Strengthening health systems for displaced populations: AA systematic review of access to surgical care in low- and middle-income countries

Abstract

There are over 122 million forcibly displaced people in the world, many of whom face complex healthcare needs. A global estimate from 2016 suggested that around three million surgical procedures are needed annually to meet the needs of refugees, internally displaced people and asylum seekers. This systematic review aims to synthesise literature on access to surgical care for displaced populations living within camp settings in low- and middle-income countries. Relevant articles were identified by searching three databases between January 2003 and June 2024, with no language restrictions, and findings were synthesised narratively. In total, 21 studies met our inclusion criteria. Findings were synthesised thematically under macro-, meso-, and micro-level factors influencing access to surgical care. Macro-level factors included political support and availability of funding, cost-effectiveness of surgical provision and interactions between displaced and host-country populations. At the meso-level, provision of surgical care within camps was constrained by limited resources. In some settings, these challenges were mitigated through task-shifting and sharing, adoption of tele-medicine and collaboration with local and international partners. Referrals to outside facilities were indispensable to treat surgical patients who could not be managed within camp settings. Micro-level factors included socio-demographic and cultural characteristics of refugees as well as patients’ ability to pay for healthcare services. Our review provides comprehensive insights into the barriers and facilitators that influence access to surgical care within these settings, which is crucial to address the pressing healthcare issues faced by displaced populations