Type: Systematic Review
Date: July 20, 2023

Summary
The decade-long armed conflict in Syria has devastated the medical education and health professionals' training (MEHPT) sector, with healthcare workers and facilities frequently targeted. This systematic review provides a comprehensive overview of the conflict's impact on MEHPT in Syria, analysing literature published between 2011 and 2021. The study focuses on both undergraduate and postgraduate education and training for various health professionals across government-controlled areas (GCAs) and non-government-controlled areas (NGCAs).
 

Key findings reveal several critical themes:

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• Attacks on MEHPT: A major cross-cutting theme, particularly prevalent in NGCAs, involving the weaponisation of healthcare, targeting of facilities and personnel, and violations of international humanitarian laws to restrict access to care.

• Challenges facing MEHPT: These include a severe exodus of healthcare workers (70% have fled the country), leading to a drastic shortage of teaching staff and a poor HCW-to-population ratio. Additionally, there are issues with the quality of training, lack of accreditation for newly established institutions in NGCAs, and insufficient funding and research support across both geopolitical contexts.

• Politicisation and division: The conflict has politicised all aspects of MEHPT, dividing the system into distinct geopolitical contexts (GCAs and NGCAs), each with unique characteristics and levels of war impact. This has influenced the nature of challenges and the types of support received.

 

Despite the devastating impact, the review also highlights innovations that have emerged, particularly in NGCAs. These include the establishment of new universities and training programs, the use of homemade training facilities, and the implementation of tele-training, online teaching, and peer-to-peer learning to bridge resource gaps and connect with the Syrian diaspora. The paper concludes that while a bottom-up approach has emerged in NGCAs to rebuild MEHPT, the system remains fragile and polarised, with limited primary research evidence reflecting a significant global inattention to this field. Sustained international and regional collaboration, innovative educational platforms, and ethical frameworks are urgently needed to strengthen the capacity of the health workforce in conflict-affected areas of Syria.