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Sekkarie M, Murad L, Alasfar S. Assessment of the response to kidney patients' needs in disaster-stricken Syria. Curr Opin Nephrol Hypertens 2024:00041552-990000000-00171. [PMID: 38900090 DOI: 10.1097/mnh.0000000000001009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
PURPOSE OF REVIEW The major fighting activities in the Syrian conflict have subsided, but the country continues to deal with significant political, economic, and psychosocial consequences that gravely impact the healthcare system, including the care of patients with kidney disease. The purpose of this manuscript is to review some of the problems faced by kidney patients in postconflict Syria and their available and proposed remedies. RECENT FINDINGS Many challenges, such as unfair, poorly planned, and poorly organized distribution of resources, suboptimal quality-monitoring infrastructure, psychosocial barriers, and workforce shortages, impede the delivery of quality care and negatively impact outcomes. The negative impact of these problems is not uniform and tends to affect certain areas more than others because of geopolitical factors imposed by the conflict. SUMMARY After prolonged conflicts, healthcare resources remain limited for prolonged periods, leading to inadequate care, poor outcomes, and worsening inequities. Involvement of the international community and expatriate nephrologists is essential to guide care delivery and improve outcomes. The lessons learned from the Syrian conflict apply to many limited resources and disaster situations.
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Affiliation(s)
- Mohamed Sekkarie
- Nephrology and Hypertension Associates, Bluefield, West Virginia
| | - Lina Murad
- Metropolitan Access Center, Washington DC
| | - Sami Alasfar
- Division of Nephrology, Department of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
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Haar R, Rayes D, Tappis H, Rubenstein L, Rihawi A, Hamze M, Almhawish N, Wais R, Alahmad H, Burbach R, Abbara A. The cascading impacts of attacks on health in Syria: A qualitative study of health system and community impacts. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002967. [PMID: 38870115 PMCID: PMC11175436 DOI: 10.1371/journal.pgph.0002967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/29/2024] [Indexed: 06/15/2024]
Abstract
Syria has experienced over a decade of armed conflict, characterized by targeted violence against healthcare. The impacts of these attacks have resulted in both direct and indirect attacks on health and reverberating effects on local communities. This study aims to explore the perspectives of health workers based in northern Syria who have experienced such attacks on health to understand the impacts on the health system as well as communities served. In-depth interviews were conducted with health workers in the northern regions of Syria where attacks on health have been frequent. Participants were identified using purposive and snowball sampling. Interviews were coded and analyzed using the Framework Method. Our inductive and deductive codes aligned closely with the WHO Health System Building Blocks framework, and we therefore integrated this framing into the presentation of findings. We actively sought to include female and non-physician health workers as both groups have been under-represented in previous research in northern Syria. A total of 40 health workers (32.5% female, 77.5% non-physicians) who experienced attacks in northern Syria between 2013 and 2020 participated in interviews in 2020-2021. Participants characterized attacks on health as frequent, persistent over years, and strategically targeted. The attacks had both direct and indirect impacts on the health system and consequently the wider health of the community. For the health system, participants noted compounded impacts on the delivery of care, health system governance, and challenges to financing, workforce, and infrastructure. Reconstructing health facilities or planning services in the aftermath of attacks on health was challenging due to poor health system governance and resource challenges. These impacts had ripple effects on the health of the community, particularly the most vulnerable. The impacts of attacks on health in Syria are multiple, with both short- and long-term consequences for the health system(s) across Syria as well as the health of communities in these respective areas. Though such attacks against healthcare are illegal under international humanitarian law, this and other legal frameworks have led to little accountability in the face of such attacks both in Syria and elsewhere. Characterizing their impacts is essential to improving our understanding of the consequences of attacks as a public health issue and supporting protection and advocacy efforts.
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Affiliation(s)
- Rohini Haar
- Division of Epidemiology, Berkeley School of Public Health Berkeley, University of California, Berkeley, California, United States of America
| | - Diana Rayes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Syrian Public Health Network, London, United Kingdom
| | - Hannah Tappis
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Leonard Rubenstein
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Anas Rihawi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Division of Pulmonary & Critical Care Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Mohamed Hamze
- Syrian American Medical Society, Washington, District of Columbia, United States of America
| | - Naser Almhawish
- Syrian Public Health Network, London, United Kingdom
- Assistance Coordination Unit, Gaziantep, Turkey
| | - Reham Wais
- Syrian American Medical Society, Gaziantep, Turkey
| | | | - Ryan Burbach
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Aula Abbara
- Syrian Public Health Network, London, United Kingdom
- Department of Infectious Disease, Imperial College London, London, United Kingdom
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Almidani S, Abo Hilal M, Alghadban M, Abou Helal O, Alkourdi M, Kannan J, Ekzayez A, Patel P, El Achi N. Demographics and risk factors for suicide in Syria: A retrospective media content analysis of online news sources. Glob Ment Health (Camb) 2024; 11:e50. [PMID: 38690572 PMCID: PMC11058519 DOI: 10.1017/gmh.2024.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/15/2024] [Accepted: 04/01/2024] [Indexed: 05/02/2024] Open
Abstract
Since the beginning of the Syrian conflict in 2011, Syrians have faced violence and displacement causing an increase in mental health issues. The COVID-19 pandemic, the 2023 earthquake, and deteriorating living conditions have exacerbated these issues. Suicide in Syria remains an under-researched topic since accurate data are difficult to obtain. In this study, we aimed to explore the demographics and risk factors of suicide in Syria by performing a retrospective content analysis of selected online news (media) outlets from across Syria. Twelve news outlets from the three regions of Syria were selected and news of suicide cases were searched retrospectively. The age range was between 9 and 79 years old with the average age being 27.1 ± SD 5.9 years. The most reported causes of suicide were harsh living conditions (18.5%) and relationship problems (18.3%). The most common method of suicide was hanging followed by using firearms. More suicides occurred at night and in the summer and spring seasons. Based on our study's results, young adult, male, unmarried, individuals in rural settings and northern governorates were at the highest risk of suicide in Syria. This study highlights the urgent need for mental health interventions that address the unique challenges faced by Syrians.
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Affiliation(s)
- Salma Almidani
- Research for Health Systems Strengthening in Syria (R4HSSS) and the Centre for Conflict and Health Research (CCHR), Department of War Studies, King’s College London, London, UK
- Department of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | | | | | | | | | | | - Abdulkarim Ekzayez
- Research for Health Systems Strengthening in Syria (R4HSSS) and the Centre for Conflict and Health Research (CCHR), Department of War Studies, King’s College London, London, UK
- Syria Public Health Network, London, UK
| | - Preeti Patel
- Research for Health Systems Strengthening in Syria (R4HSSS) and the Centre for Conflict and Health Research (CCHR), Department of War Studies, King’s College London, London, UK
| | - Nassim El Achi
- Research for Health Systems Strengthening in Syria (R4HSSS) and the Centre for Conflict and Health Research (CCHR), Department of War Studies, King’s College London, London, UK
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Hmaideh A, Tarnas MC, Zakaria W, Rifai AO, Ibrahem M, Hashoom Y, Ghazal N, Abbara A. Geographical Origin, WASH Access, and Clinical Descriptions for Patients Admitted to a Cholera Treatment Center in Northwest Syria between October and December 2022. Avicenna J Med 2023; 13:223-229. [PMID: 38144910 PMCID: PMC10736181 DOI: 10.1055/s-0043-1776045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023] Open
Abstract
Background On September 10, 2022, a cholera outbreak was declared in Syria for the first time in over a decade of protracted conflict. As of May 20, 2023, 132,782 suspected cases had been reported, primarily in northwest and northeast Syria. We aim to provide a detailed description of water sources and clinical status of a patient cohort seen at a cholera treatment center (CTC) in northwest Syria. Methods We retrospectively identified patients with confirmed cholera who presented to the CTC in Idlib governorate between October 8 and December 18, 2022. Data were obtained from clinical case records and analyzed in R v4.0.4. Results Ninety-four patients (55.3% men) were treated at the CTC. Thirty-five patients were severely dehydrated (Plan C treatment), 54 had some dehydration (Plan B), and 5 had no dehydration (Plan A). Most patients were between 11 and 20 years old ( n = 25, 26.6%) or 31 and 40 years old ( n = 19, 20.2%). Note that 70.2% ( n = 66) of patients were seen in November 2022 and most were from Harim district ( n = 44, 46.8%). Public wells ( n = 46, 48.9%) and water trucking ( n = 41, 43.6%) were the most commonly used water sources. Note that 76.6% ( n = 72) did not have access to chlorine-treated water. Forty-seven patients (50%) had more than five water, sanitation, and hygiene (WASH)-related cholera risk factors. Following treatment, six patients were transferred to another treatment center, three died (case fatality rate: 3.2%), and the remainder were discharged. Conclusion Most patients reported WASH-related risk factors for cholera, reflecting the poor state of WASH in northwest Syria after over a decade of conflict. This relates to the direct and indirect impacts of urban and periurban violence as well as the underfunded humanitarian response. Strengthening WASH and health promotion are important components to control the outbreak.
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Affiliation(s)
- Ahmad Hmaideh
- Syrian Board of Medical Specialties, Syria
- Syria Public Health Network, United Kingdom
| | - Maia C. Tarnas
- Department of Population Health and Disease Prevention, University of California Irvine, Irvine, California, United States
| | | | - Ahmad Oussama Rifai
- Syrian Board of Medical Specialties, Syria
- The Virtual Nephrologist, Florida, United States
| | | | | | | | - Aula Abbara
- Syrian Board of Medical Specialties, Syria
- Syria Public Health Network, United Kingdom
- Department of Infectious Diseases, Imperial College, London, United Kingdom
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Mtenga S, Mhalu G, Osetinsky B, Ramaiya K, Kassim T, Hooley B, Tediosi F. Social-political and vaccine related determinants of COVID-19 vaccine hesitancy in Tanzania: A qualitative inquiry. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002010. [PMID: 37315101 DOI: 10.1371/journal.pgph.0002010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 05/10/2023] [Indexed: 06/16/2023]
Abstract
Vaccines have played a critical role in the response to the COVID-19 pandemic globally, and Tanzania has made significant efforts to make them available to the public in addition to sensitizing them on its benefit. However, vaccine hesitancy remains a concern. It may prevent optimal uptake of this promising tool in many communities. This study aims to explore opinions and perceptions on vaccine hesitancy to better understand local attitudes towards vaccine hesitancy in both rural and urban Tanzania. The study employed cross-sectional semi-structured interviews with 42 participants. The data were collected in October 2021. Men and women aged between 18 and 70 years were purposefully sampled from Dar es Salaam and Tabora regions. Thematic content analysis was used to categorize data inductively and deductively. We found that COVID-19 vaccine hesitancy exists and is shaped by multiple socio-political and vaccine related factors. Vaccine related factors included worries over vaccine safety (e.g., death, infertility, and zombie), limited knowledge about the vaccines and fear of the vaccine's impact on pre-existing conditions. Participants also found it paradoxical that mask and hygiene mandates are expected even after vaccination, which further exacerbated their doubts about vaccine efficacy and their hesitancy. Participants possessed a range of questions regarding COVID-19 vaccines that they wanted answered by the government. Social factors included preference for traditional and home remedies and influence from others. Political factors included inconsistent messages on COVID-19 from the community and political leaders; and doubts about the existence of COVID-19 and the vaccine. Our findings suggest that the COVID-19 vaccine is beyond a medical intervention, it carries with it a variety of expectations and myths that need to be addressed in order to build trust and acceptance within communities. Health promotion messages need to respond to heterogeneous questions, misinformation, doubts, and concerns over safety issues. An understanding of country-specific perspectives toward COVID-19 vaccines can greatly inform the development of localized strategies for meaningful uptake in Tanzania.
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Affiliation(s)
- Sally Mtenga
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Grace Mhalu
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Brianna Osetinsky
- Swiss Tropical and Public Health Institute (Swiss TPH), Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Tani Kassim
- Ifakara Health Institute, Dar es Salaam, Tanzania
- Swiss Tropical and Public Health Institute (Swiss TPH), Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Brady Hooley
- Swiss Tropical and Public Health Institute (Swiss TPH), Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute (Swiss TPH), Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Jabbour S, Abbara A, Ekzayez A, Fouad FM, Katoub M, Nasser R. The catastrophic response to the earthquake in Syria: the need for corrective actions and accountability. Lancet 2023; 401:802-805. [PMID: 36893775 DOI: 10.1016/s0140-6736(23)00440-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/08/2023]
Affiliation(s)
- Samer Jabbour
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
| | - Aula Abbara
- Syria Public Health Network, London, UK; Imperial College London, London, UK
| | - Abdulkarim Ekzayez
- Syria Public Health Network, London, UK; King's College London, London, UK
| | - Fouad M Fouad
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon; Syria Public Health Network, London, UK; King's College London, London, UK
| | - Mohamad Katoub
- IMPACT, Civil Society Research and Development, Berlin, Germany
| | - Rabie Nasser
- Syrian Centre for Policy Research, Vienna, Austria
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Carew JW, Hamze M, Atassi B, Abbara A, Khoshnood K. Investment in Cancer Prevention and Care for Forcibly Displaced Syrians Is an Urgent Priority. JCO Glob Oncol 2023; 9:e2200382. [PMID: 36595718 PMCID: PMC10166440 DOI: 10.1200/go.22.00382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- John W Carew
- Science Health Education Center, Dana Farber Cancer Institute, Boston, MA
| | | | - Bassel Atassi
- OSF Little Company of Mary Medical Center, Evergreen Park, IL
| | - Aula Abbara
- Department of Infectious Diseases, Imperial College, London, United Kingdom
| | - Kaveh Khoshnood
- Yale School of Public Health, Yale University, New Haven, CT
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