Addressing the humanitarian surgical workforce crisis: a proposal for the International Humanitarian Surgery Training and Accreditation Board

Humanitarian and conflict settings generate a substantial burden of surgically treatable conditions, yet the delivery of safe surgical care in these environments remains constrained by workforce limitations. Surgeons experienced in war and austere surgery are increasingly scarce, and contemporary surgical training, while appropriately designed for modern health systems, does not routinely prepare surgeons for the breadth, uncertainty, and ethical complexity encountered during humanitarian deployments. As a result, surgeons without prior war-zone experience are often recruited, creating a gap between available personnel and mission-specific surgical requirements. This manuscript examines the structural and educational factors contributing to this preparedness gap. It emphasizes the need for broad procedural competence, principled decision-making under severe resource and security constraints, and appropriate contextual evaluation of surgical performance in conflict settings. To address these challenges, we propose the establishment of an International Humanitarian Surgery Training and Accreditation Board as a voluntary, post-training framework for surgeons who choose to engage in humanitarian practice. The proposed board would provide structured preparation, context-appropriate standards, and ongoing professional support before, during, and after deployment, without altering existing surgical training paradigms. By aligning training, practice, and evaluation with the realities of modern humanitarian surgery, this framework offers a pragmatic and sustainable approach to strengthening the humanitarian surgical workforce.