’We are trying to live in a normal way, but nothing is normal about us anymore…’: a qualitative study of women’s lived experiences of healthcare in opposition-controlled areas of Syria

Abstract

IntroductionThe Syrian conflict, which has included mass killings, displacement, infrastructure destruction and illegal targeting of health facilities and staff mainly by the Syrian government and allies, is in its 10th year. This study explored the lived experiences of women within healthcare, both as health workers and service users, in Syrian opposition-controlled areas (OCAs).MethodsWe chose a qualitative study design, with 20 in-depth interviews conducted remotely over WhatsApp and Messenger with purposively sampled Syrian women (ie, 15 health workers, 5 service users). We analysed data using interpretative phenomenological analysis.ResultsAnxiety, fear and horror affected women’s everyday work and wellness. Excess workload and insecurity were major challenges for women health workers, who also had household and caring responsibilities. Coping mechanisms included: (1) normalising death; (2) acceptance of God’s will; and (3) focusing on controllable issues such as health services provision while accepting the reality of insecurity and death. Conflict contributed to changing social norms and expectations, and women became key actors in healthcare provision, though this did not translate directly into greater decision-making authority. Structural biases (eg, lack of maternity leave) and gender-based violence (eg, increased harassment and child marriage) inordinately affected women.ConclusionThis is a first effort to amplify women’s voices in health policy and systems research on the Syrian conflict. Women have become key healthcare providers in OCAs but remain under-represented in decision making. While the conflict-related social transformation, increasing the role of—and demand for—women health workers could be viewed positively for women’s empowerment, the reality is complex and long-term implications are unclear.

Health system evaluation in conflict-affected countries: a scoping review of approaches and methods

“…Similarly, Murphy’s evaluation of MSF’s Integrated Diabetic Clinic in DRC indicated all health-workers interviewed were male due to limited numbers of women in the field. However, in interpreting such justifications it is worth noting that Alhaffar et al, using Douedari and Howard’s methods, noted no difficulties recruiting and interviewing women health-workers in opposition-controlled northwest Syria [ 3 , 22 ].…”

Revealing the significant shortcomings in the learning environment at the three largest medical schools in Syria: what’s next?

“…It had been previously discussed that one of the factors that drive Syrian medical students to specialize abroad was the quality of training [ 45 ]; teaching staff’s had a negative role which perpetuated students’ negative attitude towards staying in the country [ 45 ]. Medical students have a glimpse of what their working environment is like during their residency through the clinical rounds they have in 4 th , 5 th , and 6 th years of study; residents are poorly paid despite the long working hours they spend at the teaching hospitals [ 45 , 47 ]. A study conducted in 2020 on the working and learning environment of resident dentists at Damascus University in Syria reported in detail the grim reality and unfortunate circumstances they deal with [ 17 ].…”

Professional Obstacles to Anaesthesiology Practice in Punjab, Pakistan: Qualitative Study of Consultant Anaesthesiologists’ Perspectives

“…Finally, our gendered findings were complex. Challenges reported among women anaesthesiologists, such as gendered insecurity/domestic responsibilities and insufficient support for childcare, have been reported by working women across sectors and countries [ 41 ]. In higher-income countries more women can mitigate gendered concerns with higher salaries and, thus, unlike many female anaesthesiologists in Punjab, they can still choose to work [ 25 , 26 , 27 , 42 ].…”