Responding to health needs of women, children and adolescents within Syria during conflict: intervention coverage, challenges and adaptations

Abstract

Background: Women and children suffer disproportionately in armed-conflicts. Since 2011, the protracted Syrian crisis has fragmented the pre-existing healthcare system. Despite the massive health needs of women and children, the delivery of key reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH&N) interventions, and its underlying factors are not well-understood in Syria. Our objective was to document intervention coverage indicators and their implementation challenges inside Syria during conflict. Methods: We conducted 1) a desk review to extract RMNCAH&N intervention coverage indicators inside Syria during the conflict; and 2) qualitative interviews with decision makers and health program implementers to explore reasons behind provision/non-provision of RMNCAH&N interventions, and the rationale informing decisions, priorities, collaborations and implementation. We attempt to validate findings by triangulating data from both sources. Results: Key findings showed that humanitarian organisations operating in Syria adopted a complex multi-hub structure, and some resorted to remote management to improve accessibility to certain geographic areas. The emergency response prioritised trauma care and infectious disease control. Yet, with time, humanitarian organisations successfully advocated for prioritising maternal and child health and nutrition interventions given evident needs. The volatile security context had implications on populations' healthcare seeking behaviors, such as women reportedly preferring home births, or requesting Caesarean-sections to reduce insecurity risks. Additional findings were glaring data gaps and geographic variations in the availability of data on RMNCAH&N indicators. Adaptations of the humanitarian response included task-shifting to overcome shortage in skilled healthcare workers following their exodus, outreach activities to enhance access to RMNCAH&N services, and operating in 'underground' facilities to avoid risk of attacks.

10 years of the Syrian conflict: a time to act and not merely to remember

“…22 There are major women, child, and adolescent health challenges but inadequate interventions. 23 Coverage for required child immunisations has dropped considerably during the conflict years. 24 Warrelated injury prevalence is unknown, but much of the 30% disability prevalence in Syria-double the global average-is probably attri butable to war injuries.…”

Leveraging community mortality indicators to infer COVID-19 mortality and transmission dynamics in Damascus, Syria

“…However, pre-conflict health system challenges surrounding among other issues, data validity and transparency, inadequate healthcare provider coordination and staffing levels as well as uncontrolled private-sector expansion, all contributed to uneven regional health services distribution 23 . The March 2011 uprising, violent government response, and escalated armed conflict since mid-2012 is well documented 24 . Waves of population displacement has meant an estimated 11.7 million people in Syria needed humanitarian health assistance in 2019 24 , 25 .…”

“…The March 2011 uprising, violent government response, and escalated armed conflict since mid-2012 is well documented 24 . Waves of population displacement has meant an estimated 11.7 million people in Syria needed humanitarian health assistance in 2019 24 , 25 . The protracted conflict, entailing dynamic shifts in conflict lines and political boundaries, has fragmented the country’s governance among opposing military forces including the Syrian government, opposition groups, Syrian Democratic forces, and Turkish forces 24 .…”

“…Waves of population displacement has meant an estimated 11.7 million people in Syria needed humanitarian health assistance in 2019 24 , 25 . The protracted conflict, entailing dynamic shifts in conflict lines and political boundaries, has fragmented the country’s governance among opposing military forces including the Syrian government, opposition groups, Syrian Democratic forces, and Turkish forces 24 . This has fragmented the country’s governance and led to shortages of supplies and equipment, systematic targeting of healthcare facilities and staff and the forced migration of skilled healthcare professionals.…”

Researching the delivery of health and nutrition interventions for women and children in the context of armed conflict: lessons on research challenges and strategies from BRANCH Consortium case studies of Somalia, Mali, Pakistan and Afghanistan

“…Detailed reports of the BRANCH case studies [13][14][15][16][17][18][19][20][21][22] as well as a cross-case synthesis of findings [23] are published elsewhere. For this additional paper, we aimed to highlight and discuss some of the research challenges faced and the corresponding mitigation strategies used by the international research teams conducting BRANCH case studies in Somalia, Mali, Pakistan and Afghanistan ( Table 1).…”