The Impact of Armed Conflict on Utilisation of Health Services in North-West Syria: An Observational Study

Abstract

BackgroundArmed conflicts are known to have detrimental impact on availability and accessibility of health services. Consequently, utilisation of healthcare is usually affected. However, little is known on the extent of these effects largely due to challenges facing research in such settings. This study examines whether exposure to war incidents affected utilisation of key health services in conflict affected areas of north west Syria between 1 October 2014 and 30 June 2017.MethodsThe study is an observational study using routinely collected data in 8 health facilities in north west Syria and a database on conflict incidents. Longitudinal panel data analysis was used with fixed effect negative binomial regression for the monthly analysis and distributed lag model with a lag period of 30 days for the daily analysis.ResultsThe study found strong evidence for a negative association between bombardments and both consultations and antenatal care visits. The monthly Risk Ratio was 0.95 (95%CI: 0.94-0.97) and 0.95 (95%CI: 0.93-0.98) respectively; and the cumulative daily RR at 30 days was 0·19 (95%CI: 0·15 - 0·25) and 0·42 (95%CI: 0·25 - 0·69) for consultations and antenatal care respectively. Explosions were found to be associated with an increase in the number of deliveries and C-sections. The data provides evidence that each one unit increase in explosions in a given month in a given village was associated with about 20% increase in deliveries and C-sections; RR was 1·22 (95%CI: 1·05-1·42) and 1·96 (95%CI: 1·03-3·74) respectively.ConclusionThe study found that access to healthcare in affected areas in Syria has been limited. The study also provides evidence that conflict incidents were associated negatively with the utilisation of health services. Based on this evidence, health actors in conflict settings need to adopt strategies that ensure availability and accessibility of health services such as decentralisation and outreach health services.