16 October 2024, Cairo, Egypt – Each year nearly 5 million deaths occur because of trauma and a further 45 million sustain life changing injuries. This exceeds deaths caused by the combined effects of malaria, tuberculosis and HIV.

In 2023, in the Eastern Mediterranean Region, 8 Member States each recorded over 1000 conflict-related deaths (range 1038–14 248), including seven Member States classified by the World Bank as having fragile or conflict-affected situations (FCS). The Region is also subject to some of the most acute, large-scale and complex emergencies in the world. Nine of the Member States are classified as FCS, and between 2022 and 2023, 5 of the 10 deadliest natural disasters worldwide occurred in the Region.

Each of these crises has resulted in a heavy burden of trauma-related morbidity and mortality, including complex injuries and mass casualty incidents.

In Sudan, 23, 298 conflict-related deaths were reported between 15 April 2023 and 18 September 2024, figures generally acknowledged to be an underestimate due to access constraints. According to the Palestinian Ministry of Health, the war in Gaza resulted in 41, 455 fatalities and around 96000 injuries, between 27 October 2023 and 22 September 2024, with women and children accounting for 72% of the deaths.

Limited prehospital care is of particular concern. Between 60–80% of trauma deaths in FCS countries across the Region occur before reaching hospital, and in protracted humanitarian crises the trauma burden can remain at high levels for many years.

The effective management of trauma requires a functioning trauma care pathway embedded within a comprehensive system of emergency, critical and operative care services. However, in many humanitarian settings, already-fragile health systems have been severely weakened and damaged, restricting the capacity of health workers to provide essential health services, including trauma care.

Historically, there has been a reluctance to invest in emergency care systems due to a range of factors, including a perception of prohibitive costs and the complexity of care processes and the challenges of demonstrating clear morbidity and mortality outcomes when compared with interventions for single diseases such as malaria or HIV. In addition, interventions to improve care for trauma patients may have significant mortality benefits but bring with them the risk of an increasing burden of morbidity in survivors which fragile health systems may struggle to manage.

Operational constraints due to insecurity, access restrictions and bureaucratic impediments can further limit the delivery of essential health and trauma care. Moreover, there are few agencies with the mandate or capacity to provide trauma care in humanitarian settings, especially in protracted conflicts.

Building on successful experiences in Iraq and the occupied Palestinian territory, WHO established the Regional Trauma Initiative in 2020 to help address gaps in trauma care in humanitarian settings. Through technical and operational assistance and capacity-building, the Initiative has supported the response to more than 200 mass casualty incidents across five conflict-affected settings with an estimated reach of 800 000 injured patients.

To further expand and improve trauma care in humanitarian settings across the Region, WHO has developed an operational framework for these unique and challenging contexts built around linkages between emergency, critical and operative care services.

This includes community, primary and prehospital care, acute hospital care, pain management and palliative care, and rehabilitation services. The approach ensures that all opportunities to reduce morbidity and mortality for trauma patients are addressed and that a patient’s transition between different services is as smooth as possible.

A technical paper on addressing the increasing burden of trauma in humanitarian settings in the Eastern Mediterranean Region was discussed during the 71st session of the Regional Committee for the Eastern Mediterranean.