I had to leave. I had to leave my clinic, my city, leave everything behind in Syria. Qualitative accounts from Syrian health care workers migrating from the war-torn country

Abstract

Objectives: To explore the experiences of Syrian health care workers of violence since 2011 and reasons behind migration from the conflict-affected country Design: A qualitative study using semi-structured interviews and inductive content analysis. Interviews were conducted in Turkey and Europe in 2016 - 2017. Setting: Interviewees were Syrian health care workers who had been working in the country after the conflict started in 2011, but at some point, migrated from Syria to Turkey or Europe. Participants: We studied data from 20 semi-structured in-depth interviews collected with a snowball sampling method. Results: Our findings show that health care workers migrated from Syria because of security issues. In most cases, the decision to leave was a result of the generalised violence that was spreading through the country since 2011. Targeted attacks by various warring parties against health care was one of the main reasons for leaving. Some participants had a specific notable trigger event before they left; such as a colleague being detained or killed. Many just grew tired of living under constant threat and fear, with their families also at risk. Conclusions: This research adds to the body of literature on violence in Syria. It helps to understand the reasons why health care workers, even though realising that it will leave their population without proper health care provision, nevertheless decide to flee the country.

‘We will never give up’: a qualitative study of ethical challenges Syrian health workers face in situations of extreme violence

“…Our research adds to what is currently known about the experiences of healthcare workers operating in violent and insecure settings in two main ways. First, the findings respond to the call for more primary research studies in conflict settings (Bou‐Karroum et al, 2019, 2020) and enhances what is known from other qualitative studies about the experiences of health workers under attack in Syria (see, for example, Fouad et al, 2017; Footer et al, 2018; Douedari and Howard, 2019; Fardousi, Douedari, and Howard, 2019; Hamid, Scior, and Williams, 2020, Kallstrom et al, 2020). Second, by analysing the findings through the lenses of ethics and humanitarian principles, our research advances what is known about the uniquely ethical aspects and ‘unsavoury trade‐offs’ (Slim, 2015) involved in health workers’ experiences (Clarinval and Biller‐Adorno, 2014; Fraser et al, 2015; Hunt et al, 2018; Broussard et al, 2019).…”

“…Several qualitative studies have explored aspects of Syrian health workers’ experiences operating within these contexts, including: remaining in Syria to treat civilians despite the risks ( Heisler, Baker, and McKay, 2015 ); leaving Syria because of security concerns ( Kallstrom et al, 2020 ); and challenges to local integration of Syrian health worker refugees in Germany ( Abbara et al, 2019 ). Fardousi, Douedari, and Howard (2019) interviewed Syrian health workers who survived facility attacks; the authors note concerns about resource constraints and the security of personnel.…”

“…Beyond the operational difficulties inherent in conflict zones, violence directed at humanitarian health workers, particularly by their own government, presents an additional dimension to the challenges of war, as health workers may suffer the risks of bodily injury, psychological harm, economic loss, and even death. This also contributes to the shortage of skilled humanitarian health workers ( Kallstrom et al, 2020 ) and creates substantial ethical dilemmas for them ( Slim, 2015 ), as well as consequent moral distress. The latter refers to the dissonance that individuals experience when they know the right thing to do according to personal and professional ethics but cannot do so given organisational and/or situational constraints ( Jameton, 1984 ; Gotowiec and Cantor-Graae, 2017 ; Hunt et al, 2018 ).…”