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

Chaza Akik,Karl Blanchet,Hala Ghattas,Ghada E Saad,Abdulkarim Ekzayez,Neha S Singh,Jocelyn Dejong,Aline Semaan,Zeina Jamaluddine,Katherine Lopes,Joanne Constantin,Linda Shaker-Berbari

doi:10.1186/s13031-020-00263-3

Abstract

BackgroundWomen 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.MethodsWe 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.ResultsKey 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.ConclusionThe case of Syria provides a unique perspective on creative ways of managing the humanitarian response and delivering RMNCAH&N interventions, mainly in the multi-hub structure and use of remote management, despite encountered challenges. The scarcity of RMNCAH&N data is a tremendous challenge for both researchers and implementing agencies, as it limits accountability and monitoring, thus hindering the evaluation of delivered interventions.

Highlights

IntroductionSince 2011, the protracted Syrian crisis has fragmented the pre-existing healthcare system
Women and children suffer disproportionately in armed-conflicts
As part of a multi-country study coordinated by the BRANCH4 Consortium and focused on RMNCAH&N in 10 conflict-affected countries (Afghanistan, Colombia, Democratic Republic of the Congo, Mali, Nigeria, Pakistan, Somalia, South Sudan, Syria, Yemen) [31] this research aimed to document the provision and coverage of RMNCAH&N interventions and explore the factors that influenced their implementation in Syria during the crisis

Summary

Introduction

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. The ensuing deadly war led to the division of the Syrian territory among conflicting political factions, and the fragmentation of the country’s governance between the Government of Syria and opposition groups [4, 5]. Since 2011, the protracted crisis, political destabilization, targeting and destruction of healthcare facilities, attacks on health workers, and an exodus of well-trained health professionals have led to the partial collapse and fragmentation of the healthcare system [11,12,13]. The fracturing of the Syrian health system has had detrimental effects on healthcare provision, and considerable consequences on population health, including an increased risk of infectious disease outbreaks [14] and challenges in accessing maternal and child health interventions [4]

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