Milne Bay a widely known province of peaceful communities and strong cultural identity. Yet in recent years, that image has been deeply shaken by waves of crime and violence that left many residents living in fear. During the height of this unrest, the province drew national attention as criminal activity escalated, and law enforcement struggled to contain it (1,2). Sea piracy, armed robberies, assaults, and killings became increasingly frequent, and the effects were felt not only in homes and villages, but also in the hospital’s wards.
For those working on the frontline, the consequences of crime were immediate, graphic, and deeply traumatic. Violence did not remain an abstract issue discussed in public forums or reported in the news. It arrived at the doors of the emergency department in the form of gunshot wounds, bush knife wounds, shattered limbs, and young men fighting for their lives. Some patients survived long enough to reach the hospital. Others did not.
The burden placed on the health system was immense. In Alotau Provincial Hospital, cases linked to violent crime placed extraordinary strain on staff, blood supplies, theatre capacity, and already limited critical care resources. Between 2020 and 2025, more than 50 gunshot injuries resulted in almost 25 limb amputations and other serious long-term disabilities (4). The overwhelming majority of these patients were male, and the youngest was only 16 years old. These were not just statistics. They were sons, brothers, fathers, and members of the community whose lives were permanently altered in a matter of moments.
Many patients arrived in hypovolaemic shock and required urgent resuscitation, blood transfusion, and emergency surgery. In a resource-limited setting, where access to regular blood supplies and intensive care support is often constrained, treatment decisions must sometimes be made rapidly and under considerable pressure. Damage control surgery becomes not simply a surgical approach, but a necessity. In these moments, the principle is stark: life must come before limb.
The most difficult cases were those in which amputation was the only realistic option. No surgeon makes that decision lightly. To remove a limb in order to save a life is a profound and distressing act, with consequences that extend far beyond the operating table. The physical injury may be immediate, but the emotional, social, and economic effects continue long after discharge. A patient may survive the initial trauma, survive the surgery, and survive the hospital stay, only to return home to a life shaped by disability, unemployment, stigma, dependency, and uncertainty.
Crime therefore imposes costs that are rarely fully appreciated. Direct medical costs can be as much as K48 000 per patient (3). But the indirect costs to families and communities may be far greater. It does not only harm the direct victim in the moment of attack. It also burdens families who must provide care and financial support. It stretches hospitals that are already working with limited staff and resources. It diverts blood, theatre time, medication, and clinical attention away from other patients in need. It leaves healthcare workers carrying the emotional weight of repeated exposure to traumatic injuries and difficult decisions. In this way, the cost of crime is borne not only by individuals, but by the whole community.
Some of the most sobering moments in surgical practice are not the operations themselves, but what follows. A young man who has lost a leg may leave the ward alive, but he does not leave unchanged. He returns to a world in which mobility, independence, work, and identity will all be affected. Some are taken straight to prison after discharge with their disability to await trial and judgment. In settings where rehabilitation services, prosthetics, and social support are limited, the long-term burden is even greater. Survival, while important, is only the beginning of a difficult journey.
When communities speak about crime, the discussion often centres on policing, punishment, and public order. These are important. But there is another dimension that deserves equal attention: the health and human cost. Every act of violent crime has the potential to generate not only fear, but irreversible disability, preventable death, and lasting pressure on fragile health systems. Hospitals become silent witnesses to the true price of lawlessness.
Milne Bay’s experience should remind us that crime is not only a security issue. It is also a public health issue, a social issue, and a development issue. If we are serious about addressing it, then our response must extend beyond reaction and enforcement alone. Prevention, community engagement, youth support, stronger law enforcement, and social interventions all matter. So too does recognising the burden placed on victims, families, law enforcement and healthcare institutions that are left to manage the aftermath.
The cost of crime is substantial. Sometimes it is measured in blood units, emergency operations, and nights spent in theatre. Sometimes it is measured in a limb lost, a lifelong disability, or a family pushed deeper into hardship. And sometimes, most tragically, it is measured in a life that never makes it to hospital at all.
References
1. NBC PNG [Internet]. [cited 2026 May 8]. Alotau highway robberies a concern. Available from: https://www.nbc.com.pg/post/23004/alotau-highway-robberies-a-concern
2. Province not safe: Police | The National [Internet]. [cited 2026 May 8]. Available from: https://www.thenational.com.pg/province-not-safe-police/
3. Umo I, James K, Didilemu F, Sinen B, Borchem I, Inaido D, et al. The direct medical cost of trauma aetiologies and injuries in a resource limited setting of Papua New Guinea: A prospective cost of illness study. Lancet Reg Health – West Pac. 2022 Mar 1;20. doi:10.1016/j.lanwpc.2021.100379 PubMed PMID: 35146466.
4. APH Surgical unit audits.
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