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Syrians continue to endure one of the biggest human tragedies in modern times. The extent of the crisis has affected all aspects of Syrians' life. Understanding the multi-faceted transition of the Syrian population and how it reflects on their health profile can guide relief and rebuilding efforts' scope and priorities.

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Member states across the Eastern Mediterranean region face unprecedented health challenges, buffeted by demographic change, a dual disease burden, rising health costs, and the effects of ongoing conflict and population movements - exacerbated in the near-term by instability arising from recent political upheaval in the Middle East. However, health actors in the region are not well positioned to respond to these challenges because of a dearth of good quality health research. This review presents an assessment of the current state of health research systems across the Eastern Mediterranean based on publicly available literature and data sources. The review finds that - while there have been important improvements in productivity in the Region since the early 1990s - overall research performance is poor with critical deficits in system stewardship, research training and human resource development, and basic data surveillance. Translation of research into policy and practice is hampered by weak institutional and financial incentives, and concerns over the political sensitivity of findings. These problems are attributable primarily to chronic under-investment - both financial and political - in Research and Development systems. This review identifies key areas for a regional strategy and how to address challenges, including increased funding, research capacity-building, reform of governance arrangements and sustained political investment in research support. A central finding is that the poverty of publicly available data on research systems makes meaningful cross-comparisons of performance within the EMR difficult. We therefore conclude by calling for work to improve understanding of health research systems across the region as a matter of urgency.

The ongoing Syrian conflict is one of the largest humanitarian crises of the 21st century so far. Debarati Guha-Sapir and colleagues analyse the impact of weapons on civilian deaths, with a focus on women and children What started as a peaceful uprising in Syria in March 2011 escalated quickly to an armed conflict. By 2012 conflict had become the leading cause of death of Syrians. 1 Health systems have been reshaped, now being separated into areas controlled by the government, the opposition, or self proclaimed Islamic State factions-we group the last two as non-state armed groups (NSAG; fig 1⇓). These areas differ vastly in terms of service delivery capacity, number of trained staff, and access to essential medicines. 2 Indirect conflict related deaths have arisen from poor sanitation and severe disruption to Syria's healthcare system. [3][4][5] In December 2014, 20% of Syria's public hospitals were completely non-functional, and another 35% provided only partial services.4 Direct conflict related deaths are those that are caused by weapons and other violent methods used in warfare.In this article we assess the direct conflict related deaths (hereafter termed violent deaths) of women and children among civilians killed in the Syrian conflict, because they are identified as vulnerable populations in public health and under specific laws of war such as the Geneva Conventions. 6-9 War related deaths in SyriaViolent deaths have been considerable in Syria. A report commissioned by the United Nations found that from March 2011 to April 2014 over 191 369 verifiable violent deaths of individuals had occurred, including both combatants and civilians. Individuals were identified by their name and the date and location of their death, thus representing the minimum number of violent deaths from the Syrian conflict at the time. 10Population surveys can provide estimates of overall deaths and excess fatalities in a war. [11][12][13][14] But epidemiological analyses of war deaths from specific weapon types have been hampered by small sample sizes and uncertainties that limit their usefulness. Associations between weapon types and victim characteristics in armed civil conflicts are not well understood and are rarely studied.15 16 Individual records of violent deaths and their causes are difficult to obtain from death registration systems as they progressively lose functionality or become unreliable in conflict.11 The VDC considers any member of any NSAG or of the Syrian Army to be a non-civilian. 20We used VDC data to examine 78 769 civilian violent deaths that occurred in Syria from 18 March 2011 to 21 January 2015 for associations between weapon types and demographic groups. Of these deaths, 77 646 were in NSAG controlled areas and 1123 in government controlled areas (see appendix A on thebmj.com for a full description of our methods). Although the majority of deaths were of men, nearly 25% of Syrian civilians killed were women and children (see tables B1 and B2 in appendix on thebmj.com). Trends and patterns in weapon rela...