Pediatric surgical practices in children under conflict and the case of Gaza after October 7

Yıl 2024, Cilt: 29 Sayı: Special Issue on Gaza, 38 - 51, 28.12.2024

Emre Çelik , Taner Kamacı

https://doi.org/10.21673/anadoluklin.1593801

Öz

Aim: The health crisis resulting from Israel’s attacks on Gaza after October 7th, and the need for a comprehensive analysis of pediatric surgical practices in conflict zones, must be thoroughly addressed. The aim of this study is to describe the challenges encountered in providing pediatric surgical care under conditions of limited healthcare services.

Methods: A retrospective analysis was conducted on 31 pediatric cases that underwent surgical procedures at the Gaza European Hospital between March 18, 2024, and April 1, 2024. Data collected included the patients’ age, gender, place of residence, mode of admission, surgical indications, mechanism of injury, anesthesia details, shortages in medical supplies, and in-hospital morbidity and mortality rates. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as counts (n) and percentages (%). The Chi-square test was used for the comparison of categorical variables.

Results: The mean age of the 31 cases included in the study was 5.86 years (ranging from 7 months to 14 years). During this period, 20 patients (64.5%) underwent pediatric surgical procedures due to war-related injuries, such as bombings and shrapnel wounds. Of the cases, 21 (67.7%) were displaced or forcibly relocated individuals, while 10 (32.3%) were local residents. The majority of cases involved polytrauma (9 cases, 29%) and intestinal perforation (9 cases, 29%). The most common surgical procedures included laceration repair for polytrauma resulting from bombings or debris-related injuries (6 cases, 19%), primary repair of intestinal perforation via laparotomy for shrapnel-induced injuries (4 cases, 12%), intestinal resection and anastomosis via laparotomy (4 cases, 12%), and laparoscopic inguinal hernia repair (4 cases, 12%). Postoperative sepsis occurred in only one case (3.2%), which subsequently resulted in in-hospital mortality (3.2%).

Conclusion: Local healthcare providers and volunteer pediatric surgeons working with international humanitarian organizations have played a vital, life-saving role in addressing both the injuries inflicted on children due to Israeli attacks and the broader humanitarian needs. The surgical interventions performed on 31 cases demonstrate that even under challenging circumstances, highly limited pediatric surgical care and services can be delivered. Moreover, these cases highlight the critical importance and superiority of conducting pediatric surgical interventions under the expertise of specialized professionals.

Anahtar Kelimeler

Conflict, emergency treatment, first aid, Gaza, pediatrics

Çatışma altındaki çocuklarda pediatrik cerrahi uygulamaları ve 7 Ekim sonrası Gazze örneği

Öz

Amaç: 7 Ekim sonrası İsrail’in Gazze’ye başlattığı saldırılar sonucunda yaşanan sağlık krizinin ve çatışma bölgelerinde çocuklara yönelik pediatrik cerrahi uygulamalarının kapsamlı bir şekilde ele alınması gerekmektedir. Bu çalışmanın amacı, pediatrik cerrahi uygulanan olgularda sınırlı sağlık hizmeti sunumunda karşılaşılan zorlukları açıklamaktır.

Yöntemler: 18 Mart 2024’ten 1 Nisan 2024’e kadar Gazze Avrupa Hastanesi’nde pediatrik cerrahi uygulanan 31 olgu retrospektif olarak incelendi. Pediatrik olguların yaş, cinsiyet, hasta yerleşim yeri, başvuru şekli, cerrahi işlemin endikasyonu, yaralanma mekanizması, anestezi, tıbbi malzeme eksikliği ve hastane içi morbidite, mortalite verileri kaydedildi. Sürekli değişkenler ortalama ve standart sapma ile kategorik değişkenler sayı (n) ve yüzde (%) olarak ifade edilmiştir. Kategorik değişkenlerin karşılaştırmasında Ki-Kare testi kullanılmıştır.

Bulgular: Çalışmaya dâhil edilen 31 vakanın ortalama yaşı 5,86'ydı. Bu süre içinde hastaların 20’sine (%64,5) bombalanma, şarapnel parçasıyla yaralanma gibi savaş yaralanmaları nedeniyle pediatrik cerrahi işlem uygulanmıştır. Olguların 21’i (%67,7) yerinden edilmiş, göçe zorlanmış vatandaş, 10’u (%32,3) ise yerel idi. Olguların büyük çoğunluğu politravma (9, %29), barsak perforasyonu (9, % 29) vakalarıydı. Bombalanmaya ya da enkazda yaralanmaya bağlı politravma hastalarının laserasyon onarımı (6, %19), şarapnel parçasıyla yaralanmaya bağlı barsak perforasyonu için laparotomiyle barsak perforasyonu primer onarımı (4, %12), laparotomiyle barsak perforasyonu rezeksiyon ve anastomoz (4, %12), laparoskopik inguinal herni onarımı (4, %12) en yaygın işlemlerdi. Sadece bir olguda ameliyat sonrası sepsis gelişti (%3,2) ve hastada sonrasında hastane içi ölüm (%3,2) görülmüştür.

Sonuç: Yerel sağlık hizmeti sağlayıcıları ve uluslararası insani yardım kuruluşlarına bağlı çalışan gönüllü çocuk cerrahları hem İsrail’in saldırıları nedeniyle çocuklarda meydana gelen yaralanmalar hem de insani ihtiyaçlar için değerli, hayat kurtarıcı rol üstlenmişlerdir. Cerrahi müdahale uygulanan 31 olgu zorlu koşullar altında bile olsa son derece sınırlı pediatrik cerrahi hizmeti ve bakımı verilmekte olduğunu ve aynı zamanda pediatrik cerrahi müdahalelerin uzmanlaşmış kişiler eliyle yapılmasının üstünlüğünü göstermektedir.

Anahtar Kelimeler

Acil tedavi, çatışma, Gazze, ilk yardım, pediatri

Kaynakça

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