Surgical workforce in conflict: qualitative perspectives from the Middle East and North Africa

Abstract Introduction There is a paucity of data regarding the experiences of the local surgical workforce present during conflicts. Whilst we know that surgical trauma burden increases during conflict, little is known about workforce adaptation to new injury modalities, higher caseloads, and additional system pressures. Qualitative research is an effective methodology for elucidating surgical systems in such settings. Methods Medically qualified personnel performing surgery during a conflict, who had worked in this setting before the onset or escalation of conflict, were identified through a pre-interview questionnaire distributed through the Royal College of Surgeons of England and other targeted networks. A structured guide was used to conduct in-depth interviews and a thematic analysis was undertaken. Results Surgical practitioners (male:female 19:2), of different seniority and representing 9 subspecialties, from 9 Middle Eastern and North African countries were interviewed. There were notable differences in the experiences of practitioners within new conflict settings (Libya, Syria, Egypt and Sudan) compared to those with previous conflict experience, where medical education and training were more likely to be uninterrupted. This necessitated training during active situations, which many practitioners regarded as very fruitful. Junior trainees in new conflict areas often had to ‘act up’ under intense pressure, often without adequate supervision whilst practitioners in previous conflict settings have normalized conflicts and developed cultural coping mechanisms. Conclusion This study contributes to the evidence gap on the surgical workforce in conflict settings and highlights the need for innovative and swift support for entire surgical ecosystems to maximize impact.