Building Resilience: Post‑Operative Care After Reconstructive Surgery in Iraq

War leaves permanent scars. Beyond the immediate devastation, thousands across northern Iraq live with burn contractures—legacy injuries from conflict, and accidents that limit mobility, cause pain, and strip dignity. Swisscross Foundation’s humanitarian surgical missions aim not only to reconstruct—but to restore hope. Our newly published retrospective study, “Postoperative Care After Reconstructive Surgery for Burn Contractures in Communities Affected by War: A Retrospective Study in Iraq,” underscores the power of follow‑up care in transforming outcomes. 

Why leadership in post‑operative care matters

While surgical intervention is critical for contracture release, it’s only the beginning. In war‑affected settings, access to consistent follow‑up and rehabilitation is often limited by displacement, socioeconomic pressures, and fractured infrastructure. This study, funded by the UAE Ministry of International Cooperation and the Malla Mustafa Barzani office, covered reconstructive missions conducted between October 1, 2021 and February 6, 2025 among 147 episodes of care for 123 patients, precisely documents these challenges. 

What the numbers reveal

Of the 123 patients, 59 were IDPs, 19 were refuges and 45 were local residents. 27% of patients were under the age of 10 and 50% under the age of 18 years. Female patients made 60% of the group and over 39% were male.

Key findings from the study include:

• Burns as a result of a weapon of war in:

  IDPs: 14%

  Refugees: 13%

  Local: 3%

• Follow-up adherence varied by status:

  Local residents: 90% maintained full follow-up

  Refugees: 83%

  Internally displaced persons (IDPs): 64%

  Overall non‑compliance was 4%  

• Physical therapy engagement:
  
  Formal rehabilitation prescribed in 34 cases

  Highest compliance among refugees (78%), lowest among IDPs (31%)

  Nearly half of patients used ad hoc care providers when access to formal services was limited  

• Complication rates:

  Occurred in 36% of all surgeries

  Most issues were minor and managed without an additional operation

  Reoperation needed in only 4% due to immediate complications, and 8% for relapse — with no major difference across groups  

How we supported outcomes

By combining structured support with flexibility, Swisscross—and its partners—enabled real-world improvement:

• Providing transport assistance and appointment coordination, especially for IDPs

• Partnering with local clinics and caregivers to deliver flexible rehabilitation options

• Ensuring unhindered access to follow-up across demographic groups, regardless of displacement status

These interventions turned challenges into measurable successes. 

What this means for war‑affected communities

1. Treatment continuity matters: Surgical care coupled with follow-up support leads to better functional recovery—even in unstable settings.

2. Flexible rehab models empower participation. Where formal facilities are scarce, local alternatives fill gaps.

3. Displacement isn’t destiny: With tailored logistics and outreach, even IDPs can achieve outcomes on par with locals.

4. Scalable lessons: These insights provide a blueprint for similar missions elsewhere in conflict zones.

Voices on the ground

Swisscross teams—local coordinators: Dr. Sarezh Saber and Dr Lass Azad, alongside surgeons from Switzerland, Canada, the UK, and Iraq—worked hand in hand to deliver both surgical and postoperative care. Their collaboration across hospitals – Zheen International Hospital, Rozhawa Emergency Hospital and, Shaqlawa Teaching Hospital -  illustrates the power of bridging community-based rehab and specialist expertise. 

Looking forward

This retrospective analysis offers vital evidence that high-quality, complex reconstructive surgery can be effective and sustainable in conflict settings—if postoperative infrastructure is built alongside the operating table.

Swisscross Foundation remains committed to:

• Expanding follow-up frameworks in displaced communities

• Training local teams in the importance of rehabilitation and postoperative tracking

• Scaling flexible rehabilitation providers alongside formal services

Conclusion

Surgery alone doesn’t define quality of care—what matters most is how patients heal afterward. Our study confirms a clear truth: even in the chaos of conflict, coordinated postoperative care heals more than wounds—it rebuilds lives.

The study was authored by the Swisscross team: Ian M. Furst, Sarezh Mohammed Saber, Lass Azad Abdulkarim, Nicola Keller, Mustafa Subhe Muhyadin, Sarmad Nashat Ahmad, Ala Ismail Shakur, Ahmed Ibrahim Berzenji, Michael Glogauer, Kathrin Schulze, Sarkhell Radha, Enrique Steiger, Walter Künzi, and Natasha Forster