Health care is attacked in many contemporary conflicts despite the Geneva Conventions. The war in Syria has become notorious for targeted violence against health care. This qualitative study describes health care workers' experiences of violence using semi-structured interviews (n = 25) with professionals who have been working in Syria. The participants were selected using a snowball sampling method and interviewed in Turkey and Europe between 2016-2017. Analysis was conducted using content analysis. Results revealed that the most destructive and horrific forms of violence health care workers have experienced were committed mostly by the Government of Syria and the Islamic State. Non-state armed groups and Kurdish Forces have also committed acts of violence against health care, though their scope and scale were considered to have a lower mortality. The nature of violence has evolved during the conflict: starting from verbal threats and eventually leading to hospital bombings. Health care workers were not only providers of health care to injured demonstrators, they also participated in non-violent anti-government actions. The international community has not taken action to protect health care in Syria. For health workers finding safe environments in which to deliver health care has been impossible.

Background The Syrian conflict has endured for a decade, causing one of the most significant humanitarian crises since World War II. The conflict has inflicted massive damage to civil infrastructure, and not even the health care sector has been spared. On the contrary, health care has been targeted, and as a result, many health professionals have left the country. Despite the life-threatening condition, many health professionals continued to work inside Syria even in the middle of the acute crisis. This qualitative study aims to determine the factors that have motivated Syrian health professionals to work in a conflict-affected country. Methods The research is based on 20 semi-structured interviews of Syrian health care workers. Interviews were conducted in 2016–2017 in Gaziantep, Turkey. A thematic inductive content analysis examined the motivational factors Syrian health care workers expressed for their work in the conflict area. Results Motivating factors for health care workers were intrinsic and extrinsic. Intrinsic reasons included humanitarian principles and medical ethics. Also, different ideological reasons, patriotic, political and religious, were mentioned. Economic and professional reasons were named as extrinsic reasons for continuing work in the war-torn country. Conclusions The study adds information on the effects of the Syrian crisis on health care—from healthcare workers' perspective. It provides a unique insight on motivations why health care workers are continuing their work in Syria. This research underlines that the health care system would collapse totally without local professionals and leave the population without adequate health care.

The demonstrations in Syria in 2011 became an uncompromising conflict that divided the country into three main areas of control: governmental areas, northeast Syria, and Northwest Syria. A series of United Nations resolutions adopted in 2014 authorizing official cross-border humanitarian aid in opposition-held areas to allow humanitarian agencies and organizations to use routes across the border from neighborhood countries like Turkey to deliver humanitarian assistance to people in need in Syria. The resolution was extended annually until 2021 when it was adapted to involve a cross-line humanitarian response from governmental areas besides cross-border operations. The last adaptation of the cross-border resolution, whose original form was interpreted as a politicized action by Russia and China, implicates an unframed and unplanned transition from an emergency to an Early Recovery status. Without an appropriate framework for the current geopolitical complexity in Syria, Early Recovery programs are doomed to fail, resulting in further complications in the political and humanitarian scenes. Moreover, the effectiveness of the cross-line mechanism is questionable, considering the lack of accessibility and acceptability for Damascus-based humanitarian operations in areas out of government control. The article reviews studies about Early Recovery guidelines and operational frameworks of health systems recovery in post-conflict settings to derive a practical and hybrid framework for operationalizing health system recovery in Northwest Syria, considering current geopolitical and humanitarian circumstances. This article draws upon the six building blocks of the health system, the essential package of public health services, Early Recovery integration criteria, health system resilience dimensions in the literature, and public health determinants to identify context-specific health system recovery challenges and priorities. As a result, we introduce a new health system recovery framework, which is operationalized for the context of Northwest Syria.

ObjectivesTo explore the reasons why healthcare workers migrate from Syria, a country where conflict has been raging for over a decade.DesignA qualitative study was performed using semistructured interviews. Semistructured questions guided in-depth interviews. Content analysis was used.SettingParticipants were Syrian healthcare workers who had worked in the country after the conflict started in 2011, but at some point left Syria and settled abroad. The interviews took place in Turkey and Europe in 2016 and 2017.ParticipantsWe collected data from 20 participants (18 males and 2 females) through snowball sampling method.ResultsHealthcare workers migrated from Syria only because of security reasons. In most cases, the decision to leave resulted from the generalised violence against civilians by different warring parties, mainly the Government of Syria and the Islamic State. Intentional attacks against healthcare workers were also one of the main reasons for leaving. Some participants had a specific notable trigger event before leaving, such as colleagues being detained or killed. Many participants simply grew tired of living under constant fear, with their families also at risk.ConclusionsThis research adds to the body of literature on violence against healthcare workers in Syria. It helps to understand the reasons why healthcare workers leave the country. The study also indicates that the international community has failed to protect Syrian healthcare workers. The intensity of the conflict has left many healthcare workers with no other option than to leave. Understanding this migration will enable the discovery of new solutions for protecting healthcare workers in current and future conflicts.