Abstract
The occupational health literature has established that sex and gender are associated with all dimensions of the workplace. Sex and/or gender (sex/gender) factors play an important role in shaping the experiences, exposures, and health outcomes of male and female healthcare providers working in war and conflict settings. This study aims to (1) assess how sex/gender is considered in the occupational health literature on healthcare workers in conflict settings, and (2) identify the gaps in incorporating sex/gender concepts in this literature. A scoping review was carried out and nine electronic databases were searched using a comprehensive search strategy. Two reviewers screened the titles/abstracts and full-texts of the studies using specific inclusion and exclusion criteria. Key information was extracted from the studies and four themes were identified. Of 7679 identified records, 47 were included for final review. The findings underlined the harsh working conditions of healthcare workers practicing in conflict zones and showed sex/gender similarities and differences in experiences, exposures and health outcomes. This review revealed a dearth of articles with adequate consideration of sex/gender in the study design. Sex/gender-sensitive research in occupational health is necessary to develop effective occupational health and safety policies to protect men and women healthcare workers in conflict settings.
Highlights
In 2017, more than 50 armed conflicts were documented in the world, of which, most were concentrated in the Middle East and North Africa (MENA) region including Syria, Iraq, and the Occupied Palestinian Territories, where conflicts have been continuous and chronic [1]
Our findings show that male and female healthcare workers practicing in conflict settings experience hardship, fear, and precarious working conditions
While studies in this review found that physical violence was more common among male healthcare workers (HCWs) practicing in conflict zones [62,63], another study found no sex/gender differences in exposure to violence [61]
Summary
In 2017, more than 50 armed conflicts were documented in the world, of which, most were concentrated in the Middle East and North Africa (MENA) region including Syria, Iraq, and the Occupied Palestinian Territories, where conflicts have been continuous and chronic [1]. Wars have detrimental impacts on all sectors of life, including social, economic, and environmental. Wars and conflicts have led to the destruction of properties, the displacement of people, but most significantly, the loss of human life [2,3]. The loss of medical staff is a primary concern in war settings, resulting from deaths, injuries, or staff leaving the profession [6,7]. During the Syrian crisis, 70% of health workers fled the country seeking safety elsewhere, due to the continuous violent attacks on medical facilities and healthcare workers (HCWs) [8]. The loss of qualified staff forces health facilities to rely on junior and inexperienced staff and volunteers [9]. Most HCWs practicing in conflict settings are not emergency doctors and do not have experience in emergency medicine [6,7]
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