The Syrian Healthcare Crisis: ‘Brain Drain’ and Attack on Healthcare Workers

Dr. Media Rasheed, a fourth-year resident specializing in hematology, was convinced by many family members that she was in imminent danger and had to pack her possessions and flee. Violence had escalated as the country descended into war; both the Syrian Armed Forces and rebel groups committed heinous war crimes including murder, torture, rape, and enforced disappearances of civilians. Furthermore, civilians had been blocked access to food, water, and health services as a method of warfare. Within a matter of days, Dr. Rasheed had left behind her home in Damascus to find refuge in a nearby city of Erbil in Iraq [1].

What began as a series of protests in 2011 against President Bashar al-Assad’s regime rapidly escalated into a civil war between the Syrian government and anti-government rebel groups. The war has forced more than four million Syrians to flee the country, many of whom would have been the future generation of physicians. Dr. Media Rasheed explains, “I often feel guilty for leaving my country, as we doctors have pledged not to leave in times of war, but the security situation left us no choice” [1].


In a country plagued by 70 years of conflict, Syria’s healthcare system has been severely ravaged and strained. Approximately 70% of Syrian healthcare workers, including the most qualified physicians, have fled the country. The Syrian regime, backed by Russian and Iranian forces, has destroyed most of the country’s public hospitals as a strategic bombing tactic to demoralize the disenchanted civilians [2]. Healthcare professionals have gone so far as building hospitals within mountains, such as the Kafr Zita Cave, with hopes of providing medical care while escaping aerial bombardment. In March 2021, Russian forces destroyed a hospital, driving rebel forces out of the area. Unfortunately, these cruel attacks on the already disenfranchised citizens increased the demand for medical assistance, with epidemiological research providing evidence for the use of chemical weapons against civilians. Although the exact number of deaths is unknown, researchers have found many civilians in need of care as direct deaths from chemical weapon attacks are disproportionately reported in civilians (97.6%) compared to military personnel (2.4%); children alone comprise 13-14% of the mortality by chemical weapon attacks [3].


Lack of security and direct targeting of healthcare workers by the tyrants have forced a mass exodus of healthcare professionals, leading to the significant destruction of the healthcare infrastructure. Furthermore, the environment for women like Dr. Rasheed is rapidly deteriorating due to the pervasive violence from an oppressive regime as well as radical Jihadist groups, such as ISIS and Jabat al- Nusra. Cities like Aleppo have been extremely ravaged by bombs, leaving only two vascular surgeons and one plastic surgeon for the entire city. Prior to the conflict, 6,000 physicians served the population of 2.5 million. Now, the number of doctors has dwindled to a mere 20 to serve the entire area. In other cities, such as Ghouta, up to 90% of the healthcare staff have fled the country [4]. The apparent “brain drain” of healthcare workers has become an increasingly vivid reality. Studies of the medical corps revealed more than 50% of medical experts have fled the country in search for better opportunities abroad [5]. Chances of these medical experts returning to Syria are decreasing as the war continues without any signs of cessation, and as refugees seek asylum and settle into their new lives abroad. The resulting lack of skilled doctors has not only placed incredible pressure on the few remaining healthcare professionals, but also increases the risk of complications by necessitating that physicians care for patients beyond their skill sets and capabilities [6].


While the Syrian economy also follows a trajectory towards collapse, the tragic loss of healthcare workers, their skills, and knowledge will have a significant impact on the future of the nation. To combat this, the reconstruction of the Syrian healthcare system greatly depends on support of the youth who remain and feel an ethical responsibility towards rebuilding their nation. Although development in civil society remains marginal due to the region’s harsh conditions, citizens across the country have been reconstructing schools, kitchens, shelters, and hospitals in areas that were previously destroyed by warfare. However, while promising, experts are rightfully concerned that the hospitals will remain the primary target by Syrian and Russian forces.


The World Health Organization emphasizes that both parties must respect human rights and cease attacks on healthcare workers and facilities. There must also be provisional investments in the country’s healthcare system by the Syrian government and neighboring countries to assist in rebuilding the infrastructure from its foundation [7]. The people of Syria cannot have a prosperous future without proper access to clinics, hospitals, or healthcare professionals. Until the Syrian government and neighboring countries take obligatory action, individuals like Dr. Rasheed will continue to flee and seek refuge in safer regions where they are valued and respected. Though hope does remain, as Dr. Rasheed voices, “the day the war ends I will return to Syria” [1].


References:

1. CDC. (2015, February). Trends in the Use of Complementary Health Approaches Among Adults: United States, 2002–2012 (No. 79). https://www.cdc.gov/nchs/data/nhsr/nhsr079.pdf

2. Bakalar, N. (2016, June 28). The Alternative Medical Bill: $30.2 Billion. The New York Times. https://www.nytimes.com/2016/06/28/health/alternativecomplementary-medicine-costs.html

3. Why Are Complementary and Alternative Therapies Harder to Evaluate? (n.d.). American Cancer Society. https://www.cancer.org/treatment/treatments-and-sideeffects/complementary-and-alternative-medicine/complementaryand-alternative-methods-and-cancer/why-cam-is-hard-toevaluate.html

4. Cramer, H., Ward, L., Saper, R., Fishbein, D., Dobos, G., & Lauche, R. (2015). The Safety of Yoga: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. American journal of epidemiology, 182(4), 281–293. https://doi.org/10.1093/aje/kwv071

5. Cramer, H., Ostermann, T., & Dobos, G. (2018). Injuries and other adverse events associated with yoga practice: A systematic review of epidemiological studies. Journal of science and medicine in sport, 21(2), 147–154. https://doi.org/10.1016/j.jsams.2017.08.026

6. Ernst E. (2009). Acupuncture: what does the most reliable evidence tell us?. Journal of pain and symptom management, 37(4), 709–714. https://doi.org/10.1016/j.jpainsymman.2008.04.009

7. Manheimer, E., Cheng, K., Linde, K., Lao, L., Yoo, J., Wieland, S., van der Windt, D. A., Berman, B. M., & Bouter, L. M. (2010). Acupuncture for peripheral joint osteoarthritis. Cochrane Database of Systematic Reviews, https://doi.org/10.1002/14651858.cd001977.pub2

8. Rapaport, M. H., Nierenberg, A. A., Howland, R., Dording, C., Schettler, P. J., & Mischoulon, D. (2011). The treatment of minor depression with St. John's Wort or citalopram: failure to show benefit over placebo. Journal of psychiatric research, 45(7), 931–941. https://doi.org/10.1016/j.jpsychires.2011.05.001

9. Segal, G. (2018, April 18). Homeopathic remedies harmed hundreds of babies, families say. STAT. https://www.statnews.com/2017/02/21/hylands-homeopathicteething-fda/

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