery Evaluation at the Massachusetts Eye and Ear Infirmary, and as Research Director for the Program in Global Surgery and Social Change at Harvard.

He is the author of seminal papers on the global burden of surgical disease, the financial burden facing surgical patients, and the number of people who cannot access safe surgery worldwide. He served as a co-author on the Lancet Commission on Global Surgery.

Dr. Shrime graduated summa cum laude from Princeton University in 1996 with a BA in molecular biology. He received his MD from the University of Texas in 2001, after taking a year to teach organic chemistry in Singapore. Medical school was followed by a residency in otolaryngology at the joint Columbia/Cornell program in Manhattan, followed, in turn, by a fellowship in head and neck surgical oncology at the University of Toronto in 2007. He completed a second fellowship in microvascular reconstructive surgery, also at the University of Toronto, in 2008. He was the first to identify a novel independent prognostic indicator in head and neck cancer.

To date, he has worked and taught in Liberia, Sierra Leone, Guinea, Benin, Togo, Congo, Haiti, Saudi Arabia, Cameroon, and Madagascar. In May, 2011, he graduated with an MPH in global health from the Harvard School of Public Health, where he was a finalist for both the Albert Schweitzer award and the HSPH Student Recognition award, and in May, 2015, he received his PhD in health policy from Harvard University, with a concentration in decision science.

His research has been supported by the National Institutes of Health, the Iris O’Brien Foundation, the Damon Runyon Cancer Foundation, an anonymous donation to the Center for Global Surgery Evaluation, the GE Foundation’s Safe Surgery 2020 project and the Steven C. and Carmella Kletjian Foundation.

Barnabas Alayande, MBBS, PgDTh, MBA, FMCS (General Surgery) is a general surgeon and Assistant Professor of Surgery with the University of Global Health Equity. He is passionate about equity-based solutions for global surgical care, and works to achieve surgical access for underserved areas within the Center for Equity in Global Surgery through surgical education, research, innovation and improvisation for Low and Middle-Income Countries with an emphasis on sub-Saharan Africa.

He has an academic background in Medicine and Surgery, Theology, and Business, and has specialty training in general surgery with interests in trauma care, and human factors. He has carried out pilot randomized control trial dissertations in thyroid surgery, and benign anorectal haemorrhoid treatments for variable resource settings. Following medical training at a WHO collaborating center for community-based education and service, and a surgically oriented internship in Southwest Nigeria, he served in the South East as a National Youth Service Corps Camp Medical Director, Community Health Team Chair leading a team of volunteer medics serving 4.9 million people of Imo State, and a medical officer covering 19 local government health facilities. He helped start an innovative private practice in North-Central Nigeria, and then transitioned into his surgical residency with training by the West African College of Surgeons and the National Postgraduate Medical College. He graduated from the National Postgraduate Medical College, and subsequently helped establish surgical systems for underserved HIV/AIDS patients in Northern Nigeria, as a volunteer surgeon with the Faith Alive Foundation. He completed a 2-year Global Surgery fellowship with the Harvard Program in Global Surgery and Social Change, serving as chief research fellow, before transferring into a faculty role at the UGHE. He is also a Fogarty Global Health Fellow at the Harvard T.H. Chan School of Public Health.

Dr. Barnabas has contributed to strategic surgical curriculum development for Rwanda, the design of non-technical skills for surgery curriculum for the Nigerian variable resource context, trauma care evaluation and training for the West African sub-region, surgical educational research in the East, Central and Southern Africa region, and the strategic implementation of UGHE’s regional Center for Equity in Global Surgery. His research has been funded by the National Institutes of Health, Fogarty International Center, The Royal College of Surgeons, Edinburgh, Association for Academic Surgery, The UGHE Dean’s Grant. He is the recipient of awards and scholastic honors including the Baxiram S. and Kankuben B. Gelot Community Surgeons Travel Award, poster award from the Trauma Association of Canada, the HBNU Fogarty Global Health Fellowship, the Faculty of Rural Remote and Humanitarian Health Care Fellowship Award, the Association for Academic Surgery Global Surgery Research Grant, the Duro Soleye Annual prize, nomination for the Dr Hamza Olayinka Braimah academic prize, the Shell University Scholarship Award, and the Mobil Producing Nigeria Unlimited Scholarship Awards. Dr Barnabas has contributed numerous presentations, abstracts, and publications within the Global Surgery space, with work in surgical ethics and equity, disparities in access to trauma care, grassroots advocacy, conference equity, surgical quality, surgical history, COVID and surgical care, surgical improvisation, surgical systems strengthening, baselining of surgical access, non-technical skills in surgery, and machine learning and surgery, among others.

He is a member of the Association for Academic Surgery Global Affairs Committee, the West African College of Surgeons, and the Nigerian Medical Association, a fellow with the National Postgraduate Medical College of Nigeria, an international associate fellow with the American College of Surgeons, and a fellow of the Royal College of Surgeons Edinburgh Faculty of Rural, Remote and Humanitarian Healthcare.

Fundamentals of War Surgery

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Learning Objectives

Course Structure

Learn from Global Leaders in Humanitarian and War Surgery

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