Surgical Needs of Refugee Populations in the European Union: Implications for Plastic and Reconstructive Surgery

In 2015, hundreds of thousands of refugees decided to take up the dangerous and oftentimes deadly crossing into countries of the European Union (EU). Many of them were already living in dismal situations. Millions have been trapped. This situation deteriorated throughout the year. Due to the war in Syria, but also other humanitarian situations and developmental crises, including harsh poverty and social deprivation, the EU is currently facing a very high inflow of refugees and other migrants, with many children among them.1,2 Civil unrest and armed conflicts generate vital and complex needs in emergency medicine, surgery, and rehabilitation. Health conditions of refugee populations vary greatly based on origin, geographic location, underlying medical, and nutritional status, and the events causing the initial relocation. The humanitarian condition of refugees can have progressed over a long time. The years in the conflict region or refugee camps might have marked them with relative malnutrition, and insufficient access to medical services so that some may present with diseases which are uncommon under normal conditions. As the humanitarian crisis progresses, malnutrition and disease prevalence increases making a population more susceptible to illness with compromised immune systems and poorer wound healing mechanisms. During a crisis situation, resources are limited and the utilization of expensive resources for patients that will not survive is unwarranted and wasteful.1,2 While recent action on surgical care for refugees tended to focus on the acute phase of the crisis situations, this paper posits that a substantial burden of non-acute morbidity amenable to surgical intervention among refugees and other migrants upon arrivals falls upon the host countries, and their societies. Drawing on past experience in humanitarian crisis situations is crucial to understand the complexity of treating patients presenting with injuries with a long time lag, as not only humanitarian conditions prevent patients from seeking surgical treatment, but also financial, structural as well as cultural barriers exist.3 EU Member States are challenged with the medical needs of refugees upon arrival, in particular surgical needs. Large inflows of people overstretch health services available to refugees and to others of the affected countries. Although infectious diseases, malnutrition and diarrhea account for the vast majority of deaths in many crisis situations, many individuals suffer from 1. Department of Plastic Surgery, Klinikum Bogenhausen Teaching Hospital, Technical University Munich, Germany; 2. Data and Population Analysis Department, United Nations Population Fund, Technical Division, Population and Development Branch, United Nations, New York, NY, USA