title: Reconstructive Surgery in Times of Conflict.
abstract: BACKGROUND
  Smile Train is a charitable organization that partners with and trains surgeons in developing countries to provide surgical care to patients with cleft lip/palate deformities. The organization supports surgeries in several countries that experience high levels of regional conflict and violence. Nigeria, a country where Smile Train is very active, has undergone numerous periods of extreme violence over the past 12 years. The purpose of the present study is to analyze how local violence and conflict have impacted the ability of surgeons partnered with Smile Train to provide care in Nigeria.
  
  
  METHODS
  The authors retrospectively reviewed Smile Train Express, the organization's database, from 2003 to 2015 for cleft lip/palate repairs performed in Nigeria. The data was chronologically mapped against a detailed timeline of incidents of violence in Nigeria to compare how violence affected the work of Smile Train-affiliated surgeons.
  
  
  RESULTS
  Smile Train-affiliates facilitated 11,499 surgeries in Nigeria from 2003 to 2015. During the same period, 46,370 people were killed in Nigeria in acts of terrorism and violence. Major drops in the frequency of cleft surgeries were preceded by spikes in violence.
  
  
  CONCLUSIONS
  Violence in Nigeria has had a clear impact on the ability of Smile Train-affiliated surgeons to provide adequate cleft care. The international medical community needs to take steps in an attempt to continue to provide essential medical care in areas of conflict and instability.
authors.affiliation: *Division of Plastic and Reconstructive Surgery, Department of Surgery †Department of Pediatrics, Department of Genetics and Genomic Sciences, Department of Developmental and Regenerative Biology ‡Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Rami D
authors.initials: RD
authors.lastname: Sherif
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Massenburg
authors.forename: E Hope
authors.initials: EH
authors.lastname: Weissler
authors.forename: Ethylin Wang
authors.initials: EW
authors.lastname: Jabs
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Taub
mesh_terms: D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D003906:Developing Countries / Q000706:statistics & numerical data; D006801:Humans; D009549:Nigeria / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000706:statistics & numerical data*; D012066:Relief Work / Q000458:organization & administration / Q000706:statistics & numerical data; D012189:Retrospective Studies; D023481:Terrorism; D014754:Violence