Challenges of providing healthcare worker education and training in protracted conflict: a focus on non-government controlled areas in north west Syria

Abstract

Without healthcare workers (HCWs), health and humanitarian provision in Syria cannot be sustained either now or in the post-conflict phase. The protracted conflict has led to the exodus of more than 70% of the healthcare workforce. Those remaining work in dangerous conditions with insufficient resources and a healthcare system that has been decimated by protracted conflict. For many HCWs, particularly those in non-government-controlled areas (NGCAs) of Syria, undergraduate education and postgraduate training has been interrupted with few opportunities to continue. In this manuscript, we explore initiatives present in north west Syria at both undergraduate and postgraduate level for physician and non-physician HCWs. Conclusion: Challenges to HCW education in north west Syria can be broadly divided into 1. Organisational (local healthcare leadership and governance, coordination and collaboration between stakeholders, competition between stakeholders and insufficient funding.) 2. Programmatic (lack of accreditation or recognition of qualifications, insufficient physical space for teaching, exodus of faculty affecting teaching and training, prioritisation of physicians over non-physicians, informally trained healthcare workers.) 3. Healthcare system related (politicisation of healthcare system, changing healthcare needs of the population, ongoing attacks on healthcare.) Locally implementable strategies including dedicated funding are key to supporting retention of HCWs and return during post-conflict reconstruction.

Protecting healthcare workers in conflict zones during the COVID-19 pandemic: Northwest Syria

“…As elsewhere, the impact on healthcare workers both personally and professionally has been grave with a large proportion affected; however, healthcare workers in this area work in an already exhausted and under-resourced health system after almost a decade of conflict and face ongoing attacks. 5 The effects on the health workforce in areas under government control have been even more stark with suggestions that at least 165 doctors have lost their lives, however, official confirmation has been suppressed. 6 Seroprevalence studies among healthcare workers have not been performed so the true extent of exposure remains unknown.…”

Healthcare leadership in Syria during armed conflict and the pandemic

“…There are also leadership gaps in the health education and in the training of healthcare workers, something which could have long-term consequences for the workforce and the health system. 6 …”

“…There are also leadership gaps in the health education and in the training of healthcare workers, something which could have long-term consequences for the workforce and the health system. 6 After almost 10 years of conflict, Syria's health system and leadership have been fragmented, politicised and severely under-resourced. The main areas within Syria now are the north east, which is under de facto Kurdish-led Self-Administration control; the north west, which is under opposition control; areas in the north, which are under Turkish control; and the remaining two-thirds of the country, which is under the control of the Syrian government.…”

Targeting Healthcare in Syria

“…International NGOs were able to operate in nongovernment-controlled Syria through these local NGOs and local Syrian healthcare workers. For local healthcare workers, though this improved resources substantially, it limited the power of local governance structures, excluded many local actors who did not have the capacity to acquire the necessary licensing (Ekzayez, 2018) and produced challenges of accountability to external parties with cultural differences, and differing funding goals (Bdaiwi et al, 2020).…”