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Towards resilient health systems: opportunities to align surgical and disaster planning
  1. Jordan Pyda1,2,
  2. Rolvix H Patterson1,3,
  3. Luke Caddell1,4,
  4. Taylor Wurdeman1,4,
  5. Rachel Koch1,5,
  6. David Polatty6,
  7. Brittany Card6,
  8. John G Meara1,7,
  9. Daniel Scott Corlew1
  1. 1Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
  2. 2Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  3. 3Tufts University School of Medicine, Boston, Massachusetts, USA
  4. 4University of Miami School of Medicine, Miami, Florida, USA
  5. 5Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  6. 6Humanitarian Response Program, US Naval War College, Newport, Rhode Island, USA
  7. 7Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Jordan Pyda; jordanpyda{at}


Natural disasters significantly contribute to human death and suffering. Moreover, they exacerbate pre-existing health inequalities by imposing an additional burden on the most vulnerable populations. Robust local health systems can greatly mitigate this burden by absorbing the extraordinary patient volume and case complexity immediately after a disaster. This resilience is largely determined by the predisaster local surgical capacity, with trauma, neurosurgical, obstetrical and anaesthesia care of particular importance. Nevertheless, the disaster management and global surgery communities have not coordinated the development of surgical systems in low/middle-income countries (LMIC) with disaster resilience in mind. Herein, we argue that an appropriate peridisaster response requires coordinated surgical and disaster policy, as only local surgical systems can provide adequate disaster care in LMICs.

We highlight three opportunities to help guide this policy collaboration. First, the Lancet Commission on Global Surgery and the Sendai Framework for Disaster Risk Reduction set forth independent roadmaps for global surgical care and disaster risk reduction; however, ultimately both advocate for health system strengthening in LMICs. Second, the integration of surgical and disaster planning is necessary. Disaster risk reduction plans could recognise the role of surgical systems in disaster preparedness more explicitly and pre-emptively identify deficiencies in surgical systems. Based on these insights, National Surgical, Obstetric, and Anesthesia Plans, in turn, can better address deficiencies in systems and ensure increased disaster resilience. Lastly, the recent momentum for national surgical planning in LMICs represents a political window for the integration of surgical policy and disaster risk reduction strategies.

  • health policy
  • health systems
  • public health
  • surgery

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  • JP and RHP are joint first authors.

  • Handling editor Seye Abimbola

  • Contributors JP and RHP contributed equally to this paper. JP, RHP, LC, TW, RK and DSC conceived the manuscript. All authors contributed to the analysis. JP, RHP, LC, TW and DSC drafted the manuscript. RK, DP, BC and JGM provided critical review and final approval. All authors agreed to be accountable for all aspects of the work.

  • Funding RK reports grants from Ronda Stryker and William Johnston Global Surgery Fellowship Fund at Harvard Medical School, Boston, MA, USA, outside the submitted work. The Program in Global Surgery and Social Change at Harvard Medical School reports support from Monitoring and Evaluation for GE S2020-Developing Health Globally, a GE Safe Surgery Grant, and from the Steven C. and Carmella R. Kletjian Foundation, both outside the submitted work.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No additional data are available.

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