Safe anaesthesia in unsafe corners of the world

Humanitarian organizations like the International Committee of the Red Cross (ICRC) provide surgical services in countries where the clinical standards may be lower than those described as minimal and some surgical procedures cannot be considered safe [6]. In times of armed conflicts and widespread violence, health care systems become more vulnerable and are unable to respond to population needs. Since 2015, the ICRC has followed the International Standards for a Safe Practice of Anaesthesia ratified by the World Federation of Societies of Anesthesiologists (WFSA). The ICRC's anaesthesia equipment and drugs kits are designed to conduct safe anaesthesia even in very basic settings and the institution has published an Anaesthetic Handbook [2] to provide guidance for anesthetists working in these austere environments. Even when working in an environment affected by armed conflict, minimum standards for pre, peri and post -operative care must be applied. The choice of anaesthetic techniques will have to be adjusted to suit the environment, equipment and professional competencies of the team. Particular challenges exist where conflict has damaged medical infrastructure, and health care financing is facing significant gaps. Furthermore, these settings might be affected by lack of supplies of drugs and equipment, especially controlled drugs due to security regulations or embargoes/sanctions. Skilled local staff may have fled to protect themselves and their families. All these factors will add to the challenges of providing surgical services in a country traumatized by war. (c) 2018 Elsevier Ltd. All rights reserved.