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MSF-run hospital offers 3D-printed prostheses to war wounded

A MSF-run hospital in Jordan offers 3D-printed prosthetics to amputated war victims from across the Middle East.

Pierre Moreau, MSF clinical coordinator for the 3D-project, takes a scan of Ibrahim*’s amputated hand, a patient from Iraq. The scanned image appears in real-time on his computer. The image will provi
Pierre Moreau, MSF clinical coordinator for the 3D-project, scans the amputated hand of Ibrahim, a patient from Iraq. The scanned image appears in real-time on his computer. The image will provide accurate measurements for his tailor-made prosthetics. [Elisa Oddone/Al Jazeera]
By Elisa Oddone
Published On 6 Dec 2018

Amman, Jordan – A hospital in Jordan is offering amputee war victims from across the region 3D-printed prostheses in an attempt to help patients regain partial functionality of their missing upper limbs.

With 3D technology, printed prosthetics are lighter, cheaper and faster to produce than conventional ones. Patients at the hospital say they stopped using their previous devices due to their weight and ineffectiveness in addressing daily-life needs.

The Amman-based Doctors Without Borders (known by their French acronym MSF) reconstructive surgery hospital has been operating for over a decade on victims of conflicts suffering from wounds inflicted by bomb blasts, bullets, shrapnel and burns.

Patients mostly hail from Gaza, Iraq, Syria, and Yemen, where access to proper treatment and subsequent therapy is limited or costs are too high.

Starting as a study two years ago, the 3D project is still in its experimental phase. Patient feedback helps improve the quality of the technology each time a new prosthesis is delivered.

“The MSF Foundation launched the 3D project in Amman in February last year, and we started to see the first patients two months later,” said Pierre Moreau, clinical coordinator for the 3D project.

“So far, we have delivered 16 printed prosthetics. But our role doesn’t stop here. We support patients through a string of occupational therapy sessions to show what they can do with them.”

The raw material for a printed prosthesis, a type of thermoplastic polyurethane, costs between $20 and $50. The final costs, including case estimation, assessment of the patient’s needs and printing time, is around $250. Prices of conventional prosthetics vary, with below-elbow prosthetics starting from $200 and reaching up to $2,000.

The possibilities of 3D-technology seem limitless. Needing only a scanner and a printer, technicians can potentially print and produce prostheses everywhere, especially in war zones, where prosthetics need to be made in no time and at no cost.

“The idea is to be able to produce 3D-printed prosthetics in the future in places difficult to access and lacking a sound healthcare system, like in conflict areas. But the way to do it is still under discussion, as it is not always easy to find technicians available in these areas, and printers are still expensive,” said Moreau.

But new developments in innovative materials and cheaper printers are expected to further push prices down in the near future.

Some of the names have been changed on request

Ibrahim*, a 34 year-old Iraqi from Mosul. He says it was around 10.30 and he was walking in the street when an air strike targeting IS fighters happened. A secondary explosion in a car left him with
Ibrahim, 34, is from Iraq's Mosul province. He was injured by a car explosion while walking on the street, affecting his head, leg and hand. He has undergone six surgeries in total, three of which were for his head. Ibrahim says he used to be a driver back home. The prosthetics, he says, will allow him to get back to work. [Elisa Oddone/Al Jazeera]
Moreau takes a scan of Ibrahim*’s intact hand. The image will be later reversed using software. The result will be a mirrored picture to be matched with the scan of the injured part. This process give
A scan of Ibrahim's intact hand. The image will be later reversed using the software. The result will be a mirrored picture to be matched with the scan of the injured part. This process allows for more accuracy when producing the prosthesis. In the case of a partially injured hand, Moreau says, the top priority is that the prosthetic doesn't affect the hand's remaining functions. [Elisa Oddone/Al Jazeera]
Ibrahim* says his hand was only broken initially. Yet, it wasn’t properly treated in Iraq, causing it to rot. A week later, it was amputated in a hospital mostly dedicated to treat IS fighters. He say
Ibrahim says his hand was only broken initially. Yet, it wasn't properly treated in Iraq, causing it to rot. A week later, it was amputated in a hospital mostly dedicated to treating fighters from the Islamic State of Iraq and the Levant (ISIL). He says he has been in excruciating pain for over two years. [Elisa Oddone/Al Jazeera]
As a part of the 3D printing project, MSF started printing transparent masks for patients with facial burns. Following a skin graft surgery procedure —where skin from one area of the body is transplan
As a part of the 3D-printing project, MSF started printing transparent masks for patients with facial burns. Following skin graft surgery, where skin from one area of the body is transplanted to a different one, surgeons suggest applying pressure on the affected surface with a mask. The face mask keeps the skin soft and flat during the scar formation phase of healing, helping the face heal with the least amount of scarring. [Elisa Oddone/Al Jazeera]
Nour Saleh, 7, from Fallujah in Iraq. Her brother, Salah, says the accident happened in 2014. A device on the ground resembling a bottle of perfume exploded near their home. Nour was injured. She was
Nour Saleh, 7, is from Fallujah in Iraq. Her brother, Salah, said the accident happened in 2014. A device on the ground resembling a bottle of perfume exploded near their home and Nour was injured; half of her head was affected. She was treated in several Iraqi hospitals and eventually moved to the capital, Baghdad, where a skin graft procedure was carried out. Salah said their family didn't have enough money to cover all medical costs. MSF accepted Nour's case in 2016 and Nour underwent four surgeries in Jordan. The treatment helped a lot, it brought back her hair, which Salah says is very important because she didn't want people to look at her initially. [Elisa Oddone/Al Jazeera]
Abu Mohammad*, 44, from Dara’a, is seen in the aisle of the MS
Abu Mohammad, 44, from Syria's Deraa, was working in a field by his home when an aeroplane dropped a bomb near him. Both his hands and legs were affected by the accident. Today, he can only move with the help of a walker. "It was impossible to escape the accident. Warplanes arrive suddenly and when you notice their presence, it is because you are on the ground groaning in pain," said Abu Mohammad. [Elisa Oddone/Al Jazeera]
Abu Mohammad* receives his final prosthetics two weeks after modifications were applied on the initial test device. In light of a nerve injury and amputated fingers on his other limb, the patient rece
Abu Mohammad receives his final prosthetics two weeks after modifications were applied on the initial test device. In light of a nerve injury and amputated fingers on his other limb, the patient receives an active-system prosthetic. By moving his shoulder the patient will be able to activate the prosthetic thumb and open and close his hand. This will allow him to perform different movements, such as holding a phone or combing his hair. [Elisa Oddone/Al Jazeera]
MSF 3D Project Supervisor Samar Ismail searches for a suitable skin tone based on the patient’s complexion to paint the prosthetics. Post processing on the prosthesis also includes smoothing its insid
MSF 3D Project Supervisor Samar Ismail searches for a suitable skin tone based on the patient's complexion to paint the prosthetics. Post-processing on the prosthesis also includes smoothing its insides and edges. A final varnish safety layer will allow the patient to touch food safely and wash the prosthesis as many times as required. [Elisa Oddone/Al Jazeera]
Moataz Al Khateeb, 15, Palestinian residing in Amman, Jordan. His left arm was affected by a congenital limb defect. His 3D-printed prosthetic arm was realized by using the image of the intact limb as
Moataz Al Khateeb, 15, is a Palestinian residing in Amman. His left arm was affected by a congenital limb defect. His 3D-printed prosthetic arm was built using the image of the intact limb as a template. He says the conventional prosthetic he used before was heavy, tight and caused pain in his shoulder and he never got used to it. He wore it at school, but not for more than five minutes. [Elisa Oddone/Al Jazeera]
With his new 3D-printed prosthesis Al Khateeb is able to hold objects including cans, and glasses. Based on the patient’s needs, occupational therapy will follow. Technicians will reach out to Al Khat
With his new 3D-printed prosthesis Moataz is able to hold objects including cans and glasses. Based on the patient’s needs, occupational therapy will follow. Technicians will reach out to Moataz in a couple of days to understand which daily activities will still be difficult to perform with the prosthesis. The goal of the occupational therapy is to have patients carry out all their desired movements with their prosthetics or with the help of some adaptable terminal devices that can be added. [Elisa Oddone/Al Jazeera]
Ahmad’s family relocated to Jordan following his accident. After a short stay in the country’s Zata’ari refugee camp, they found shelter in the town of Al Salt. The neighbourhood they were living in b
Ahmad Meqdad, 17, is a war victim from Deraa. A plane dropped a barrel bomb in his house's proximity seven years ago. His mother says he refuses to talk about the accident. She says the air suddenly felt strange and they felt as if something was going to fall on their home. Ahmad was outside. After the explosion, they found him injured on the ground with his arm hanging from his body. Tiny strings of flesh were still connecting the limb to his body. His hand was amputated at a hospital in Syria. [Elisa Oddone/Al Jazeera]
Ahmad is the first patient to receive an above-elbow 3D printed prosthetic from the MSF programme. For this prosthesis, technicians added an extra piece to substitute the humerus. He will be able to b
Ahmad is the first patient to receive an above-elbow 3D printed prosthetic from the MSF programme. For this prosthesis, technicians added an extra piece to substitute the humerus. He will be able to both bend and stretch the arm depending on the movements he desires to perform. [Elisa Oddone/Al Jazeera]
Abdulkareem**, 23, from Homs, Syria. Two months in the Syrian conflict, he says he was home when a plane dropped a bomb. He was injured but couldn’t realize where exactly. His arm was hanging with onl
Abdulkareem, 23, is from Homs in Syria. Two months into the Syrian conflict, he was home when a plane dropped a bomb. He was injured but didn't immediately realise where exactly. His arm was hanging with only a few patches of skin still connecting it to his body. He went to the local hospital, where they treated him temporarily. He says the conventional prosthesis lying next to him is of no use. It is not comfortable and is stuck in a position that serves no purposes. He quit using it long ago. [Elisa Oddone/Al Jazeera]