The study, led by Mohammed Yousof Bakhiet, a surgeon affiliated with Al-Baha University in Saudi Arabia and the University of Kordofan in Sudan, used a structured online questionnaire distributed between June 15 and 20, 2025. Every one of the 14 plastic surgeons working in Sudanese governmental hospitals responded, a 100 percent response rate that itself speaks to the tiny size of the workforce. The respondents had a median age of 48.5 years, and 13 of the 14 were men, a distribution the author attributes to the pre-existing gender imbalance in Sudanese plastic surgery rather than any war-specific effect. Half were consultants and half were specialists who had completed postgraduate training within the previous five years, and half reported more than a decade of surgical experience.

The most striking demographic finding was displacement. Nearly two-thirds of the surgeons — nine of the 14 — had been forced from their homes by the fighting, joining the millions of Sudanese internally displaced since the conflict began. Most plastic surgery units in the country were run by a single surgeon, and when those surgeons fled, the units effectively ceased to exist. Before the war, plastic surgery services were concentrated in Khartoum, with smaller regional units in Atbara, Kassala, Port Sudan and Shendi. As fighting engulfed the capital, most Khartoum-based services stopped, and the burden shifted to the already under-resourced peripheral centers. A single plastic surgeon in Elobied, a city under active fighting and siege, now represents the only provider of plastic surgery services in a combat zone in the country.

The survey’s central result is bleak: 86 percent of respondents said the availability of plastic surgery services in their facilities had been severely disrupted or had ceased entirely. Only a small minority reported no impact. Reconstructive work — burn management, complex wound reconstruction, facial trauma repair and limb salvage — was universally affected, with nearly 79 percent of surgeons reporting that all of these procedure categories had been compromised. Half of the respondents said reconstructive operations were often delayed, and another 28 percent said they were always delayed. For patients with war wounds, where soft tissue loss, exposed bone, and damaged vessels and nerves demand advanced reconstructive techniques within tight time windows, such delays translate directly into amputations, disfigurement and death.

Perhaps counterintuitively, the raw numbers of operations did not collapse. Before the war, half of the surgeons reported performing three to six emergency operation lists per month; during the war, 64 percent reported more than six. Elective lists and outpatient clinics showed no statistically significant change before versus during the conflict, with p-values of 0.357 and 0.564 respectively. But the author cautions that these figures mask a profound shift in the character of surgical work. Personal communication with colleagues suggests the operation lists have swung heavily toward emergency and trauma-related procedures, while elective reconstruction and patient follow-up have withered. This pattern — where a surge in trauma volume conceals the erosion of routine surgical services — has been documented in other conflict zones, including Syria, Yemen and Ukraine, and it carries a hidden long-term cost: surgeons who operate only on blast and gunshot injuries for years risk losing the broader technical repertoire that defines their specialty.

The logistical failures underpinning this erosion were consistent across respondents. Limited access to surgical equipment and disruption of supply chains for medications and disposables were each cited by 86 percent of surgeons as major challenges. Close behind, 71 percent pointed to the lack of intensive care or post-operative capacity — a critical gap for patients undergoing complex reconstructions, who often require prolonged ventilatory support and flap monitoring in the hours after surgery. Shortages of qualified plastic surgeons and inadequate anesthesia support, each reported by 57 percent, rounded out the list. These findings mirror earlier reports from Sudan, including a 2024 study that found more than half of surgical practitioners in conflict zones had ceased practice entirely, and analyses showing that only about one-third of hospitals in war-affected areas continue to function at all.

The human resource picture may be the most consequential for Sudan’s recovery. Twelve of the 14 surgeons — 86 percent — reported a severe impact on the availability and retention of trained staff. Continuing medical education was rarely available for 64 percent of respondents and only occasionally available for the rest; just 7 percent reported regular access. The author links this academic isolation to a documented decline in training quality, citing a separate study of Sudanese surgical residents that found widespread concern about reduced case volumes and learning opportunities in operating theaters. The risk is a compounding brain drain: as training pipelines dry up, the next generation of reconstructive surgeons never materializes, and the country’s capacity to treat war injuries — and, eventually, the enormous backlog of untreated deformity and disability — shrinks further.

Institutional support, which in most humanitarian crises cushions health systems against exactly this kind of shock, was largely absent. Half of the respondents’ hospitals received no external support for surgical services at all, and only 29 percent reported receiving any. The author contrasts this isolation with other conflict settings, where international partnerships with non-governmental organizations have helped sustain at least essential medical services, and suggests that insecurity, access difficulties and competing organizational priorities have left Sudan’s surgical services outside the reach of the global humanitarian response. The result is a health system running on local goodwill and improvisation, with surgeons continuing to operate despite unpaid salaries, personal displacement and physical danger.

When asked what they needed most urgently, the surgeons’ answers formed a stark roadmap. Medical equipment and supplies topped the list at 43 percent, followed by trained plastic surgeons and personnel at 36 percent. Education and training programs and health system logistics each drew 21 percent, and funding 7 percent. The emphasis on training, even amid active combat, reflects a professional conviction that sustainable care requires continuous development — that a surgeon who cannot learn cannot long remain effective. The author acknowledges the study’s limitations: a sample of 14, self-reported data vulnerable to recall bias, restriction to governmental hospitals, and the use of categorical ranges for case volumes, which limited statistical analysis. But with only 14 plastic surgeons in the entire country, the sample is effectively the population, and the picture it paints is unlikely to be distorted by small numbers.

What emerges from this survey is a case study in how war hollows out a surgical specialty from the inside — not through a single dramatic event, but through the slow attrition of supplies, staff, training and institutional support. Plastic surgery occupies a peculiar position in wartime medicine: it is simultaneously a frontline necessity for the complex wounds that modern violence inflicts and a long-horizon discipline whose value is measured in function restored and lives rebuilt over years. Sudan’s 14 wartime plastic surgeons are holding that dual mandate together under siege conditions. The survey’s message to the international community is unambiguous: without urgent deliveries of equipment, supplies and trained personnel, the specialty that Sudan’s wounded most need may simply not survive the war that created the need.

Subject of Research: The impact of armed conflict on plastic surgery services and surgical workforce in Sudan

Article Title: Survey of challenges faced by plastic surgery services during the current Sudan conflict

Article References: Bakhiet, M. Y. (2025). Survey of challenges faced by plastic surgery services during the current Sudan conflict. BMC Plastic and Reconstructive Surgery, 1(1), Article 8. https://doi.org/10.1186/s44452-025-00008-2

Image Credits: AI Generated

DOI: 10.1186/s44452-025-00008-2

Keywords: Sudan conflict, plastic surgery, reconstructive surgery, war injuries, health system collapse, humanitarian crisis, surgical workforce, trauma surgery, displacement, supply chain disruption, medical education, global surgery

The research, conducted by Elizabeth Kafui Senya of Accra Technical University and Anthony Bordoh of the University of Education, Winneba, focuses on the Accra Metropolitan Area, the commercial heart of Ghana and the hub of its tourism economy. Published in SN Social Sciences, the study surveyed 90 senior managers drawn from hotels, restaurants, shopping malls, car rental services and allied venues across the Greater Accra Region. Using a multi-stage sampling procedure, the researchers first selected nine Municipal and Metropolitan District Assemblies and then reached the managers who had lived through the pandemic’s worst disruptions at first hand.

The findings document a cascade of operational failures that unfolded in a predictable but devastating sequence. Mobility restrictions imposed by the government, including the Executive Instrument E.I. 63 that limited movement and gatherings, triggered an acute contraction in demand. With travellers staying home and international visitors absent, revenues collapsed. Firms responded by retrenching workers, deepening the economic pain in a sector that is one of Ghana’s most important employers. Supply chains fractured at the same time, as suppliers of food, beverages and hospitality consumables faced their own lockdown constraints. The cancellation of international conferences removed another critical revenue stream, one that fills hotel rooms and restaurant tables in Accra throughout the year, particularly during the peak season.

These results align with a broader international literature on the pandemic’s impact on hospitality. Studies from India, Spain and global assessments of tourism during COVID-19 all recorded demand shocks, workforce losses and supply disruption. But the Ghanaian study adds an important dimension: the perspective of firms operating in an emerging economy where government support was limited and where many businesses had no financial reserves to fall back on. The authors argue that structural vulnerabilities in developing economies made the pandemic disproportionately damaging, and that understanding how firms in such contexts coped is essential for building crisis-ready industries worldwide.

Methodologically, the study is notable for the rigour of its measurement. The researchers employed a quantitative cross-sectional survey design consistent with the positivist research paradigm, distributing structured questionnaires to the participating managers. To test whether their survey instruments reliably captured the concepts they intended to measure, they turned to Confirmatory Factor Analysis embedded within Partial Least Squares Structural Equation Modelling, a statistical framework widely used in business research for handling complex relationships between latent constructs. The psychometric results were exceptionally strong. Cronbach’s alpha, a measure of internal consistency, ranged from 0.979 to 0.987 across the study’s three constructs, far above the conventional threshold of 0.70. Composite reliability values ranged from 0.981 to 0.990, and the average variance extracted, which indicates how much of the variance in the indicators is captured by the underlying construct, fell between 0.795 and 0.898, well above the 0.50 benchmark typically required for convergent validity. All factor loadings exceeded 0.70, meaning every survey item contributed meaningfully to its construct.

For readers unfamiliar with these statistics, the numbers matter because they tell us the findings rest on solid measurement rather than noisy data. When Cronbach’s alpha approaches 0.99, respondents answered related questions in a highly consistent way, suggesting the survey tapped a coherent underlying reality. High average variance extracted means the constructs are distinct and well defined. In practical terms, the study’s conclusions about disruption and resilience are not artefacts of a poorly designed questionnaire; they reflect carefully validated evidence from the field.

So what actually helped firms survive? The managers surveyed identified a clear hierarchy of resilience levers. At the top of the list were prophylactic health programmes, preventive measures designed to protect staff and customers from infection and to keep operations running safely. Closely linked to this was a call for equitable health infrastructure, reflecting the recognition that business resilience in a pandemic is inseparable from public health capacity. Firms that could trust the surrounding health system, and that invested in their own protective protocols, were better positioned to reassure customers and maintain operations under restrictions.

Insurance uptake emerged as another critical strategy. In an economy where many small and medium-sized hospitality businesses operate without formal risk coverage, the pandemic exposed the cost of that gap. Managers who had insurance, or who recognised its value during the crisis, identified it as a key buffer against revenue collapse. The study suggests that expanding insurance penetration in the sector should be a policy priority, not only for individual firms but for the industry’s collective resilience.

Diversification of delivery services and digitalisation rounded out the resilience agenda. With dine-in traffic restricted, restaurants and hotels that could pivot to delivery, takeaway and online ordering maintained at least a trickle of revenue. Digital tools, from online booking platforms to mobile payment systems and social media marketing, allowed firms to reach customers without physical contact and to adapt their offerings as conditions changed. The pandemic, in effect, accelerated a digital transition that many Ghanaian hospitality firms had postponed, and the managers surveyed now regard digital capability as a core survival asset rather than an optional extra.

The study’s contribution goes beyond documenting damage. By providing empirical, firm-level evidence from an understudied Sub-Saharan emerging economy, it fills a gap in the crisis management and organisational resilience literature, which has historically been dominated by research from Europe, North America and Asia. The authors argue that resilience in hospitality is not a one-size-fits-all formula: strategies that work in well-resourced markets may be unavailable or insufficient in contexts with weaker institutions and thinner financial safety nets. Their findings point toward a resilience agenda tailored to developing economies, one that combines firm-level actions such as digitalisation, diversification and insurance with system-level investments in health infrastructure and public health preparedness. As the world braces for future pandemics and climate-related disruptions, the experience of Accra’s hotels, restaurants and malls offers a sobering lesson: the businesses most vulnerable to global shocks are often those with the fewest buffers, and strengthening their resilience requires action at every level, from the individual firm to the national health system.

Subject of Research: Firm-level operational disruptions and resilience strategies in Ghana's hospitality industry during the COVID-19 pandemic

Article Title: Operational disruptions and resilience strategies in Ghana’s hospitality industry during the COVID-19 pandemic: firm-level evidence from the Accra Metropolitan Area

Article References: Senya, E. K., & Bordoh, A. (2026). Operational disruptions and resilience strategies in Ghana’s hospitality industry during the COVID-19 pandemic: firm-level evidence from the Accra Metropolitan Area. SN Social Sciences, 6(10), Article 452. https://doi.org/10.1007/s43545-026-01744-7

Image Credits: AI Generated

DOI: 10.1007/s43545-026-01744-7

Keywords: COVID-19, hospitality industry, organisational resilience, Ghana, Accra, PLS-SEM, confirmatory factor analysis, pandemic recovery, Sub-Saharan Africa, supply chain disruption, digitalisation, insurance uptake