Humanitarian catastrophe for civilians in northwest Syria

Abbara, Aula; Rayes, Diana; Khalil, Munzer; Kewara, Mazen; Tarakji, A.

doi:10.1136/bmj.m451

Cited by 10 publications

(18 citation statements)

References 3 publications

(3 reference statements)

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“…Despite early promise of political reform, when peaceful uprisings began in Syria in March 2011, civilians were violently repressed, leading to one of the most violent and protracted conflicts since the Second World War. More than half a million civilians have been directly killed by the conflict (Abbara et al, 2020;Syria Public Health Network, 2020). This conflict has rendered < 50% of health facilities functional and led to the exodus of nearly 70% of the qualified healthcare workforce, with limited opportunities to sufficiently train new healthcare workers (Kherallah et al, 2012;Adam, 2013).…”

Section: Syria Politics and The Sars-cov-2 Pandemicmentioning

confidence: 99%

“…An estimated 22,000 Iranians visit Syria each year on pilgrimage and there are thousands of Iranian militia in Syria (Mazen and Mehchy, 2020). Despite the official declaration of border closures with all neighbouring countries, there are concerns that some crossing points (which are vital for humanitarian aid) (Abbara et al, 2020) remain unmonitored and porous, which could facilitate the spread of SARS-CoV-2.…”

Section: Syria Politics and The Sars-cov-2 Pandemicmentioning

confidence: 99%

“…Since 01 December 2019, a further escalation of violence has displaced almost one million Syrian civilians in NWS (where the estimated population is 4.17 million) towards the Syria-Turkish border; 81% of these are women and children (Abbara et al, 2020;Syria Public Health Network, 2020). This has left hundreds of thousands with inadequate food, shelter or health and humanitarian care.…”

Section: A Focus On Northwest Syria Where Recent Escalation Has Displaced 1 Million Civiliansmentioning

confidence: 99%

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Coronavirus 2019 and health systems affected by protracted conflict: The case of Syria

Abbara

Rayes

Fahham³

et al. 2020

International Journal of Infectious Diseases

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Introduction: Two thirds of countries globally are unprepared to respond to a health emergency as per the International Health Regulations ( 2005), with conflict-affected countries like Syria being particularly vulnerable. Political influences on outbreak preparedness, response and reporting may also adversely affect control of SARS-CoV-2 in Syria. Syria reported its first case on 22 March 2020; however, concerns were raised that this was delayed and that underreporting continues. Discussion: Syria's conflict has displaced more than half of its pre-war population, leaving 6.7 million people internally displaced. The consequent overcrowdingwith insufficient water, sanitation and healthcare (including laboratory capacity)could lead to conditions that are ideal for spread of SARS-CoV-2 in Syria. Political changes have led to the formation of at least three health systems within Syria's borders, each with its own governance, capacity and planning. This fragmentation, with little interaction between them, could lead to poor resource allocation and adversely affect control. As such, COVID-19 could overwhelm the health systems (particularly intensive care capacity), leading to high deaths across the population, particularly for the most vulnerable such as detainees. Conclusions: Locally implementable interventions that rapidly build WASH and health system capacity are required across Syria to ensure early detection and management of COVID-19 cases.

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Section: Syria Politics and The Sars-cov-2 Pandemicmentioning

confidence: 99%

Section: Syria Politics and The Sars-cov-2 Pandemicmentioning

confidence: 99%

Section: A Focus On Northwest Syria Where Recent Escalation Has Displaced 1 Million Civiliansmentioning

confidence: 99%

See 1 more Smart Citation

Coronavirus 2019 and health systems affected by protracted conflict: The case of Syria

Abbara

Rayes

Fahham³

et al. 2020

International Journal of Infectious Diseases

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“…49 Between December 2019 and February 2020, this escalation of violence forcibly displaced around one million people from their homes. 50 51 Many were displaced away from facilities in which SAMS provided maternal healthcare and, as seen in figure 3A , there was a decline in the number of open facilities. Of the five facilities that remained open during March 2020, the majority had historically tended to have above-average caesarean section rates, as seen in figure 3B , contributing to the greater proportion of caesarean sections.…”

Section: Discussionmentioning

confidence: 99%

Protracted armed conflict and maternal health: a scoping review of literature and a retrospective analysis of primary data from northwest Syria

et al. 2022

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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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“…As of May 2020, it describes an area which includes Idlib, north west Hama, northern Aleppo and north eastern Lattakia governorates [18]. This area has seen a further escalation of violence in February 2019 and then again between December 2019 and March 2020 when almost 1 million civilians were forcibly displaced from their homes, including many HCWs [19].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Humanitarian catastrophe for civilians in northwest Syria

Abstract: Nearly 2.7 million people urgently need food and water, shelter, sanitation, and healthcare

Cited by 10 publications

References 3 publications

Coronavirus 2019 and health systems affected by protracted conflict: The case of Syria

Coronavirus 2019 and health systems affected by protracted conflict: The case of Syria

Protracted armed conflict and maternal health: a scoping review of literature and a retrospective analysis of primary data from northwest Syria

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

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