title: Averted health burden over 4 years at Médecins Sans Frontières (MSF) Trauma Centre in Kunduz, Afghanistan, prior to its closure in 2015.
abstract: On October 3, 2015, a United States airstrike hit Médecins Sans Frontières (Doctors Without Borders) Trauma Centre in Kunduz, Afghanistan. Our aim was to describe the care provided and estimate the health burden averted by surgical care at the hospital. We also report the benefit rendered by the Trauma Centre to the health of the local population prior to its destruction.
  
  
  
  All operations performed in an operating theater at the Trauma Centre from its opening on August 30, 2011, to August 31, 2015, were described. Disability-adjusted life years averted by operative care over the same period were estimated.
  
  
  
  The Trauma Centre performed 13,970 operations, which included 17,928 procedures for 6,685 patients. The median age of patients who required operative intervention was 21 years (interquartile range 12-34 years). More than 85% of patients were men (12,034 patients; 86%). Of the 6,685 patients who required operative care, 4,387 suffered unintentional, non-violence-related injuries (66%), while 2,276 suffered violence-related injuries (34%). The perioperative death rate at the facility decreased from 7.2 deaths per 1,000 operations in 2011 to 1.3 deaths in 2015 (P = .03). More than 154,250 disability-adjusted life years were averted by operative care (95% confidence interval 153,042-155,465).
  
  
  
  The health burden averted by the surgical care provided at the Trauma Centre was large; it is critically felt by those still living in the region. Access to essential trauma care for all victims of armed conflict is a human right; as directed by International Humanitarian Law, we must guarantee special protection for the wounded, sick, and medical personnel and facilities during war.
authors.affiliation: Anaesthesia, Gynaecology, and Emergency Medicine Unit, Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium. Electronic address: miguel.trelles@brussels.msf.org.
authors.forename: Miguel
authors.initials: M
authors.lastname: Trelles
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA; School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa.
authors.forename: Barclay T
authors.initials: BT
authors.lastname: Stewart
authors.affiliation: Médecins Sans Frontières, Afghanistan Mission, Kabul, Afghanistan.
authors.forename: Hamayoun
authors.initials: H
authors.lastname: Hemat
authors.affiliation: Médecins Sans Frontières, Afghanistan Mission, Kabul, Afghanistan.
authors.forename: Masood
authors.initials: M
authors.lastname: Naseem
authors.affiliation: Médecins Sans Frontières Trauma Centre, Kunduz, Afghanistan.
authors.forename: Sattar
authors.initials: S
authors.lastname: Zaheer
authors.affiliation: Médecins Sans Frontières Trauma Centre, Kunduz, Afghanistan.
authors.forename: Mutallib
authors.initials: M
authors.lastname: Zakir
authors.affiliation: Médecins Sans Frontières Trauma Centre, Kunduz, Afghanistan.
authors.forename: Edris
authors.initials: E
authors.lastname: Adel
authors.affiliation: Cell 4, Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium.
authors.forename: Catherine
authors.initials: C
authors.lastname: Van Overloop
authors.affiliation: Surgeons Over Seas (SOS), New York, NY; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Surgery, Columbia University, New York, NY.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Kushner
mesh_terms: D000293:Adolescent; D000328:Adult; D000346:Afghanistan; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D017048:Health Care Costs; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008493:Medical Missions / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D014193:Trauma Centers / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D055815:Young Adult