Healthcare leadership in Syria during armed conflict and the pandemic

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Aula Abbara , Abdulkarim Ekzayez


The COVID-19 pandemic has challenged political and healthcare leadership internationally, including in settings that have seen sustained investment and emphasis in both. Although there has been increasing recognition for the critical role of healthcare leadership, particularly by women in areas of armed conflict, there has yet to be effective and sustained investment with sufficient support for the development of future leaders from within cohorts of healthcare professionals. This has been particularly so among the healthcare communities in countries that have been adversely affected by protracted conflict or humanitarian crises where violence, including attacks on healthcare, has driven the forced migration of healthcare workers, limiting the pool from which medical and healthcare leaders can emerge.
These healthcare workers may have seen sparse opportunities before the conflict to develop relevant leadership or management skills, with little attention given to these during their undergraduate or postgraduate studies. Such skill sets among healthcare workers are crucial during times of peace and more so during crises. The COVID-19 pandemic has demonstrated just how essential these skills are with requirements for flexible and capable leadership at a national or international scale, as well as more locally at a community or health facility level community or health facility level.

In Syria, a country that descended into conflict after violent suppression of peaceful uprisings in 2011, thousands of healthcare workers, particularly doctors, have been forcibly displaced, with many citing ongoing attacks on healthcare as a key push factor. Healthcare itself has been weaponised with targeted attacks continuing with impunity despite being in contravention of International Humanitarian Law. There have been almost 600 attacks on healthcare, and more than 900 healthcare workers have been killed with accusations that such attacks are deliberate. As a result, healthcare workers who remain face extreme challenges working in their health system with severe shortages of equipment, consumables and personnel while also being under attack. The COVID-19 pandemic in Syria has compounded this with the reported deaths of dozens of doctors in areas under the control of the Syrian government (currently accounting for two-thirds of the country), although the politicised nature of the response in these areas has led to accusations that the true extent of the pandemic is being suppressed.