Surgical challenges in Non-combatant Evacuation Operations.

Background: Global uncertainties have prompted nations to adopt vigilant approaches to safeguard their citizens. Recent crises have compelled Western nations to undertake evacuations, ranging from peaceful scenarios to urgent military interventions. In April 2023, Sudan descended into civil war, prompting France to orchestrate a complex evacuation operation leveraging prepositioned forces in Djibouti.

Materials & Methods: This retrospective observational study aims to analyze the surgical challenges encountered during Operation SAGITTAIRE (OS), focusing on human, technical, and logistical requirements for successful military interventions in multinational civilian populations.

Results: OS successfully evacuated 1017 individuals of 84 nationalities from Khartoum using road, sea, and air routes. Special forces teams, including the Surgical Life-saving Module (SLM), were mobilized alongside conventional military elements. The Joint Medical Surgical Center (JMSC) in Djibouti served as a permanent medical facility with comprehensive facilities and staff. Air Medical evacuations were performed for vicitms and surgical interventions were conducted, including damage control surgery, orthopedic procedures, and debridements. Five surgical evaluations and four surgical procedures were performed. The operation spanned 96 h without death. The SLM, deployed in Khartoum and within an aircraft, played a crucial role.

Discussion: OS highlighted the need for a comprehensive health support system. Challenges in assessing health needs led to the establishment of a substantial and adaptable system. The report emphasizes the importance of a comprehensive approach to support Non-combatant Evacuation Operations in French Doctrine.

Conclusion: OS showcased the French Health Military Service's capabilities in deploying a comprehensive damage control chain in challenging environments. This fatality-free success underlines the effectiveness of coordinated resuscitation, damage control, and transportation. Evacuation operations in non-combatant settings during civil wars pose formidable challenges, requiring a modular and adaptable support concept. Coordination, communication, logistical preparation, and training are crucial elements for successful management of such operations.