International medical non-profit Médecins Sans Frontières is using 3D printing technology to help victims of war live with autonomy and dignity, writes Megha Merani.

A hospital in Jordan has 3D-printed prosthetic limbs for more than 30 amputee victims of war in the Middle East to help them live with autonomy, dignity, and new hope for the future.

Doctors Without Borders/Médecins Sans Frontières (MSF), a Nobel Peace Prize-winning international medical non-profit, began using 3D printing technology at its hospital in Amman in 2017 as part of a Reconstructive Surgery Programme (RSP).

The innovative pilot phase has seen prosthetics fitted for amputees from Iraq, Palestine, Syria and Yemen.

The project aspires to address poor access to prosthetics, says Marc Schakal, MSF deputy programme manager for Jordan, Yemen and Iraq and former RSP head of mission.

“Health systems have collapsed, and there is no way to access these kinds of surgeries,” he explains. “So, the idea is how we can use 3D technology to improve access for patients.”

He also notes that 3D-printed limbs are easier, faster and cheaper to produce.

“It costs between $50 to $100, which is five to six times cheaper than the conventional ones.”

The RSP provides orthopaedic, maxillofacial and plastic surgery, treating patients wounded in conflict zones by bomb blasts, bullets, shrapnel or fire. More than 12,000 surgeries on over 5,000 patients have been performed under the programme in the past decade.

CHANGING LIVES

Among those to have received 3D-printed prosthetics from the RSP is a 5-year-old football lover who lost his right arm and leg after an explosion hit his home in Aden, Yemen. Two years on, Abdulbari can play with a ball thanks to his new limbs.

Schakal says printing is also a practical option in cases of children and teenagers.

“We had some cases where we provided a prosthesis last year, and this year, we just reprinted a bigger size with some adjustments,” he explains. “The other advantage is that we can very easily print a second spare in case of any damage.”

The 3D-printed prosthetics are more comfortable for patients due to their lighter weight, he adds. The process is less bothersome for patients because measurements are taken from a scan.

Haider, an electrical engineer from Iraq, was also fitted with a 3D-printed prosthetic arm.

“He was working on the electrical lines when a car bomb exploded next to him, and as a result, he lost his arm,” says Faris Al-Jawad, MSF content editor and former RSP field communications manager.

Doctors worked with Haider to custom-design a prosthetic, even sharing colour palettes to choose a shade nearest to his uninjured arm, Al-Jawad recalls.

“He was able to do basic things with it, like shake hands and pick up a piece of fruit, and he had something aesthetic, which was a huge thing for him. He was elated by the time he left.”

Al-Jawad points out that while functionality is really important to patients, the aesthetic element does “enormous things” for their psycho-social and mental health.

Meanwhile, MSF has also been exploring other applications of 3D technology in reconstructive surgery, such as printing compression masks for burn victims.

“The conventional way is [to use] plaster or dressing,” Schakal says. “This is very difficult for the patient – a 3D-printed transparent mask is easier to wear, lighter and more comfortable.”

The RSP has created 3D-printed masks for 15 burn victims since June 2018, among them 7-year-old Noor from Fallujah, Iraq. Her face was burned when she stepped on a landmine.

SILVER LINING

The World Health Organization estimates that over 40 million amputees live in developing nations. Many are conflict victims, and only 5% of them have access to some kind of prosthetic care, according to MSF.

“It is a very grim, dark reality that a lot of people are facing in these countries [..] so for them - and us - the hospital is kind of a silver lining,” Al-Jawad says. “You see a lot of kids who are so badly disfigured, and I think the hospital for them is a nice place in a way because they’re surrounded by other children, men, and women who have also gone through these horrific things.”

More than 250 amputees are currently on a waiting list to receive a 3D-printed limb from the RSP, Schakal says.

“The need is much [greater], of course. Even if the war stops, the wounded people are still there,” he adds.