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Fragmented geographies and trauma pathways in the Middle East

Lookup NU author(s): Dr Alaa Ismail, Dr Craig JonesORCiD

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).

Abstract

Enduring and interlocking conflicts across the Middle East over the last 25 years have generated injuries on a large scale. While civilian injuries in the region have been widely documented, very little is known about civilian trauma pathways—the system designed to manage patients from the moment of injury through to rehabilitation. Military trauma pathways are premised on rapid evacuation, coordinated referral and timely access to treatment, but replicating these systems for civilians, under conditions of active and ongoing conflict, presents many challenges. Civilians can be injured almost anywhere—far away from hospitals, without access to ambulances, emergency and other services—and in absence of a clear trauma pathway, their care trajectory in the weeks and years after sustaining injury is highly inequitable and geographically fragmented. This analysis examines some of the problems posed by the geographical fragmentation of civilian trauma pathways and reflects on what might be done to rebuild and improve them.

Publication metadata

Author(s): Skelton M, Abu Sittah G, Sater ZA, Ismail A, Wild HB, Fakhri RM, Bowsher G, Sullivan R, Jones C

Publication type: Article

Publication status: Published

Journal: BMJ Global Health

Year: 2026

Volume: 11

Online publication date: 04/05/2026

Acceptance date: 04/04/2026

Date deposited: 09/09/2026

ISSN (electronic): 2059-7908

Publisher: BMJ Publishing Group

URL: https://doi.org/10.1136/bmjgh-2025-021217

DOI: 10.1136/bmjgh-2025-021217

Data Access Statement: There are no data in this work.

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