MSF RECONSTRUCTIVE
SURGERY PROGRAMME

HEALING WAR WOUNDS IN THE MIDDLE EAST

 

ABOUT THE RSP

The Reconstructive Surgery Programme (RSP) in Amman was established in 2006 to treat people injured in war and unrest. With a high level of surgical expertise, extensive facilities, and a holistic approach to care, the hospital provides a base for MSF to treat patients with complicated injuries - primarily from Iraq, Syria, Yemen and Palestine - who could not be treated in their own countries. The programme was initiated after victims of war in Iraq were unable to access the necessary medical attention needed, and has continued due to the ongoing conflicts in the region and the lack of appropriate healthcare facilities in war-torn countries.

The eight-story hospital has 148 beds, an operating theater with three surgery rooms, physiotherapy and psychosocial departments, a microbiology lab, and a new social and recreational space. In addition to orthopedic, maxillofacial and plastic surgery, the RSP provides psychological healthcare, physiotherapy and a safe space to recover, for adults and children who have faced far too much violence.

In 2017, the MSF Foundation introduced the 3-D printing project to develop prosthetics. Over the past decade, the hospital has become a hub for medical innovation, offering a holistic package of services and cutting-edge solutions to the extraordinary medical challenges facing its patients. MSF has also initiated a learning and training initiative at RSP where experts apply learner-centred methodologies to promote the development of highly specialized medical and paramedical competencies.

Patients by Nationality:

  • Iraq: 45%
  • Syria: 24%
  • Yemen: 30%
  • Palestine / Others: 1%

Most of our patients stay with us for months at a time. MSF provides transport to and from our patient’s homes as well as accommodation and per diem for them and a guardian if required.

  • There is immense progress and success with which the surgery team manages to redress both the malfunctions and the aesthetics of the injured body parts. These achievements, which we are proud of as humanitarian surgeons, have had a considerable contribution to rehabilitating the victims and helping reintegrate them into their societies.” - Ashraf Al Bustanji, Maxillofacial Surgeon at the RSP.

THE RECONSTRUCTIVE SURGERY

The surgeons at the RSP perform very specific operations to war wounds inflicted by bomb blasts, shrapnel, bullet wounds and burns from conflict. The RSP's surgical team consists of four orthopedic surgeons, one maxillofacial surgeon, and one plastic surgeon –– all from Iraq and Jordan –– who have, over the past 10 years performed more than 12,000 surgeries on over 5000 patients. On average five to six operations are performed every day at the RSP. As a result of the regularity with which they treat such injuries, they have developed unique experience and skills. In tandem with physiotherapy, the reconstructive surgery aims to restore functionality and mobility to patients who have had their bodies and lives altered by weapons of war.

The RSP's surgical team consists of four orthopedic surgeons, one maxillofacial surgeon, and one plastic surgeon –– all from Iraq and Jordan –– who have, over the past 10 years performed more than 11,000 surgeries on over 4,500 patients. On average five to six operations are performed every day at the RSP.

Percentage of cases since 2006

78%

Orthopaedic

Often the result of bomb explosions or bullet wounds, patients come to the hospital with injuries that reduce or completely prevent them from using their limbs.

In response to these injuries, surgeons perform a number of complex operations to manage bone defects. Hand surgeries and soft-tissue surgeries, such as nerve and tendon surgeries, are also performed. In addition, injuries with bone infections, typically osteomalitis, are treated at the hospital, through a very strict and regimented antibiotic stewardship programme.

All these reconstructive procedures aim to give back functionality to patients with injured limbs.

15%

Plastic and burn surgery

Many patients in the RSP, particularly women and children, are victims of serious burns, often caused by bombings and explosions, or other violent incidents. Typical cases involve severe skin contractures that impair joint functionality, impede vision, and compromise a patient's ability to eat and speak. In order to improve the functionality of the affected areas, the plastic surgeon at the RSP performs operations to release contractures followed by soft tissue coverings with skin grafts and skin flaps.

7%

Maxillofacial

Patients who arrive at the RSP with maxillofacial injuries – injuries to the neck, face and jaw – are often victims of shelling, explosions and gun shots, particularly from the conflicts in Syria and Iraq. Their wounds generally include fractures and bone defects, as well as skin and soft tissue defects that affect breathing, eating, or speaking. The maxillofacial surgeon at the RSP performs complex surgeries in the affected areas, often refiguring the jaw and mouth with metal plates and skin grafts, which restore the patients’ ability to eat, drink and speak again.

“Many patients who come to the RSP with maxillofacial injuries come with severe injuries to the face, sometimes even missing their whole lower jaw, bottom lip, and teeth. As a result their speech, eating and sometimes even breathing is compromised. In response we perform special reconstructive surgery to rebuild the lower jaw, mouth and teeth. It’s an incredible sight, to see people talking, eating and laughing again, after having lost so much.” Dr Rasheed Al Sammaraie, Surgical Coordinator.

 

PATIENTS STORIES

Patients at the RSP come from different countries in the Middle East, each suffering under conflict. As well as sharing a common language, patients share the residual trauma of war. While being treated at the RSP, sometimes for as long as one year, these war-wounded patients live, eat, sleep and share their stories together.

They are of all ages, from infants to adults, men and women, and together they are bound by the fact that their lives were impacted by wars. The patients all stay at the hospital in Amman for many months, sharing coffee and war stories, all with the hope of getting treatment that will put them back on their feet and allow to return home with dignity.

 

HOLISTIC APPROACH

Surgery is only one element of the comprehensive and holistic rehabilitation offered at the hospital. It is crucial for patients to receive specific and regular physiotherapy, as well as psychosocial support, in order to optimize a full recovery.

Physiotherapy

Physiotherapy and bedside exercises are a core element of the patient rehabilitation process- after and in between surgeries. It is vitally important that patients receive specific and intensive physiotherapy in order to develop functionality and build strength in the affected areas.

Some patients to walk again after months in a wheelchair, while others begin to conduct basic tasks for the first time since their injuries.

MSF also provides prostheses or modifications on current prostheses for patients with amputations. Follow-up physiotherapy is also provided to increase and optimize the functionality of the prosthetic limb. All prostheses, orthosis aids and therapy services are provided free of charge for RSP patients.

 

Psychosocial Care

MSF psychologists provide psychosocial care to RSP patients throughout their stay, through individual consultations and counseling, as well as group activities and interaction. It is a vital service offered to those who have experienced the horrors and trauma of war.

Psychosocial support helps identify specific issues among the hospital's children. MSF runs activities for the children of the RSP to aid with this process, including educational classes (with a customized curriculum to cater to individualized student needs, nationalities, and previous education levels) and occupational therapy in the morning, as well as afternoon activities like music or art classes.

A new social and recreational space was built in the hospital, to provide patients with some fresh air, and give the younger patients an opportunity to play and create new, positive childhood memories.

RESEARCH AND INNOVATION

Antibiotic Stewardship Programme

More than 50% of patients arrive at the RSP with chronic infection, and more than 60% of these infections are multidrug-resistant. It is vital for MSF to find a way to respond to the severity of antibiotic resistance, which is a worldwide public health issue, and a particularly serious one when dealing with war-wounded patients in the Middle East. In Amman, patients are coming from countries where access to antibiotics is not regulated, where infection control and hygiene systems in hospitals have been destroyed, and where emergency life-saving treatment, not infection control, is the priority.

The Antimicrobial Stewardship Programme at the RSP aims to promote optimal antibiotic use in hospitals to help combat the ever-growing global threat of antibiotic resistant infections. This is achieved through the implementation of the 4 Ds: correct drug, correct dose, correct duration, and de-escalation of antibiotic therapy.

Microbiology Lab

In 2015, the RSP implemented a microbiology laboratory in the hospital with the objective of improving the quality of MSF's medical interventions for patients with infectious complications of conflict injuries, and to provide guidance for the management of drug-resistant orthopedic infections faced by other regional medical providers.

The laboratory has three specific aims:

  • Provide high-quality bacteriological analysis of patient specimens, including the detection of antibiotic resistance.
  • Support ongoing research and data collection in the field of orthopedic surgery from a microbiological standpoint.
  • Referent centre for the training of MSF laboratory staff.

The laboratory receives bone, tissue, urine, swab, and blood samples for culture. The laboratory team then work together with the antibiotic stewardship programme to help interpret the results with clinicians.

  • More than 50 per cent of patients at the RSP arrive with chronic infection and more than 60 per cent of these infections are multidrug-resistant (MDR), reflecting the high levels of resistance in the region.” – Dr Nagham Khafaji
 

3D Printing Prosthetics

The implementation of a 3D-Printing project was introduced to the RSP through the MSF Foundation at the beginning of 2017, which aims to design and produce prosthetics for upper-limb amputees as an alternative to conventional prosthetics, as well assess the feasibility of other 3D-printed rehabilitation and prosthetic devices.

Although there are many prosthetic options for lower-limb amputees, there is little available for upper-limbs. As a result, the 3D-Printing team aims to target this population offering a customised lighter and cheaper prosthetic for patients, which is potentially significantly faster to produce than a traditional prosthetic.

For each patient, the team first assess the stump and the needs of the patient, and then make a scan of the stump, designing a socket and upper-limb prosthesis on digital software. Finally, the device is printed and customized to suit the patients’ needs. The aim of the project is to design and create upper-limb prosthetics unique to each patient, offering a cosmetic solution to their stump, as well as enabling them to carry out specific tasks.

This project is still a work in process, but will hopefully expand to meet the needs of other MSF missions in the future.

 

Support

Thanks to our generous supporters, we can provide emergency, independent, medical humanitarian assistance to people living in extreme circumstances.

© 2017 MSF UAE All Rights Reserved.

Pictures by: Faris Al-Jawad, Florian Seriex, Tom Barnes, Chris Huby, Alessio Mamo

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