Delivering Humanitarian Teleradiology Services to Besieged Areas in Syria

Masrani, Abdulrahman; Mamoun, Ihsan; Tarabishy, Bisher; Tarabishy, Abdulrahman; Arabi, Mohammad

doi:10.1016/j.jacr.2018.03.052

Cited by 6 publications

(26 citation statements)

References 3 publications

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“…Included articles were observational studies (10 articles, all case series) [27][28][29][30][31][32][33][34][35][36], commentaries and case reports (8 articles) [37][38][39][40][41][42][43][44], interventional studies (4 articles, randomised control trials and before-after interventions) [45][46][47][48] and cross-sectional studies (2 articles) [49,50] (Fig. 2).…”

Section: Resultsmentioning

confidence: 99%

Telemedicine interventions in six conflict-affected countries in the WHO Eastern Mediterranean region: a systematic review

et al. 2022

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Background The COVID-19 pandemic has escalated the use of telemedicine in both high and low resource settings however its use has preceded this, particularly in conflict-affected settings. Several countries in the WHO Eastern Mediterranean (EMR) region are affected by complex, protracted crises. Though telemedicine has been used in such settings, there has been no comprehensive assessment of what interventions are used, their efficacy, barriers, or current research gaps. Main body A systematic search of ten academic databases and 3 grey literature sources from January 1st 2000 to December 31st 2020 was completed, identifying telemedicine interventions in select EMR conflict-affected settings and relevant enablers and barriers to their implementation. Included articles reported on telemedicine use in six conflict-affected EMR countries (or territories) graded as WHO Health Emergencies: Afghanistan, Gaza, Iraq, Libya, Syria and Yemen. Data were extracted and narratively synthesised due to heterogeneity in study design and outcomes. Of 3419 articles identified, twenty-one peer-reviewed and three grey literature sources met the inclusion criteria. We analysed these by context, intervention, and evaluation. Context: eight related to Afghanistan, eight to Syria and seven to Iraq with one each in Yemen and Gaza. Most were implemented by humanitarian or academic organisations with projects mostly initiated in the United States or Europe and mostly by physicians. The in-country links were mostly health professionals rather than patients seeking specialist inputs for specialities not locally available. Interventions: these included both SAF (store and forward) and RT (real-time) with a range of specialities represented including radiology, histopathology, dermatology, mental health, and intensive care. Evaluation: most papers were observational or descriptive with few describing quality measures of interventions. Conclusions Telemedicine interventions are feasible in conflict-affected settings in EMR using low-cost, accessible technologies. However, few implemented interventions reported on evaluation strategies or had these built in. The ad hoc nature of some of the interventions, which relied on volunteers without sustained financial or academic investment, could pose challenges to quality and sustainability. There was little exploration of confidentiality, ethical standards, data storage or local healthcare worker and patient acceptability.

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Section: Resultsmentioning

confidence: 99%

Telemedicine interventions in six conflict-affected countries in the WHO Eastern Mediterranean region: a systematic review

et al. 2022

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“…Table 3 presents a summary of the 31 papers reporting on field and operational activities, of which 12 describe humanitarian assessment, responses or needs, including development of a rapid gender analysis tool [ 127 ], cross-border, sectoral and cluster coordination mechanisms [ 104 , 115 – 117 ], and needs assessments and/or operational programming [ 98 , 105 , 107 – 110 , 122 ]. Nineteen papers discuss various aspects of the health system, most commonly reporting on experiences of establishing and / or presentations to field hospitals [ 99 – 101 , 103 ], or establishing or delivering specific services including renal [ 102 , 112 ], dental [ 106 ], mental health [ 113 ], obstetric [ 111 ], maternal and child health [ 119 ], tele-cardiology [ 120 ], tele-intensive care [ 114 , 121 ], tele-radiology [ 118 , 123 ] and polio outbreak response activities [ 124 ]. Other papers described the national tuberculosis control program [ 125 ], activities of Syrian expatriate medical associations in supporting the health system, including through training, establishment of hospitals and provision of telemedicine services [ 97 ], and translation and uptake of an online medical education platform into Arabic by Syrian medical students [ 126 ].…”

Section: Resultsmentioning

confidence: 99%

“…Other papers described the national tuberculosis control program [ 125 ], activities of Syrian expatriate medical associations in supporting the health system, including through training, establishment of hospitals and provision of telemedicine services [ 97 ], and translation and uptake of an online medical education platform into Arabic by Syrian medical students [ 126 ]. War strategies and alleged IHL violations are the secondary theme of two papers, one describing experiences in besieged settings [ 123 ] and one paper reporting birth outcomes by chemical weapons exposure status for pregnant women seen at Al Ghouta hospital in late 2014 [ 111 ]. Only 12 (39%) of these field and operational activities publications are first-authored by an author with a Syrian affiliation.…”

Section: Resultsmentioning

confidence: 99%

“… Health system (service provision) Alrifai (2018) [ 120 ] First: USA Last: USA Describes tele-cardiology service provision from the United States to support hospitals in Syria Health system (service provision) Ghbeis (2018) [ 121 ] First: USA Last: USA Describes implementation of the “Tele-Pediatric Intensive Care” program Health system (service provision) Lester (2018) [ 122 ] First: UK Last: N/A Describes a training programme for White Helmets members in which the trauma-informed framework was used to design and implement a range of mental health and psychosocial interventions. Humanitarian assessment, response or needs Masrani (2018) [ 123 ] First: USA Last: Saudi Arabia Describes a remote tele-radiology service supporting staff in besieged Ghouta between 2015 and 2018 Health system (service provision); War strategies / alleged IHL violations Mbaeyi (2018) [ 124 ] First: USA Last: Switzerland Describes the WHO response to the emergence of vaccine-derived polioviruses (VDPVs) in Deir ez-Zor governorate in Syria in 2017 Health status, Health system (service provision) Muhjazi (2018) [ 125 ] First: not stated Last: not stated Describes the national tuberculosis control program Health system (service provision) Kouba (2019) [ 126 ] First: Syria Last: USA Describes translation of an online US-based medical education platform from English into Arabic by Syrian medical students, and uptake of the platform by Syrian universities and students Health system (workforce) Quay (2019) [ 127 ] First: Switzerland Last: N/A Describes development of Rapid Gender Analysis by CARE during its humanitarian response in Syria Humanitarian assessment, response or needs a Field hospitals are categorized under the health system theme as although these hospitals may be funded by humanitarian agencies and NGOs, the staff are generally local healthcare workers …”

Section: Resultsmentioning

confidence: 99%

“…These highly vulnerable populations are rarely studied. For example, only three papers [ 40 , 58 , 80 ], one field and operational activities publication [ 123 ] and one personal narrative [ 130 ] covered issues of siege. Understanding the health status and humanitarian needs of such populations is essential in order to inform programmatic action.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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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Impact of armed conflict on health professionals’ education and training in Syria: a systematic review

et al. 2023

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ObjectivesTo provide an overview of the holistic impact of the armed conflict on medical education and health professionals’ training (MEHPT) in Syria.SettingSyria is a country which underwent an armed conflict for 10 years and suffered from the weaponisation of health.MethodsA mixed-methods systematic review including quantitative, qualitative, mixed-methods and textual literature between 2011 and 2021 including papers on the Syrian MEHPT undergraduate and postgraduate education and training personnel (including medicine, dentistry, pharmacy, nursing, midwifery and allied health professionals). The electronic search was conducted in October 2018 in Embase, Global Health, Medline, PsycINFO, Web of Science, PubMed, Scopus, CINAHL and grey literature. And an update to the search was conducted in August 2021 in PubMed, Google Scholar and Trip database.OutcomesThe impact of conflict on the MEHPT system, personnel, experiences, challenges and channels of support.ResultsOf the 5710 citations screened, 70 met the inclusion criteria (34 quantitative, 3 qualitative, 1 mixed-method, and 32 reports and opinion papers). The two major cross-cutting themes were attacks on MEHPT and innovations (present in 41% and 44% of the papers, respectively), followed by challenges facing the MEHPT sector and attitudes and knowledge of trainees and students, and lastly health system and policy issues, and narrating experiences.ConclusionConflict in Syria has politicised all aspects of MEHPT. Influenced by political control, the MEHPT system has been divided into two distinguished geopolitical contexts; government-controlled areas (GCAs) and non-GCAs (NGCAs), each having its characteristics and level of war impact. International and regional academic institutes collaboration and coordination efforts are needed to formulate educational platforms using innovative approaches (such as online/blended/store-and-forward/peer-training/online tutoring) to strengthen and build the capacity of the health workforce in conflict-affected areas.

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Delivering Humanitarian Teleradiology Services to Besieged Areas in Syria

Cited by 6 publications

References 3 publications

Telemedicine interventions in six conflict-affected countries in the WHO Eastern Mediterranean region: a systematic review

Telemedicine interventions in six conflict-affected countries in the WHO Eastern Mediterranean region: a systematic review

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

Impact of armed conflict on health professionals’ education and training in Syria: a systematic review

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