title: Global Estimation of Surgical Procedures Needed for Forcibly Displaced Persons.
abstract: Sixty million people were displaced from their homes due to conflict, persecution, or human rights violations at the end of 2014. This vulnerable population bears a disproportionate burden of disease, much of which is surgically treatable. We sought to estimate the surgical needs for forcibly displaced persons globally to inform humanitarian assistance initiatives.
  
  
  
  Data regarding forcibly displaced persons, including refugees, internally displaced persons (IDPs), and asylum seekers were extracted from United Nations databases. Using the minimum proposed surgical rate of 4669 procedures per 100,000 persons annually, global, regional, and country-specific estimates were calculated. The prevalence of pregnancy and obstetric complications were used to estimate obstetric surgical needs.
  
  
  
  At least 2.78 million surgical procedures (IQR 2.58-3.15 million) were needed for 59.5 million displaced persons. Of these, 1.06 million procedures were required in North Africa and the Middle East, representing an increase of 50 % from current unmet surgical need in the region. Host countries with the highest surgical burden for the displaced included Syria (388,000 procedures), Colombia (282,000 procedures), and Iraq (187,000). Between 4 and 10 % of required procedures were obstetric surgical procedures. Children aged <18 years made up 52 % of the displaced, portending a substantial demand for pediatric surgical care.
  
  
  
  Approximately three million procedures annually are required to meet the surgical needs of refugees, IDPs, and asylum seekers. Most displaced persons are hosted in countries with inadequate surgical care capacity. These figures should be considered when planning humanitarian assistance and targeted surgical capacity improvements.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. yzha1@jhu.edu.|University of California, Irvine School of Medicine, Irvine, CA, USA. yzha1@jhu.edu.
authors.forename: Yuanting
authors.initials: Y
authors.lastname: Zha
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA, USA.|School of Medical Sciences, Kwame Nkrumah University, Kumasi, Ghana.|Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa.
authors.forename: Barclay
authors.initials: B
authors.lastname: Stewart
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Department of Surgery, University of Southern California, Los Angeles, CA, USA.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Lee
authors.affiliation: Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.|Military Deputy, Combat Casualty Care Research Program, Fort Detrick, MD, USA.
authors.forename: Kyle N
authors.initials: KN
authors.lastname: Remick
authors.affiliation: Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, NY, USA.|Department of Surgery, State University of New York at Buffalo, Buffalo,  NY, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Rothstein
authors.affiliation: Department of Gynecology & Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Reinou S
authors.initials: RS
authors.lastname: Groen
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Burnham
authors.affiliation: University of California, Irvine School of Medicine, Irvine, CA, USA.
authors.forename: David K
authors.initials: DK
authors.lastname: Imagawa
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Department of Surgery, Columbia University, New York, NY, USA.|Surgeons OverSeas, New York, NY, USA.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Kushner
mesh_terms: D000293:Adolescent; D000352:Africa, Northern; D002648:Child; D002675:Child, Preschool; D003105:Colombia; D016208:Databases, Factual; D015023:Democratic Republic of the Congo; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D038622:Internationality; D007493:Iraq; D008297:Male; D013513:Obstetric Surgical Procedures / Q000706:statistics & numerical data; D010154:Pakistan; D010372:Pediatrics / Q000706:statistics & numerical data; D012036:Refugees / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D013593:Syria; D014480:United Nations / Q000706:statistics & numerical data*; D035862:Vulnerable Populations / Q000706:statistics & numerical data