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1. The health of internally displaced people in Syria: are current systems fit for purpose?

Author

Aula Abbara, Diana Rayes, Abdulkarim Ekzayez, Samer Jabbour, Manar Marzouk, Houssam Alnahhas, Sara Basha, Zahed Katurji, Richard Sullivan, and Fouad M Fouad

Subjects
Syria, Internally displaced, Health, Conflict, Public aspects of medicine, RA1-1270, Colonies and colonization. Emigration and immigration. International migration, JV1-9480
Abstract

Introduction: Syria has the largest number of internally displaced people (IDPs) globally with 6.7 million forced from their homes since the uprising erupted in 2011. Most face multiple intersecting vulnerabilities with adverse health impacts. We explore the key health concerns among IDPs, how the various health systems in Syria have responded to the dynamic health needs of IDPs and what modalities have been used by humanitarian actors to address these needs. Methods: We undertook a scoping review of academic and grey literature for available evidence regarding the health of IDPs in Syria. We then organised an online workshop in November 2021 with around 30 participants who represent local, regional, and international organisations and who have relevant expertise. The discussion focused on how the health systems in Syria's various territories have responded to the health needs of IDPs, what this means to the structure and dynamics of these health systems and their intended outcomes and responsiveness. Findings: These emphasised the weak evidence base around IDP health in Syria, particularly in certain geographical areas. Workshop participants explored the applicability of the term IDP in the Syrian context given the fragmented health system and its impact on IDPs, the importance of considering co-determinants (beyond forced displacement) on the health of IDPs and taking a transectoral, community led approach to identify and respond to needs. Conclusion: This manuscript presents some of the current issues with regards to IDP health in Syria, however, there remain numerous unknowns, both for the health of IDP as well as non-IDP populations. We hope that it will be the foundation for further discussions on practical steps relating to research, analysis and interventions which can support health system responses for IDPs in Syria.

Published
2022
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2. Protracted armed conflict and maternal health: a scoping review of literature and a retrospective analysis of primary data from northwest Syria

Author

Sara Basha, Alex Socarras, Mohammed Waseem Akhter, Mohamed Hamze, Ahmad Albaik, Imad Hussein, Ahmad Tarakji, Mufaddal Hamadeh, Randa Loutfi, Mazen Kewara, Fares Alahdab, and Aula Abbara

Subjects
Science & Technology, Adolescent, Syria, Cesarean Section, Health Policy, Maternal Health, Public Health, Environmental and Occupational Health, WOMEN, CARE, Armed Conflicts, Obstetrics, Pregnancy, Humans, Surgery, Female, Public Health, Life Sciences & Biomedicine, Public, Environmental & Occupational Health, Retrospective Studies
Abstract

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.

Published
2021

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