Background: The Syrian conflict has resulted in significant displacement and increase in humanitarian needs within the last decade. Reports of increased prevalence of substance misuse and deliberate self-harm among internally-displaced Syrians are concerning, particularly given barriers to care for these conditions due to cultural stigma and legal repercussions for those reporting them. The aim of this study is to provide an overview of prevalence, risk factors and health services available for substance misuse and deliberate self-harm in Syria as well as share findings from a workshop with Syrian mental health stakeholders exploring current challenges with regards to these conditions. Methods: A scoping review was conducted using key search terms regarding substance misuse and suicide and/or self-harm inside Syria. These findings were supplemented by a discussion among 25 Syrian mental health stakeholders, including psychologists, psychiatrists, public health, and policy professionals to highlight key challenges and identify locally appropriate solutions. Results: Data regarding the prevalence of substance misuse and self-harm inside Syria among internally displaced populations varies greatly quality and accuracy. Substance misuse and deliberate self-harm, including suicide, are considered stigmatised and at times, criminalized, in Syria, leading to massive underreporting of prevalence, as well as underutilization of available treatment, which is also limited. The health system response in Syria, which has been compromised by a decade of conflict, is not prepared to cope with increasing rates of mental health disorders and particularly, substance misuse (i.e. Captagon) and instances of self-harm. Key suggestions from the workshop include the following: a) use of telepsychiatry and telepsychology interventions b) adaptation of WHO interventions c) multi-year investment and prioritisation of MHPSS programs and d) utilizing family skills interventions as a key tool in the prevention for substance abuse and self-harm, while embedding social and cultural sensitivities into interventions. Conclusions: Though current evidence gaps around substance misuse and deliberate self-harm in Syria remain, with the current socio-political climate in Syria, alongside significant shortfalls in funding for health, there is a present, urgent need to address these neglected MHPSS concerns. Emphasis must be placed on the needs of vulnerable populations including IDPs, war injured, children and teenagers.
IntroductionSyria’s protracted conflict has devastated the health system reversing progress made on maternal health preconflict. Our aim is to understand the state of maternal health in Syria focused on underage pregnancy and caesarean sections using a scoping review and quantitative analysis; the latter draws on data from the Syrian American Medical Society’s (SAMS) maternal health facilities in northwest Syria.MethodsWe performed a scoping review of academic and grey literature on the state of maternal health across Syria since the onset of conflict (taken as March 2011). Identified articles were screened using pre-established criteria and themes identified. We also performed a retrospective quantitative analysis of maternal health data from SAMS’ facilities in a microcontext in north-west Syria between March 2017 and July 2020, analysing the trends in the proportion of births by caesarean section and age at pregnancy.ResultsScoping review: of 2824 articles, 21 remained after screening. Main themes related to maternal mortality rates, caesarean sections, maternal age and perinatal care. 12 studies reported caesarean section rates; these varied from 16% to 64% of all births: northern Syria (19%–45%,) Damascus (16%–54%,) Lattakia (64%) and Tartous (59%.) Quantitative analysis: Of 77 746 births across 17 facilities, trend data for caesarean sections showed a decrease from 35% in March 2017 to 23% in July 2020 across SAMS facilities. Girls under 18 years accounted for 10% of births and had a lower proportion of caesarean section births. There was notable geographical and interfacility variation in the findings.ConclusionThe quality of available literature was poor with country-level generalisations. Research which explores microcontexts in Syria is important given the different effects of conflict across the country and the fragmented health system. Our quantitative analysis provides some evidence around the changes to caesarean section rates in northwest Syria. Despite limitations, this study adds to sparse literature on this important topic.
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