BACKGROUND: Access to surgical care in low-to-middle-income countries (LMIC) especially in war-torn and refugee-densely populated areas such as Palestine is increasingly recognized as a global health priority. Plastic surgical capacity in Palestine has not been evaluated before in the current published literature. The aim of this study was to conduct the first systematic, comprehensive, and nationwide evaluation of plastic surgical capacity in Palestine.
METHODS: This is a cross-sectional study conducted between December 2022 and February 2023 and included all healthcare facilities that provide plastic surgery services in Palestine except private centers run by non-surgeons. A modified version of the validated 5-domain Personnel, Infrastructure, Procedures, Equipment, and Supplies (PIPES) tool was administered in each facility through a face-to-face interview. Hospitals’ PIPES indices were computed; data were aggregated and analyzed for geographic and private/public disparities.
RESULTS: A total of 9 facilities were included in the study; 5 (55.6%) were in the West Bank and 4 (44.4%) in Gaza. The majority were governmental hospitals (n=5, 55.6%). The mean PIPES index was (Personnel = 4.1, Infrastructure = 18.6, Procedures = 10.2, Equipment = 19.7, and Supplies = 22.4). The number of hospital beds, functioning operating rooms, and plastic surgeons (regardless of board-certification status), per 100,000 people were 41.3, 0.9 and 0.4, respectively. There were only 4 board-certified plastic surgeons; only one in Gaza. None of the facilities surveyed had a plastic surgery residency training program. Deficiencies in PIPES were significant as follows: 77.8% of facilities do not perform free flaps (none in Gaza), 55.6% do not perform any microsurgical procedures (none in Gaza), 55.6% lack a system to identify complications, and 55.6% of facilities do not offer regular plastic surgery CME courses to their plastic surgeons. The average hours of electricity per day in Gaza vs West Bank was 8.0 vs 24.0, p=0.02.
CONCLUSIONS: Evaluating plastic surgical capacity in Palestine reveals significant deficiencies across all five domains of the modified PIPES tool, most pronounced in Gaza. We hope these results would inform stakeholders about the status of plastic surgery in Palestine to help eliminate surgical care disparities, to build plastic surgical training programs, and to improve access to safe plastic surgical care in the country.