Paper: MSF and care for the victims of war: dilemmas on treatment priorities

Paper details

Paper authors Vanja Kovacic
In panel on Medical quality and Patient-centered care
Paper presenter(s) will be presenting In-Person / Online


BACKGROUND: MSF Reconstructive Surgery Programme (RSP) in Amman Jordan is providing health care for the victims of war from Syria, Yemen, Palestine and Iraq. The lengthy rehabilitation of patients includes surgical interventions, physiotherapy and psychosocial support. Complicated surgical cases often require innovative surgical approaches, which make this programme unique in the global landscape of war related surgery. Such specialized care is focused primarily on improving functionality of injured limbs.
METHODS: A two-years long qualitative research was conducted to explore how successfully were medical objectives transmitted to patients’ quality of life after discharge. The original aspect of this research is that patients’ own definitions of the quality of life were used to conduct this exploration. The methods included in-depth interviews (76) with Iraqi and Syrian patients about two years after discharge. In addition prolonged observations in the hospital and in patients’ homes, where interviews were conducted, provided insights. The interviews were transcribed and analysed using thematic analysis approach.
RESULTS: For patients who accessed hospital to treat orthopaedic injuries, the medical objectives met or exceeded their expectations. In contrast, for those patients who suffered from physical impairments (burns, scars) there was an obvious discrepancy. They reported that aesthetic improvements rather than functionality of their limbs were their priority, but not the priority of MSF. Very little negotiation space was given to them in the process of planning their treatment or in communication of their preferences. The programme also lacked elements of emotional support for paediatric patients and long-term post discharge care.
CONCLUSION: Outcomes of the highly- quality specialized surgical care delivered at the RSP did not completely overlap with patients’ own treatment objectives. The rehabilitation process, from patients’ perspective is not limited to the reconstruction of their bodies, but also requires emotional, social and symbolic healing. Up to which extend could providers of care for war-injured accompany patients on this journey is a question that remains opened.



Vanja Kovacic