Fifteen Years of Free Surgical and Obstetric Care in Conflict-Affected Afghanistan: A Retrospective Analysis of EMERGENCY’s Scalable Surgery Model (2007–2022)

Authors

  • Gina Portella Emergency onlus ONG
  • Martin Langer Emergency onlus ONG
  • Sofia Gatti Emergency onlus ONG
  • Khushal Ebrahini Emergency Onlus ONG Surgical Centre for War Victims Lashkar Gah Afghanistan
  • Mir Abdul Azim Shahir Emergency onlus ONG Surgical Centre for War Victims Kabul Afghanistan
  • Raffaela Baiocchi Emergency onlus ONG
  • Marya Qurezada Emergency onlus ONG Maternity Centre Anabah Afghanistan
  • Michele Usuelli Emergency onlus ONG Maternity Centre Anabah Afghanistan
  • Manuela Valenti Emergency onlus ONG
  • Mohammad Amin Abdul Amin Emergency onlus ONG Surgical and Pediatric Centre Anabah Afghanistan
  • Antonio Pesenti University of Milan
  • Ceert Morren Emergency onlus ONG
  • manuela Cormio Emergency onlus ONG
  • Michela Paschetto Emergency onlus ONG
  • Pietro Parrino Emergency onlus ONG
  • Rossella Miccio Emergency onlus ONG

DOI:

https://doi.org/10.62463/surgery.187

Keywords:

Afghanistan, Health Care, Global Surgery, War Surgery, low-income countries, humanitarian healthcare, obstetrics, EMERGENCY NGO

Abstract

Background: Global disparities in surgical access continue to limit healthcare equity, particularly in low-income and conflict-affected countries. Afghanistan exemplifies this challenge, where the health system is constrained by conflict, resource limitations, and political instability. Since 1999, the international NGO EMERGENCY has delivered free surgical and obstetric care in Afghanistan through a network of hospitals and first aid posts. This study evaluates the scale, outcomes, and sustainability of their work from 2007 to 2022.

Methods: A retrospective, descriptive analysis was conducted using aggregate administrative data from EMERGENCY’s three surgical hospitals and one maternity centre. Data on admissions, procedures, maternal and neonatal outcomes, and financial expenditures were reviewed. Statistical comparisons were made before and after the U.S. military withdrawal in 2021 using chi-squared and t-tests. Ethical approval was obtained from EMERGENCY’s independent review board.

Results: Between 2007 and 2022, 120,226 surgical patients were treated, with 58.4% undergoing war-related procedures. In-hospital mortality averaged 3.6%. Following 2021, admissions for civilian trauma increased significantly. Nearly 695,000 outpatient visits were recorded. Maternity services expanded sixfold, with maternal and neonatal mortality rates approaching Sustainable Development Goal targets. The average annual cost of operations was €10.95 million, funded through private and institutional support.

Conclusion: EMERGENCY’s model demonstrates that sustained, high-volume surgical and obstetric care is feasible in conflict-affected settings. The transition to civilian trauma care highlights the need for adaptable surgical systems. This model provides a viable blueprint for global surgery initiatives in low-resource environments.

Author Biographies

Gina Portella, Emergency onlus ONG

Medical Director

Martin Langer, Emergency onlus ONG

Scientific Director

Sofia Gatti, Emergency onlus ONG

Data analyst, statistical analysis

Khushal Ebrahini, Emergency Onlus ONG Surgical Centre for War Victims Lashkar Gah Afghanistan

MD Chief Surgeon

Mir Abdul Azim Shahir, Emergency onlus ONG Surgical Centre for War Victims Kabul Afghanistan

MD Chief Surgeon

Raffaela Baiocchi, Emergency onlus ONG

ChairPerson Maternity Centre  Anabah  Afghanistan

Marya Qurezada, Emergency onlus ONG Maternity Centre Anabah Afghanistan

Head Midwife

Michele Usuelli, Emergency onlus ONG Maternity Centre Anabah Afghanistan

Chief Neonatologist

Manuela Valenti, Emergency onlus ONG

Chief Pediatrician

Mohammad Amin Abdul Amin, Emergency onlus ONG Surgical and Pediatric Centre Anabah Afghanistan

Chief paediatrician Anabah Afghanistan

Ceert Morren, Emergency onlus ONG

Senior Surgical Advisor Emergency onlus NGO

manuela Cormio, Emergency onlus ONG

Medical Training Coordinator

Michela Paschetto, Emergency onlus ONG

Clinical Director Emergency NGO

Pietro Parrino, Emergency onlus ONG

Director, Field Operations Emergency onlus NGO

Rossella Miccio, Emergency onlus ONG

President, Emergency onlus NGO

Downloads

Published

30-05-2025

How to Cite

Portella, G., Langer, M., Gatti, S., Ebrahini, K., Shahir, M. A. A., Baiocchi, R., … Miccio, R. (2025). Fifteen Years of Free Surgical and Obstetric Care in Conflict-Affected Afghanistan: A Retrospective Analysis of EMERGENCY’s Scalable Surgery Model (2007–2022). Impact Surgery, 2(4), 109–117. https://doi.org/10.62463/surgery.187

Issue

Section

Original research paper