title: The hidden war: humanitarian surgery in a combat zone.
abstract: BACKGROUND
  Humanitarian surgical care (HSC) provided during wartime plays a substantial role in military operations, but has not been described or quantified beyond individual experiences.
  
  
  METHODS
  Prospective survey was conducted of all military members deployed to Iraq or Afghanistan between 2002 and 2011.
  
  
  RESULTS
  There were 266 responses. On average, surgeons had been in practice for 3 years at their 1st deployment and the majority were not fellowship trained. HSC was performed on all body systems and patient populations, including surgery for malignancy. Although 30% of responders performed surgeries they had never done before as a staff surgeon, 84% felt well prepared by their residency. The majority felt that performing HSC improved unit readiness (60%), benefited local population (64%), and contributed to counterinsurgency operations (54%).
  
  
  CONCLUSIONS
  Over our 10-year period, hundreds of military surgeons performed countless HSC cases in Iraq and Afghanistan and the majority felt that HSC had numerous benefits.
authors.affiliation: Department of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Avenue, Tacoma, WA 98431, USA. Electronic address: reesporta@yahoo.com.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Porta
authors.affiliation: Department of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Avenue, Tacoma, WA 98431, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Robins
authors.affiliation: Department of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Avenue, Tacoma, WA 98431, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Eastridge
authors.affiliation: Department of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Avenue, Tacoma, WA 98431, USA.
authors.forename: John
authors.initials: J
authors.lastname: Holcomb
authors.affiliation: Department of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Avenue, Tacoma, WA 98431, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Schreiber
authors.affiliation: Department of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Avenue, Tacoma, WA 98431, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Martin
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000533:Altruism; D001291:Attitude of Health Personnel; D003625:Data Collection; D006801:Humans; D054542:Iraq War, 2003-2011; D008875:Middle Aged; D008887:Military Medicine / Q000193:education / Q000458:organization & administration; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D013514:Surgical Procedures, Operative / Q000523:psychology / Q000706:statistics & numerical data*; D014481:United States
keywords: Afghanistan; Humanitarian aid; Humanitarian surgery; Iraq; Military combat