The Effect of the Conflict on Syria’s Health System and Human Resources for Health

Prior to the conflict, Syria’s health system was comparable with that of other middle-income countries; however, the prolonged conflict has led to significant destruction of the health infrastructure. The lack of security and the direct targeting of health workers and health facilities have led to an exodus of trained staff leaving junior health workers to work beyond their capabilities in increasingly difficult circumstances. This exodus together with the destruction of the health infrastructure has contributed to the increase in communicable and non-communicable diseases and the rising morbidity and mortality of the Syrian population. Strengthening the health system in the current and post-conflict phase requires the retention of the remaining health workers, incentives for health workers who have left to return as well as engagement with the expatriate Syrian and international medical communities

Study of the damping of waves through Dykes at embankment

peer reviewe

Unique complication of laparoscopic adjustable gastric band? A misplaced band encircling the abdominal aorta.

In the recent past, laparoscopic adjustable gastric bands (LAGBs) have been used extensively in bariatric surgery. Despite questionable long-term efficacy, they are generally safe and reversible. We report a possibly unique presentation of a potential hazard of the insertion technique; a misplaced LAGB encircling the abdominal aorta, which was confirmed radiologically and on operative removal of the gastric band. This is a dramatic complication of LAGB, representing an important anatomical hazard for gastric band insertion

Etudes d'impact d'aménagements sur le littoral corse

peer reviewe

The challenges of tuberculosis control in protracted conflict: the case of Syria

Objectives Syria’s protracted conflict has resulted in ideal conditions for the transmission of tuberculosis (TB) and the cultivation of drug resistant strains. This paper compares TB control in Syria before and after the conflict using available data, examines the barriers posed by protracted conflict and those specific to Syria, and discusses what measures can be taken to address the control of TB in Syria. Results Forced mass displacement and systematic violations of humanitarian law have resulted in overcrowding and has destroyed key infrastructures leading to an increased risk of both sensitive and drug resistant TB while restricting the ability to diagnose, contact trace, treat and follow up. Pre-conflict, TB in Syria was officially reported at 22 per 100,000 population; the official figure for 2017 of 19 per 100,000 is likely a vast underestimate given the challenges and barriers to case detection. Limited diagnostics also affects the diagnosis of multidrug and rifampicin resistant TB which is reported at 8.8% of new diagnoses in 2017. Conclusion Control of TB in Syria requires a multipronged, tailored and pragmatic approach to improve timely diagnosis, increase detection, stop transmission and mitigate the risk of drug resistance. Solutions must also consider vulnerable populations such as imprisoned and besieged communities where the risk of drug resistance is particularly high and must recognize the limitations of national programming. Strengthening capacity to control TB in Syria with particular attention to these factors will positively impact other parallel conditions; this is key as attention turns to post-conflict reconstruction

Cancer Care at Times of Crisis and War: The Syrian Example

Purpose: As Syria enters its fifth year of conflict, the number of civilians killed and injured continues to rise sharply. Along with this conflict comes the rapid decline of medical care, specifically cancer care. To determine physician and equipment availability, cancer screening and management, and possible solutions relative to various major cities, a survey was distributed to physicians inside Syria through the help of the humanitarian organization Syrian American Medical Society. Methods: Online surveys were distributed to both certified oncologists who work in cancer clinics and general physicians who work in rural and mobile clinics inside Syria. Variables assessed were physician specialty, location, population, cost, regional situation (besieged versus government controlled), and resource availability and access. Results were stratified by location and physician specialty. Results: Survey results revealed a large shortage of specialized physicians and inhibited accessibility to screening and management options in besieged areas compared with government-controlled regions. Physicians within both government-controlled and besieged cities reported limited or no targeted agents, radiation therapy, clinical trials, bone marrow transplantation, positron emission tomography scans, magnetic resonance imaging, and genetic testing. Conclusion: The Syrian civil war has resulted in suboptimal oncology care in the majority of the region. In consideration of specific deficiencies in cancer care, we recommend several solutions that may better the level of care in Syria: patient education on medical documentation and self-examination; online consultation; and cheap, effective screening methods. The implementation of these recommendations may change the course of cancer care in a country that has deteriorated into the worst humanitarian crisis of the century