title: Emergency and essential surgical services in Afghanistan: still a missing challenge.
abstract: 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.
authors.affiliation: Department of Surgical Sciences, University of Parma, Via Gramsci 14, 43100, Parma, Italy. sandro.contini@unipr.it
authors.forename: Sandro
authors.initials: S
authors.lastname: Contini
authors.forename: Asadullah
authors.initials: A
authors.lastname: Taqdeer
authors.forename: Meena
authors.initials: M
authors.lastname: Cherian
authors.forename: Ahmad Shah
authors.initials: AS
authors.lastname: Shokohmand
authors.forename: Richard
authors.initials: R
authors.lastname: Gosselin
authors.forename: Peter
authors.initials: P
authors.lastname: Graaff
authors.forename: Luc
authors.initials: L
authors.lastname: Noel
mesh_terms: D000346:Afghanistan; D000776:Anesthesiology; D003151:Community Health Centers / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000600:supply & distribution*; D013502:General Surgery / Q000592:standards / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data*; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006767:Hospitals, District / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D013514:Surgical Procedures, Operative / Q000592:standards / Q000706:statistics & numerical data; D000078329:Workforce