Access, Quality, and Outcomes of Surgical Care in Humanitarian Crises, Gallstone disease complications in the Gaza Strip as a case: a prospective study

Text: Introduction: While trauma dominates surgical priorities in armed conflicts, patients with non-traumatic chronic surgical conditions silently bear the consequences of disrupted care. The deliberate destruction of Gaza's healthcare system, rendered half of the hospitals non-functional, with the remainder facing critical shortages. We evaluate how this forced shift of priorities affected the accessibility, quality, and outcomes of surgical care for patients with complicated gallstone disease (CGSD). Methods: A prospective observational study was conducted between October and December 2025 across Ministry of Health and NGO-led hospitals in Gaza. 101 patients with CGSD were included, 60 completing 30-day follow-up. Data was collected using the Austere Settings Surgical Evaluation Tool-Gallstone Module (ASSET-G). Results: Of 101 patients, 71.3% were female with a median age of 44 years, and 94.1% were forcibly displaced. Acute cholecystitis was the most common presentation (75.2%). Ultrasound was used in 98% of cases. Conservative management predominated (58.4%), while 37.6% had surgery-laparoscopic cholecystectomy (29.7%). Notably, 35% of conservatively managed patients required surgery. Barriers to care included lack of transportation (69.3%), long waiting times (44.6%), and medication shortages (41.6%). Despite these constraints, 61.4% rated care as good or excellent. Two deaths (3.3%) were recorded, one attributable to system-level delays in re-intervention. Conclusion: Even though CGSD care remained partially functional at times of armed-conflict escalations, this study reveals critical gaps in access, resource availability, and continuity of care that compromised patient outcomes, emphasizing the urgent need for support to restore surgical services and reduce the preventable burden of disease during wartime.