Abstract
Introduction: Health care workers (HCWs) are essential for the delivery of health care services in conflict areas and in rebuilding health systems post-conflict. The objective of this study was to systematically identify and map the published evidence on HCWs in conflict and post-conflict settings. Methods: We conducted a systematic mapping of the literature. We included a wide range of study designs, addressing any type of personnel providing health services in either conflict or post-conflict settings. We conducted a descriptive analysis of the general characteristics of the included papers and built two interactive systematic maps organized by country, study design and theme. Results: Out of 13,863 identified citations, we included a total of 474 studies: 304 on conflict settings, 149 on post-conflict settings, and 21 on both conflict and post-conflict settings. For conflict settings, the most studied counties were Iraq (15%), Syria (15%), Israel (10%), and Palestine (9%). The most common types of publication was opinion pieces in conflict settings (39%), and primary studies (33%) in post-conflict settings. In addition, most of the first and corresponding authors were affiliated with countries different from the country subject of the paper. The majority of papers in both conflict and post conflict settings did not report funding sources (81% and 53%), conflicts of interest of authors (73% and 62%) and around half of primary studies did not report on ethical approvals (45% and 41%). Conclusion: This systematic mapping provide a comprehensive database of evidence about HCWs in conflict and post-conflict settings on a global scale. It can inform policymakers, funders and researchers working in the field of health care workers in conflict and post-conflict settings. Funding: This study was funded by the Lebanese National Council for Scientific Research (CNRS) and the Alliance for Health Policy and Systems Research of the World Health Organization. Declaration of Interest: We declare no competing interests. Ethical Approval: Not required.
Highlights
Health care workers (HCWs) are essential for the delivery of health care services in conflict areas and in rebuilding health systems post-conflict
Out of 13,863 identified citations, we included a total of 474 studies: 304 on conflict settings, 149 on post-conflict settings, and 21 on both conflict and post-conflict settings
We excluded military HCWs, because we aimed to focus on the delivery of health care primarily to civilians
Summary
HCWs in conflict areas around the world are being threatened, detained, and killed. In Syria, Physicians for Humans Rights has reported that, since the start of the conflict till December 2017, 847 medical personnel have been killed [1]. In Afghanistan, around 92 attacks against health facilities and health workers killed 14 health workers and four caretakers in the period extending from March 1, 2015 till February 10, 2016 [2]. Direct attacks and insecurity have led to the exodus of HCWs from conflict areas. In Syria, 50% of the health workers and 95% of physicians living in Aleppo have left the country since 2011. Health care workers (HCWs) are essential for the delivery of health care services in conflict areas and in rebuilding health systems post-conflict
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