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

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.