1. MSF NGO since 40 years Provide assistance to populations victim of crisis : –Conflicts, natural disasters –Epidemic –Exclusion from health care Chart: humanity, impartiality, independance,professionalism… 5 sections: France, Belgium, NL, Switz, Spain 63 countries 2000 volunteers + 30 000 nat staff Epidemiologic dpt : epicentre Logistic center : Bordeaux

2. Surgical activity MSF OCP sept 2011 Haiti : Port au prince (631) Nigeria : Port Harcourt, Jahun (262) (85) RDC : Nyanzale, Rushuru (422) Congo : Bétou (60) RCA : Paoua (137) Jordanie : Amman (77) Pakistan : Hangu, Peshawar (69) (15) Soudan : Aweil (250) Sri-Lanka : Point-Pedro, Mullaitivu(175) (200) Yemen : Khameer, Althal, Saana stand by (80) Palestine : Gaza( 33) Cote d’ivoire : Abidjan, Doueque (178) Lybie : Misrata (150) Somalia : Mogadiscio remote control (?)

3. Surgical activity MSFF jan-dec 2010 25 516 procedures 2126 /month (2009 : 23.417 p )

4. Surgical indications MSF OCP jan-dec 2010 18% 20% Accidents 51% Violence 10% 61% 2009 : 15% obst ; 24% med ; 61 % trauma 43 % acct 18 % violence

5. Types of surgery MSF OCP 2010 Soft tissues: 20% Ortho 15% 18% 24% 4% 6%

6. Surgical emergencies MSFF jan-dec 2010 Planned & elective surgery 14% Acute (35%) & delayable (51%) emergencies 86% 2009 : emergency 70% planned 30%

7. Peri operative mortality MSFF jan-sept 2009 10 813 procedure records evaluated (62%) 132 deaths pre opper oppost op 15%9%76%

8. Causes of perioperative mortality MSFF jan-sep 2009 Shock (88%) –hemo 33% (43) trauma, obst… –Septic 17% (22) acute abdomen.. –X organ failure 38% (50) burns, trauma… Pulmonary embolism suspected 5% (7) Head injury 3% (4) Unclear, anesthesia … 4% (6)

9. Factors contributing to mortality : Lack of post op surveillance No recovery room Haemorragic shock associated with inadequate monitoring Poor surveillance by nurses (ICU) : No or suboptimal prophylaxis : pulm.embolism : Hypovolemic shock associated with difficulties of veinous acces : Lack of anaesth pre op assessment : Complications of elective surgery

10. Objective 2012 Implementation ICU units of level 1 in each MSF hospital