Emergency and essential surgical care

Surgical Care at the District Hospital - The WHO Manual

The WHO manual SCDH has been developed as a practical resource for individual practitioners and for use in undergraduate and postgraduate programmes, in-service training and continuing medical education programmes.

It has been translated to French, Korean, Mongolian, Vietnamese, Dari, Farsi, and an International Edition is also available.

The manual is a successor of three earlier publications:

  • General Surgery at the District Hospital (WHO, 1998)
  • Surgery at the District Hospital: Obstetrics and Gynaecology, Orthopaedics and Traumatology (WHO, 1991)
  • Anaesthesia at the District Hospital (WHO, 1988; 2nd edition 2000)

This manual draws together material from these three publications into a single volume which includes new and updated material, as well as material from "Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors" (WHO, 2000).

The following tools supplement the use of the manual in training programmes:

To get a copy of the manual:


Organising the District Hospital Surgical Service

Organization and management of the district surgical service

The district hospital, Leadership, team skills and management, Ethics, Education, Record keeping, Evaluation, Disaster and trauma planning

The surgical domain: creating the environment for surgery

Infection control and asepsis, Equipment, Operating room, Cleaning, sterilization and disinfection, Waste disposal

Fundamentals of surgical practice

The surgical patient

Approach to the surgical patient, The paediatric patient

Surgical techniques

Tissue handling, Suture and suture technique Prophylaxis

Basic Surgical Procedures

Wound management, Specific lacerations and wounds, Burns, Foreign bodies, Cellulitis and abscess, Excision and biopsies

The Abdomen

Laparotomy and abdominal trauma

Laparotomy, Abdominal trauma

Acute abdominal conditions

Assessment and diagnosis, Intestinal obstruction, Peritonitis, Stomach and duodenum, Gallbladder, Appendix

Abdominal wall hernia

Groin hernias, Surgical repair of inguinal hernia, Surgical repair of femoral hernia, Surgical treatment of strangulated groin hernia, Surgical repair of umbilical and para-umbilical hernia, Surgical repair of epigastric hernia, Incisional hernia

Urinary tract and perineum

The urinary bladder, The male urethra, The perineum, Male circumcision

Emergency obstetric care

Hypertension in pregnancy

Hypertension, Assessment and management, Delivery, Postpartum care, Chronic hypertension, Complications

Management of slow progress of labour

General principles, Slow progress of labour, Progress of labour, Operative procedures

Bleeding in pregnancy and childbirth

Bleeding, Diagnosis and initial management, Specific management, Procedures, Aftercare and follow-up

Resuscitation and practical anaesthesia

Resuscitation and preparation for anaesthesia and surgery

Management of emergencies and cardiopulmonary resuscitation, Other conditions requiring urgent attention, Intravenous access, Fluids and drugs, Drugs in resuscitation, Preoperative assessment and investigations, Anaesthetic issues in the emergency situation, Important medical conditions for the anaesthetist

Practical anaesthesia

General anaesthesia, Anaesthesia during pregnancy and for operative delivery, Paediatric anaesthesia, Conduction anaesthesia, Specimen anaesthetic techniques, Monitoring the anaesthetised patient, Postoperative management

Anaesthetic infrastructure and supplies

Equipment and supplies for different level hospitals, Anaesthesia and oxygen, Fires, explosions and other risks, Care and maintenance of equipment

Traumatology and orthopaedics

Acute trauma management

Trauma in perspective, Principles of Primary Trauma Care, Six phases of Primary Trauma Care, Procedures

Orthopaedic techniques Traction

Casts and splints, Application of external fixation, Diagnostic imaging, Physical therapy, Cranial burr holes

Orthopaedic trauma

Upper extremity injuries, The hand, Fractures of the pelvis and hip, Injuries of the lower extremity, Spine injuries, Fractures in children, Amputations, Complications, War related trauma

General orthopaedics

Congenital and developmental problems, Bone tumours, Infections, Degenerative conditions

"...While the general reader is most likely enjoying all the advantages of sophisticated surgery, much of the world's population has no access to even simpler procedures and trauma care. This worthwhile manual goes a long way to closing that gap." - Annals of Burns and Fire Disasters