Trauma stabilization points in armed conflict: operational evolution and strategic reflections from mosul to Gaza

Background: Forward trauma care remains a critical gap in emergency responses to armed conflict, particularly where conventional medical evacuation is disrupted. Trauma Stabilization Points (TSPs) were introduced in previous conflicts to bring life-saving care closer to the point of injury. To improve standards and adaptability, the World Health Organization convened a Technical Working Group to develop operational guidance for TSPs, drawing on diverse field experiences, including the ongoing Gaza deployments. Case presentation: Between February and July 2024, three TSPs were established in Gaza, managing over 4,000 consultations. Initially focused on trauma stabilization and referral, these sites quickly adapted to minor injuries and non-traumatic conditions, reflecting population needs and access challenges. Referral rates varied across sites due to hospital proximity, ambulance availability, and shifting frontlines. Security threats limited forward deployment and safe patient access, requiring high mobility and rapid relocation. Experience from Gaza highlighted key operational principles: locating TSPs near the point of injury; integrating within a functioning trauma referral pathway supported by evacuation capacity and hospital readiness; maintaining clear clinical functions and staffing standards; and using standardized documentation for quality assurance and continuity. Lessons from Gaza aligned with those from other conflict zones, emphasizing challenges such as insecurity, fragmented oversight, and disrupted referral systems. The guidance recognizes the need for adaptable models that balance mobility with advanced interventions, including damage control resuscitation in austere settings. Conclusions: The Gaza experience, together with lessons from other conflict settings, is shaping the development of flexible, context-sensitive operational guidance for TSPs. This guidance aims to support emergency care actors and national authorities in determining when and how to deploy TSPs in complex emergencies, balancing core trauma functions with the realities of modern warfare.