Trauma hospitals in Syria remain open despite war

An injured man waits inside a field hospital after airstrikes hit a market in Idlib city (Copyright Reuters 2016)

Most of Syria's trauma hospitals are still doing emergency surgeries despite having been in a war zone for the past five years, according to a new report.

"I was surprised that as many hospitals in our study were able to function to provide operative trauma care inside Syria," said lead author Dr. Hani Mowafi, of the Yale University School of Medicine in New Haven, Connecticut.

Conflicts in Syria began in 2011 and have resulted in hundreds of thousands of deaths. Nearly 7 million Syrians have fled their homes, Mowafi and colleagues write in JAMA Surgery.

Reuters reported last month that some 10,000 doctors have fled the country, and just 1,000 are left in opposition areas.

"We are witnessing in Syria one of the worst humanitarian crises of the past 100 years," Mowafi told Reuters Health via email.

To calculate the current capacity of the country's healthcare system, the Union of Medical Care and Relief Organizations sent data collectors to survey 94 surgical hospitals inside Syria during two months in 2015.

Overall, 91 percent of the hospitals could perform emergency surgery, but only 16 percent could keep patients at their facility after surgery.

"Many of these facilities were treating complex injuries with limited staff and resources in facilities that were converted schools and basements of apartment buildings," Mowafi said.

Overall, there were 538 surgeons, 378 doctors and 1,444 nurses at the hospitals, but more than 20 percent of hospitals weren't paying salaries.

"Staff in these facilities operate nearly around the clock in some cases and many go without pay for weeks on end," Mowafi said.

Hospital services were also limited. While 70 percent of hospitals could transfuse whole blood, only about 7 percent could separate and bank blood products. About a quarter of hospitals didn't have any pharmacy services.

Few hospitals had functioning equipment like X-ray machines and CT scanners.

Mowafi said some of the hardest hit areas of Syria, such as Aleppo, have a shortage of specialists and life-saving equipment while other areas have a surplus.

"There is a highly uneven distribution of resources across trauma hospitals in Syria and more work needs to be done to help target support to areas that are hardest hit," he said.

The study only shows a snapshot in time from over a year ago, but Mowafi said more recent data suggests the situation in Syria has worsened.

"While efforts have been made to rationalize distribution of resources, the repeated attacks on health facilities as well as the loss of personnel have caused many facilities to shutter their doors and to fear sharing any data with research personnel for fear that it could be used to target them," he said.

Attacking hospitals destroys any sense of security for the population, Mowafi said.

A number of additional steps could help hospitals in Syria, he said. Those include sending medicine and supplies, supporting staff, taking steps to increase capacity even at a distance by strengthening internet coverage, providing education materials and supporting data collection efforts.

SOURCE: http://bit.ly/28ND0S3 JAMA Surgery, online June 22, 2016.