Conflict-related health research in Syria, 2011–2019: a scoping review for The Lancet - AUB Commission on Syria

Abstract

Background The volume of health-related publications on Syria has increased considerably over the course of the conflict compared with the pre-war period. This increase is largely attributed to commentaries, news reports and editorials rather than research publications. This paper seeks to characterise the conflict-related population and humanitarian health and health systems research focused inside Syria and published over the course of the Syrian conflict. Methods As part of a broader scoping review covering English, Arabic and French literature on health and Syria published from 01 January 2011 to 31 December 2019 and indexed in seven citation databases (PubMed, Medline (OVID), CINAHL Complete, Global Health, EMBASE, Web of Science, Scopus), we analyzed conflict-related research papers focused on health issues inside Syria and on Syrians or residents of Syria. We classified research articles based on the major thematic areas studied. We abstracted bibliometric information, study characteristics, research focus, funding statements and key limitations and challenges of conducting research as described by the study authors. To gain additional insights, we examined, separately, non-research publications reporting field and operational activities as well as personal reflections and narrative accounts of first-hand experiences inside Syria. Results Of 2073 papers identified in the scoping review, 710 (34%) exclusively focus on health issues of Syrians or residents inside Syria, of which 350 (49%) are conflict-related, including 89 (25%) research papers. Annual volume of research increased over time, from one publication in 2013 to 26 publications in 2018 and 29 in 2019. Damascus was the most frequently studied governorate (n = 33), followed by Aleppo (n = 25). Papers used a wide range of research methodologies, predominantly quantitative (n = 68). The country of institutional affiliation(s) of first and last authors are predominantly Syria (n = 30, 21 respectively), the United States (n = 25, 19 respectively) or the United Kingdom (n = 12, 10 respectively). The majority of authors had academic institutional affiliations. The most frequently examined themes were health status, the health system and humanitarian assistance, response or needs (n = 38, 34, 26 respectively). Authors described a range of contextual, methodological and administrative challenges in conducting research on health inside Syria. Thirty-one publications presented field and operational activities and eight publications were reflections or first-hand personal accounts of experiences inside Syria. Conclusions Despite a growing volume of research publications examining population and humanitarian health and health systems issues inside conflict-ravaged Syria, there are considerable geographic and thematic gaps, including limited research on several key pillars of the health system such as governance, financing and medical products; issues such as injury epidemiology and non-communicable disease burden; the situation in the north-east and south of Syria; and besieged areas and populations. Recognising the myriad of complexities of researching active conflict settings, it is essential that research in/on Syria continues, in order to build the evidence base, understand critical health issues, identify knowledge gaps and inform the research agenda to address the needs of the people of Syria following a decade of conflict.

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“…10 More than 12 million are in dire need of health care, as the war also forced about 70% of health workers to flee Syria and excluded half of the primary health facilities from service, 11 affecting the management of both communicable and uncommunicable diseases. [12][13][14][15][16][17][18][19] Furthermore, diagnostic and therapeutic approaches became progressively restricted, often proving prohibitively expensive for patients to access. 8,17 In the realm of cancer care, approximately 18 000 new cases were diagnosed in 2008, including 1818 cases of lung cancer.…”

“…In the case of the Syrian conflict, the 12-year war has evolved into one of the most severe global humanitarian crises, displacing large masses of people and leading the Syrian population, initially around 23 million in 2011 (reported pre-war), to fall below 19 million by 2016 . More than 12 million are in dire need of health care, as the war also forced about 70% of health workers to flee Syria and excluded half of the primary health facilities from service, affecting the management of both communicable and uncommunicable diseases . Furthermore, diagnostic and therapeutic approaches became progressively restricted, often proving prohibitively expensive for patients to access …”