title: Before the bombing: High burden of traumatic injuries in Kunduz Trauma Center, Kunduz, Afghanistan.
abstract: BACKGROUND
  Médecins Sans Frontières (MSF) has been providing healthcare in Afghanistan since 1981 including specialized health services for trauma patients in Kunduz Trauma Center (KTC) from 2011. On October 3rd, 2015, a US airstrike hit the KTC, killing 42 people including 14 MSF staff. This study aims to demonstrate the impact on healthcare provision, after hospital destruction, by assessing the extent of care provided for trauma and injuries by the MSF KTC and to report on treatment outcomes from January 2014 to June 2015, three months prior to the bombing.
  
  
  METHODS
  This is a descriptive, retrospective review of hospital records. All patients with traumatic injuries registered in the Emergency Department (ED) or hospitalized in In-Patients Department (IPD) and/or Intensive Care Unit (ICU) of KTC between January 2014 and June 2015 were included in the study.
  
  
  RESULTS
  A total of 35647 patients were registered in KTC during the study period. 3199 patients registered in the ED were children aged <5 years and 310 of them were admitted including 47 to the ICU. 77.5% patients were from Kunduz province and the remaining were from other provinces. The average length of stay was 7.3 days and 3.3 days while the bed occupancy rate was an average 91.1% and 75.8% in IPD and ICU, respectively. Of 4605 IPD patients, 105 (2.3%) developed complications. Among those admitted to the ICU, 12.6% patients died. About one-third surgical interventions were carried out on an urgent basis and the major proportion (45.8%) of surgical procedures was wound surgery followed by orthopedic surgery (27.0%).
  
  
  CONCLUSIONS
  This study highlights the high burden of traumatic injuries in Kunduz province and MSF Trauma Center's contribution to saving lives, preventing disabilities and alleviating suffering among adults and children within the region. The bombing and destruction of KTC has resulted in a specific gap in critical healthcare services for the local communities in the health system of this war-ravaged region. This suggests the urgent need for reconstruction and re-opening of the center.
authors.affiliation: Médecins Sans Frontières-Operational Center Brussels, Kabul, Afghanistan.
authors.forename: Hamayoun
authors.identifier: http://orcid.org/0000-0003-0221-3846
authors.initials: H
authors.lastname: Hemat
authors.affiliation: Médecins Sans Frontières-Operational Research Unit, Luxembourg City, Luxembourg.
authors.forename: Safieh
authors.initials: S
authors.lastname: Shah
authors.affiliation: Médecins Sans Frontières-Operational Research Unit, Luxembourg City, Luxembourg.
authors.forename: Petros
authors.initials: P
authors.lastname: Isaakidis
authors.affiliation: Médecins Sans Frontières-Operational Research Unit, Luxembourg City, Luxembourg.
authors.forename: Mrinalini
authors.initials: M
authors.lastname: Das
authors.affiliation: International Union against Tuberculosis and Lung Disease, Mandalay, Myanmar.
authors.forename: Nang Thu Thu
authors.initials: NT
authors.lastname: Kyaw
authors.affiliation: Médecins Sans Frontières-Operational Center Brussels, Kunduz, Afghanistan.
authors.forename: Sattar
authors.initials: S
authors.lastname: Zaheer
authors.affiliation: Médecins Sans Frontières-Operational Center Brussels, Kunduz, Afghanistan.
authors.forename: Abdul Qayeum
authors.initials: AQ
authors.lastname: Qasemy
authors.affiliation: Médecins Sans Frontières-Operational Center Brussels, Kunduz, Afghanistan.
authors.forename: Mutallib
authors.initials: M
authors.lastname: Zakir
authors.affiliation: Médecins Sans Frontières-Operational Center Brussels, Kabul, Afghanistan.
authors.forename: Gbane
authors.initials: G
authors.lastname: Mahama
authors.affiliation: Médecins Sans Frontières-Operational Center Brussels, Brussels, Belgium.
authors.forename: Catherine
authors.initials: C
authors.lastname: Van Overloop
authors.affiliation: Médecins Sans Frontières-Operational Center Brussels, Brussels, Belgium.
authors.forename: Lynette
authors.initials: L
authors.lastname: Dominguez
mesh_terms: D000293:Adolescent; D000328:Adult; D000346:Afghanistan; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000473:pathology* / Q000601:surgery; D055815:Young Adult