IDEAS home Printed from https://ideas.repec.org/a/plo/pgph00/0002967.html
   My bibliography  Save this article

The cascading impacts of attacks on health in Syria: A qualitative study of health system and community impacts

Author

Listed:
  • Rohini Haar
  • Diana Rayes
  • Hannah Tappis
  • Leonard Rubenstein
  • Anas Rihawi
  • Mohamed Hamze
  • Naser Almhawish
  • Reham Wais
  • Hesham Alahmad
  • Ryan Burbach
  • Aula Abbara

Abstract

Syria has experienced over a decade of armed conflict, characterized by targeted violence against healthcare. The impacts of these attacks have resulted in both direct and indirect attacks on health and reverberating effects on local communities. This study aims to explore the perspectives of health workers based in northern Syria who have experienced such attacks on health to understand the impacts on the health system as well as communities served. In-depth interviews were conducted with health workers in the northern regions of Syria where attacks on health have been frequent. Participants were identified using purposive and snowball sampling. Interviews were coded and analyzed using the Framework Method. Our inductive and deductive codes aligned closely with the WHO Health System Building Blocks framework, and we therefore integrated this framing into the presentation of findings. We actively sought to include female and non-physician health workers as both groups have been under-represented in previous research in northern Syria. A total of 40 health workers (32.5% female, 77.5% non-physicians) who experienced attacks in northern Syria between 2013 and 2020 participated in interviews in 2020–2021. Participants characterized attacks on health as frequent, persistent over years, and strategically targeted. The attacks had both direct and indirect impacts on the health system and consequently the wider health of the community. For the health system, participants noted compounded impacts on the delivery of care, health system governance, and challenges to financing, workforce, and infrastructure. Reconstructing health facilities or planning services in the aftermath of attacks on health was challenging due to poor health system governance and resource challenges. These impacts had ripple effects on the health of the community, particularly the most vulnerable. The impacts of attacks on health in Syria are multiple, with both short- and long-term consequences for the health system(s) across Syria as well as the health of communities in these respective areas. Though such attacks against healthcare are illegal under international humanitarian law, this and other legal frameworks have led to little accountability in the face of such attacks both in Syria and elsewhere. Characterizing their impacts is essential to improving our understanding of the consequences of attacks as a public health issue and supporting protection and advocacy efforts.

Suggested Citation

  • Rohini Haar & Diana Rayes & Hannah Tappis & Leonard Rubenstein & Anas Rihawi & Mohamed Hamze & Naser Almhawish & Reham Wais & Hesham Alahmad & Ryan Burbach & Aula Abbara, 2024. "The cascading impacts of attacks on health in Syria: A qualitative study of health system and community impacts," PLOS Global Public Health, Public Library of Science, vol. 4(6), pages 1-18, June.
  • Handle: RePEc:plo:pgph00:0002967
    DOI: 10.1371/journal.pgph.0002967
    as

    Download full text from publisher

    File URL: https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0002967
    Download Restriction: no

    File URL: https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0002967&type=printable
    Download Restriction: no

    File URL: https://libkey.io/10.1371/journal.pgph.0002967?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Siddiqi, Sameen & Masud, Tayyeb I. & Nishtar, Sania & Peters, David H. & Sabri, Belgacem & Bile, Khalif M. & Jama, Mohamed A., 2009. "Framework for assessing governance of the health system in developing countries: Gateway to good governance," Health Policy, Elsevier, vol. 90(1), pages 13-25, April.
    2. Yamama Bdaiwi & Safwan Alchalati & Ammar Sabouni & Munzer Al-Khalil & Omer Abdrabbuh & Ahmad Kejah & Abdulhadi Shaban & Mohammad Almousa & Hasan Almarei & Abdalhakem Haj Asaad & Abdulhaseb Alkdro & Mo, 2023. "Medical education system (re)building in a fragile setting: Northwest Syria as a case study," PLOS Global Public Health, Public Library of Science, vol. 3(4), pages 1-23, April.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Veillard, Jeremy Henri Maurice & Brown, Adalsteinn Davidson & Barış, Enis & Permanand, Govin & Klazinga, Niek Sebastian, 2011. "Health system stewardship of National Health Ministries in the WHO European region: Concepts, functions and assessment framework," Health Policy, Elsevier, vol. 103(2), pages 191-199.
    2. Leena Eklund Karlsson & Anne Leena Ikonen & Kothar Mohammed Alqahtani & Pernille Tanggaard Andersen & Subash Thapa, 2020. "Health Equity Lens Embedded in the Public Health Policies of Saudi Arabia: A Qualitative Document Analysis," SAGE Open, , vol. 10(4), pages 21582440209, October.
    3. VĂTAVU Sorana & ȚĂRAN Alexandra-Mădălina & MOLDOVAN Nicoleta-Claudia & LOBONȚ Oana-Ramona, 2022. "Does Technical And Democratic Governance Have The Potential To Enhance Health Spending Allocations?," Studies in Business and Economics, Lucian Blaga University of Sibiu, Faculty of Economic Sciences, vol. 17(3), pages 251-268, December.
    4. Abdulaziz Aldegheishem, 2024. "Assessing progress towards smart governance in Saudi Arabia," Palgrave Communications, Palgrave Macmillan, vol. 11(1), pages 1-9, December.
    5. Ferreira, Pedro L. & Raposo, Vitor & Tavares, Aida Isabel & Correia, Tiago, 2020. "Drivers for emigration among healthcare professionals: Testing an analytical model in a primary healthcare setting," Health Policy, Elsevier, vol. 124(7), pages 751-757.
    6. Changwoo Shon & Myoungsoon You, 2020. "Evaluation of Health Policy Governance in the Introduction of the New DRG-Based Hospital Payment System from Interviews with Policy Elites in South Korea," IJERPH, MDPI, vol. 17(11), pages 1-18, May.
    7. Heba Mohtady Ali & Jamie Ranse & Anne Roiko & Cheryl Desha, 2023. "Enabling Transformational Leadership to Foster Disaster-Resilient Hospitals," IJERPH, MDPI, vol. 20(3), pages 1-17, January.
    8. Tolib N. Mirzoev & Andrew Green & Ricky Van Kalliecharan, 2015. "Framework for assessing the capacity of a health ministry to conduct health policy processes—a case study from Tajikistan," International Journal of Health Planning and Management, Wiley Blackwell, vol. 30(2), pages 173-185, April.
    9. Sofie Buch Mejsner & Maria Kristiansen & Leena Eklund Karlsson, 2021. "Civil Servants and Non-Western Migrants’ Perceptions on Pathways to Health Care in Serbia—A Grounded Theory, Multi-Perspective Study," IJERPH, MDPI, vol. 18(19), pages 1-17, September.
    10. Jackline Sitienei & Lenore Manderson & Mabel Nangami, 2021. "Community participation in the collaborative governance of primary health care facilities, Uasin Gishu County, Kenya," PLOS ONE, Public Library of Science, vol. 16(3), pages 1-19, March.
    11. Yuan, Beibei & Jian, Weiyan & Martinez-Alvarez, Melisa & McKee, Martin & Balabanova, Dina, 2020. "Health system reforms in China a half century apart: Continuity but adaptation," Social Science & Medicine, Elsevier, vol. 265(C).
    12. World Bank, 2013. "Fairness and Accountability : Engaging in Health Systems in the Middle East and North Africa [Equité et redevabilité: S’engager en faveur des systèmes de santé au Moyen-Orient et en Afrique du Nord," World Bank Publications - Reports 16109, The World Bank Group.
    13. Ettelt, Stefanie & Fazekas, Mihaly & Mays, Nicholas & Nolte, Ellen, 2012. "Assessing health care planning – A framework-led comparison of Germany and New Zealand," Health Policy, Elsevier, vol. 106(1), pages 50-59.
    14. Maryanne Sharp & Ioana Kruse, 2011. "Health, Nutrition, and Population in Madagascar 2000-09," World Bank Publications - Books, The World Bank Group, number 5957, April.
    15. Iyad Ibrahim Shaqura & Ebrahim Jaafaripooyan & Batoul Ahmadi & Ali Akbari Sari, 2022. "Responsiveness of hospitals to inpatient and outpatient services in the low‐ and middle‐income countries: A systematic review," International Journal of Health Planning and Management, Wiley Blackwell, vol. 37(1), pages 78-93, January.
    16. Geoffrey Meads & Grant Russell & Amanda Lees, 2017. "Community governance in primary health care: towards an international Ideal Type," International Journal of Health Planning and Management, Wiley Blackwell, vol. 32(4), pages 554-574, October.
    17. Ciccone, Dana Karen & Vian, Taryn & Maurer, Lydia & Bradley, Elizabeth H., 2014. "Linking governance mechanisms to health outcomes: A review of the literature in low- and middle-income countries," Social Science & Medicine, Elsevier, vol. 117(C), pages 86-95.
    18. P Th Houngbo & H L S Coleman & M Zweekhorst & Tj De Cock Buning & D Medenou & J F G Bunders, 2017. "A Model for Good Governance of Healthcare Technology Management in the Public Sector: Learning from Evidence-Informed Policy Development and Implementation in Benin," PLOS ONE, Public Library of Science, vol. 12(1), pages 1-22, January.
    19. Yuewen Sun & Xing Liu & Junfeng Jiang & Peigang Wang, 2018. "Comprehensive Evaluation Research on Healthcare Development in China from 2002 to 2014," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 138(3), pages 1259-1278, August.
    20. Rechel, Bernd & Khodjamurodov, Ghafur, 2010. "International involvement and national health governance: The basic benefit package in Tajikistan," Social Science & Medicine, Elsevier, vol. 70(12), pages 1928-1932, June.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pgph00:0002967. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: globalpubhealth (email available below). General contact details of provider: https://journals.plos.org/globalpublichealth .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.