Table 2 Summary of conflict-related health research studies inside Syria, January 2011–December 2019
First author (Publication year) | First & Last (Senior) authors’ country of institutional affiliation | Type of institutional affiliation | Description | Theme (Subtheme) | Study Period (month/year) | Methodology | Study Population | Geographic focus | Funding |
|---|---|---|---|---|---|---|---|---|---|
Alasaad (2013) [8] | First: Syria, Switzerland, Spain Last: N/A | First: academic | Reviews YouTube and social media videos to describe leishmaniasis outbreaks in Deir ez-Zor. | Health status | January–March 2013 | YouTube and Facebook video review, contact with local communities | General population | Deir ez-Zor | Not reported |
Ahmad (2014) [9] | First: UK Last: N/A | First: academic | Assesses the influences of neighborhood socioeconomic position and urban informal settlements on women’s health. | Health determinants and risks | April–May 2011 | Key informant interviews, unstructured observations | Professionals working with populations in informal communities; women in informal settlements | Aleppo | Institute of Health and Society, Newcastle University, UK |
Hoetjes (2014) [10] | First: Netherlands Last: Netherlands | First: humanitarian Last: humanitarian | Documents results of a screening program and examines food security and factors affecting nutritional status amongst the Tal-Abyad population (Al-Raqqa), and describes MSF nutrition programs. | Health status; humanitarian assistance, response or needs | 2013 | Mixed methods (middle-upper arm circumference screening; qualitative survey) | IDPs living in schools | Al-Raqqa | Not reported |
Rosman (2014) [11] | First: Israel Last: Israel | First: academic/ military Last: academic/ military | Reports on physician reviews of YouTube videos documenting a sarin attack to determine clinical presentation and review the management of a mass casualty event | War strategies / alleged IHL violations | August–September 2013 | Physician review of YouTube videos | Casualties of Ghouta sarin attack | Damascus | Not reported |
Alshiekhly (2015) [12] | First: Syria Last: Syria | First: academic Last: academic | Evaluates feasibility of Facebook as a teaching modality for a course on medical emergencies in dental practice | Health system (workforce) | March–April 2014 | Pre and post questionnaire | Dental students | Not reported | None |
Doocy (2015) [13] | First: USA Last: Belgium | First: academic Last: academic | Documents humanitarian needs and priorities among households in need of assistance in accessible communities | Humanitarian assistance, response or needs | April–June 2014 | Needs assessment | General population | Predominantly government-controlled areas (Aleppo, As-Sweida, Damascus, Dara’a, Al-Hasakeh, Homs, Lattakia, Rural Damascus, Tartous) | Humanitarian assistance programs |
Doocy (2015) [14] | First: USA Last: USA | First: academic Last: academic | Describes trends in internal displacement and analyzes the association between displacement and household well-being and humanitarian needs. | Humanitarian assistance, response or needs | March 2011–June 2014 | Review of published IDP estimates; needs assessment | General population | National | Not reported |
Guha-Sapir (2015) [15] | First: Belgium Last: Lebanon | First: academic Last: academic | Documents direct conflict-related deaths of women and children using VDC data. | Mortality; war strategies / alleged IHL violations | March 2011–January 2015 | VDC data analysis | Civilians | National | emBRACE—Building resilience amongst communities in Europe & Chatham House |
Price (2015) [16] | First: USA Last: USA | First: humanitarian Last: humanitarian | Applies capture - recapture methods to data from four sources to estimate mortality, and describes the issues associated with accurately documenting mortality estimates in conflict settings | Mortality | December 2012–March 2013 | Multiple systems estimation / capture -recapture | Civilians and combatants | Homs, Hama | Not reported |
Sekkarie (2015) [17] | First: USA Last: USA | First: clinical Last: academic | Explores the impact of conflict on dialysis services | Health system (service provision, workforce) | 2013 | Key informant Interviews | Dialysis facility administrators, providers and patients | Non-government-controlled areas (Aleppo, Homs, Idlib) | Not reported |
Tajaldin (2015) [18] | First: USA Last: USA | First: academic Last: academic | Compares polio case rates using laboratory versus clinical case definitions and different surveillance systems | Health system (information systems); health status | 2013–2014 | Analysis of EWARS and EWARN data | General population | National | Not reported |
Trelles (2015) [19] | First: Belgium Last: Belgium | First: humanitarian Last: humanitarian | Reports on surgical cases and intraoperative mortality rates at an MSF field hospital | Humanitarian assistance, response or needs | September 2012–January 2014 | Analysis of MSF programme data | Surgical patients | Jabal Al Akrad, Latakia Northwest Syria | Médecins Sans Frontières-Operational Centre, Belgium. |
Charlson (2016) [20] | First: Australia, USA Last: Australia, USA | First: academic Last: academic | Estimates prevalence of depression and PTSD and models likely current and future mental health service requirements | Health status; Health system (service provision, workforce) | Global Burden of Disease Study 2010, modelling for period 2015–2030 | Global Burden of Disease (GBD) methodology and modelling | General population | National | Queensland Department of Health, Australia |
El-Khani (2016) [21] | First: UK Last: UK | First: academic Last: academic | Examines feasibility of the “bread wrapper approach” which involves distribution of psychological support information on leaflets inserted into bread wraps and using the bread wraps to circulate questionnaires assessing the usefulness of the information provided. | Humanitarian assistance, response or needs | Not reported | Questionnaire | General population | Northern Syria next to the borders with Turkey | The University of Manchester’s ESRC Transformative Research Prize Committee |
Elsafti (2016) [22] | First: Qatar, Egypt Last: Belgium | First: clinical Last: academic | Documents the family, educational, and health status of Syrian children and associated humanitarian needs | Health status; humanitarian assistance, response or needs | May 2015 | Needs assessment | Children less than 15 years old | Aleppo, Hama, Idlib, Lattakia | None |
Ismail (2016) [23] | First: UK Last: Lebanon | First: academic Last: academic | Describes trends in tuberculosis, measles and polio case numbers in Syria and challenges of disease surveillance in the conflict context. | Health system (information systems); health status | Peer-reviewed analysis (2005–2015), EWARN & EWARS analysis (2014–2015) | Analysis of EWARN, EWARS data | General population | National | Not reported |
Jefee-Bahloul (2016) [24] | First: USA Last: USA | First: academic Last: academic | Examines attitudes of Syrian healthcare providers towards Store & Forward tele-mental health consultations | Health system (service provision) | Not reported | Online survey | Syrian health-care professionals affiliated with humanitarian NGOs | Aleppo, Damascus, Idlib, Othersa | Not reported |
Mowafi (2016) [25] | First: USA Last: France | First: academic Last: humanitarian | Assesses the functional status and capacity of trauma hospitals | Health system (service provision, workforce) | February–March 2015 | Survey | Hospitals providing secondary or tertiary surgical care in non-government-controlled areas | Aleppo, Damascus (non-government-controlled area), Dara’a, Hama, Homs, Idlib, Lattakia, Quneitra, Rural Damascus | Yale University & UOSSM. |
Sparrow (2016) [26] | First: USA Last: Australia | First: academic Last: academic | Compares two infectious disease surveillance systems, the Ministry of Health-run EWARS system and the independent, non-governmental EWARN | Health system (information system); health status | 2014–2015 | Analysis of EWARS and EWARN data | General population | National | Not reported |
Al-Saadi (2017) [27] | First: Syria Last: Syria | First: academic Last: academic | Reports prevalence and risk factors of psychological distress among medical students in Damascus | Health status; Health system (workforce) | November 2015 | Online questionnaire | Second to sixth-year medical students at Damascus University | Damascus | None |
Alsaied (2017) [28] | First: USA Last: Canada, Qatar | First: clinical Last: academic, clinical | Reports on the operations of UOSSMb primary care clinics in Opposition Territories and reasons for consultations | Humanitarian assistance, response or needs; health status | January 2014–December 2015 | Retrospective administrative database review | Patients seen at 10 primary care centers | Opposition-controlled areas (Aleppo, Deir ez-Zor, Hama, Homs, Idlib, Lattakia) | None |
Arafat (2017) [29] | First: Syria Last: Syria | First: clinical Last: academic | Describes differences in patterns of injury and mortality rates among patients with penetrating abdominal injuries at Damascus Hospital | Health status | October 2012–June 2013 | Retrospective review of records | Patients with penetrating abdominal injuries | Damascus | None |
Baaity (2017) [30] | First: Syria Last: Syria | First: academic Last: academic | Reports the prevalence of extended spectrum β lactamases of E. coli in isolates from patients in Al-Assad Teaching Hospital, Lattakia | Health status | October 2014–November 2016 | Analysis of data regarding clinical isolates | Patients in Al-Assad teaching hospital | Lattakia | Not reported |
Cummins (2017) [31] | First: Not stated Last: Turkey | First: humanitarian Last: humanitarian | Aims to understand the impact of providing food kits in Idlib and how it disturbs the food market, and proposes market-based approach as an alternative for food aid provision. | Humanitarian assistance, response or needs | 2016 | Interviews | Community members in Idlib (Darkoush and Salquin) | Idlib | UK Department for International Development (DFID) through the Urban Crises Learning Fund. |
Diggle (2017) [32] | First: UK Last: UK | First: humanitarian Last: academic | Reflects on operational experiences and analyses humanitarian health response data collected in contested and opposition-held areas of Syria | Mortality; health status; humanitarian assistance, response or needs | 2013–2014 | Analysis and review of data from multiple operational databases | Civilians & combatants | Contested and opposition-controlled areas (governorates not specified) | None |
Doocy (2017) [33] | First: USA Last: USA | First: academic Last: academic | Identifies humanitarian needs and priorities among displaced and female headed households in government-controlled areas | Humanitarian assistance, response or needs | April–June 2016 | Needs assessment | Displaced & female headed households | Government-controlled areas (Aleppo, As-Sweida, Damascus, Dara’a, Hama, Al-Hasakeh, Homs, Lattakia, Rural Damascus, Tartous) | US-based international nongovernmental organization |
Doocy (2017) [34] | First: USA Last: Turkey | First: academic Last: humanitarian | Examines the effectiveness of three assistance programs (in-kind food commodities, food vouchers, unrestricted vouchers) in improving food security in northern Syria. | Humanitarian assistance, response or needs; Health determinants and risks | September–December 2014, May/June 2015 | Serial household surveys, shopkeeper survey and analysis of program monitoring data | Beneficiary households; shopkeepers participating in the voucher program | Idlib | GOAL |
Elamein (2017) [35] | First: Turkey Last: Turkey, Egypt | First: UN agency Last: UN agency, academic | Describes the first operational use of the Monitoring Violence against Health Care (MVH) tool to report real-time incident data for attacks on healthcare infrastructure, workers and patients | War strategies / alleged IHL violations; health system (service provision; workforce) | November 2015–December 2016 | Analysis of MVH data | Healthcare workers, health service users | Aleppo, Al-Raqqa, Damascus, Dara’a, Deir ez-Zor, Hama, Homs, Idlib, Lattakia, Quneitra, Rural Damascus | None |
Fouad (2017) [36] | First: Lebanon Last: Lebanon | First: academic Last: academic | Reports on attacks on healthcare and experiences of health workers inside Syria | War strategies / alleged IHL violations; health system (workforce; service provision) | Not reported | Mixed methods study (quantitative data analysis, consultations, testimonials) | Health workers | National | IDRC; American University of Beirut |
Fujita (2017) [37] | First: Japan Last: Sweden | First: academic Last: academic | Presents daily time series analysis of violent deaths in Syria, including temporal and spatial analysis, and compares trends with those of violent and non-violent deaths in the non-conflict context of England | Mortality | 1200-day period commencing 500 days post conflict onset | Secondary analysis and modelling of Violations Documentation Center data | Civilians and military personnel | Aleppo, Damascus, Dara’a, Homs, Idlib | Bilateral Joint Research Project between JSPS, Japan, and FRS-FNRS, Belgium. Grants-in-Aid for Scientific Research from MEXT Japan |
Hawat (2017) [38] | First: Syria Last: Syria | First: academic Last: academic | Reviews the epidemiology of cutaneous and visceral leishmaniasis in Lattakia and examines the effects of the Syrian conflict on incidence | Health status | 2006–2016 | Analysis of Leishmaniasis and Contagious Diseases Centre data for new cases of leishmaniasis | General population | Lattakia | Not reported |
Mohammad (2017) [39] | First: Syria Last: Canada | First: academic Last: clinical, academic | Assesses asthma prevalence, asthma control and quality of life among those with diagnosed asthma; Among non-asthmatics, estimates prevalence of respiratory symptoms, PTSD symptoms and other chronic disease co-morbidities. | Health status | Not reported | Cross-sectional survey | IDPs in Al-Herjalleh shelter aged > = 5 years | Damascus | Syrian Private University |
Sahloul (2017) [40] | First: USA Last: USA | First: academic Last: clinical | Examines quality of cancer care and needs in government-controlled areas versus besieged areas, and provision of care in general clinics compared with specialized cancer care clinics. | Health system (service provision, workforce); war strategies / alleged IHL violations | Not reported | Cross-sectional survey | Oncologists and surgeons working in cancer clinics, and general physicians | Government-controlled areas (Damascus, Lattakia, Homs, and West Aleppo) and besieged areas (East Ghouta, East Aleppo, and Idlib) | Not reported |
van Berlaer (2017) [41] | First: Belgium Last: Belgium | First: academic Last: academic | Documents diagnoses, injuries and comorbidities in children in Northern Syria | Health status; humanitarian assistance, response or needs | May 2015 | Cross-sectional household survey | Children younger than 15 years | Aleppo, Hama, Idlib, Lattakia | None |
Abbas (2018) [42] | First: Syria Last: Syria | First: academic Last: academic | Examines efficacy and feasibility of peer- led versus professional-led training in basic life support course for medical students | Health system (workforce) | April 2016 | Randomized controlled trial | Medical students in pre-clinical years at Syrian Private University | Damascus | None |
Albaroudi (2018) [43] | First: Syria Last: Syria | First: academic Last: academic | Examines prevalence of iron deficiency and iron deficiency anemia in children and socioeconomic associations, and effectiveness of oral iron supplements | Health status; health determinants and risks | 1) Retrospective part: November 2011–November 2015 2) Prospective part: 2 month period, not specified | Retrospective medical record review; parental questionnaire & clinical data analysis | Children seen at primary care clinics at the Children’s Hospital in Damascus | Damascus | Damascus University |
Ballouk (2018) [44] | First: Syria Last: Syria | First: academic Last: academic, government | Assesses gingival health status in children aged 8–12 years in Damascus city | Health status | September 2016–January 2017 | Cross-sectional, school-based oral health survey | Children aged 8–12 years | Damascus | None |
Chen (2018) [45] | First: USA Last: USA | First: academic Last: academic | Estimates the number of unique identifiable deaths in the Syrian conflict by deduplicating four datasets | Mortality; war strategies and alleged IHL violations | March 2011–April 2014 | Unique entity estimation using mortality data from VDC, SNHR, CSR-SY, SSc | Civilians and combatants | Not reported | National Science Foundation (NSF), Amazon Research Award, Laboratory for Analytic Sciences (LAS). |
Darwish (2018) [46] | First: Syria Last: Syria | First: academic Last: academic | Reviews pediatric chest injuries treated in the Mouassat University Hospital in Damascus before and during the Syrian crisis | Health status | January 2005–December 2016 | Hospital record review | Pediatric chest trauma patients | Damascus | None |
de Lima Pereira (2018) [47] | First: Syria Last: Netherlands | First: humanitarian Last: humanitarian | Assesses vaccine-preventable disease risk and vaccination needs, and vaccination coverage following an immunization program | Humanitarian assistance, response or needs; health status | June–September 2015 | Cross-sectional household survey | Children < 5 years old | Aleppo | None |
Doocy (2018) [48] | First: USA Last: USA | First: academic Last: academic | Assesses humanitarian needs in government-controlled areas of Syria | Humanitarian assistance, response or needs | April – June 2016 | Needs assessment | General population | Government-controlled areas (Aleppo, As-Sweida, Damascus, Dara’a, Hama, Al-Hasakeh, Homs, Lattakia, Rural Damascus, Tartous) | US-based international nongovernmental organization |
Footer (2018) [49] | First: USA Last: USA | First: academic Last: academic | Explores the impact of the Syrian conflict on health workers and healthcare in opposition-controlled areas and challenges faced, including in responding to chemical weapons attacks | Health system (service provision, workforce); war strategies / alleged IHL violation | October 2014 (Gaziantep), July–August 2017 (online) | Semi-structured interviews | Health-care professionals with experience in opposition-controlled areas of Syria | Opposition- controlled areas (governorates not specified) | MacArthur Foundation |
Garry (2018) [50] | First: UK Last: UK | First: academic Last: academic | Explores factors impacting provision of healthcare for NCDs in opposition-controlled Syria | Humanitarian assistance, response or needs | June–August 2017 | Semi-structured interviews | Humanitarian healthcare staff or Syrian health workers from opposition-controlled / contested areas | Opposition-controlled areas (governorates not specified) | UK Research and Innovation (Global Challenges Research Fund) |
Guha-Sapir (2018) [51] | First: Belgium Last: USA | First: academic Last: academic | Reports demographic, spatial, and temporal patterns of direct deaths among civilians and opposition combatants using VDC data | Mortality; war strategies / alleged IHL violations | March 2011–December 2016 | VDC data analysis | Civilians and combatants | Non-government-controlled areas (governorates not specified) | None |
Haar (2018) [52] | First: USA Last: USA | First: academic Last: academic | Describes a standardized field survey tool for documenting attacks on healthcare, and compares this dataset to PHR’s database that uses open sources to track attacks on health facilities | War strategies / alleged IHL violations; health system (service provision, workforce) | 2016 | Development of prospective surveillance methodology, standardized reporting questionnaire | NA | Aleppo, Hama, Homs, Idlib | MacArthur Foundation, the Oak Foundation, Berkeley Research Impact Initiative |
Idris (2018) [53] | First: Syria Last: Syria | First: academic Last: academic | Reports prevalence of cigarette smoking among university students and examines the impact of war on smoking behavior | Health determinants and risks | May 2015 | Online cross-sectional survey | Undergraduate students at Damascus University. | Damascus | None |
Khamis (2018) [54] | First: Syria Last: Lebanon | First: government Last: academic | Reports National AIDS Program data and examines how the war affected HIV surveillance and voluntary counselling and testing | Health status; health system (service provision) | 2010–2016 | Secondary analysis of National AIDS Program surveillance data | General population | National | Not reported |
Kubitary (2018) [55] | First: Syria Last: Syria, France | First: academic Last: academic | Examines validity of the Arabic version of the two-question Quick Inventory of Depression (QID-2-Ar) in Syrian multiple sclerosis patients. | Health status | Not reported | Cross-sectional study | Multiple sclerosis patients aged 18–60 years seen at two hospitals | Damascus | None |
Kubitary (2018) [56] | First: Syria Last: France, Syria | First: academic Last: academic | Examines the effects of Therapy by Repeating Phrases of Positive Thoughts (TRPPT) on PTSD, Sleep Disorder and War Experiences among school children and adolescents | Health systems (service provision); health status | Not reported | Clinical trial | Children & adolescents aged 13–17 years | Damascus | Not reported |
Meiqari (2018) [57] | First: Netherlands Last: Netherlands | First: humanitarian, academic Last: humanitarian | Describes the impact of the war on child health in Tal Al-Abyad and Kobane, using available medical and humanitarian data from Médecins Sans Frontières | Health status; humanitarian assessment, response or needs | April 2013–September 2016 | Analysis of MSF clinical data and reports | Children < 5 years old who attended an MSF facility | Aleppo, Al-Raqqa | Not reported |
Morrison (2018) [58] | First: UK Last: N/A | First: academic | Reports the experiences and challenges of health service delivery under siege | Health system (service provision); war strategies / alleged IHL violations | Mid-2016 | Interviews and focus group discussions | Interim Council and healthcare professionals in four besieged urban areas | Opposition-controlled areas (Aleppo, Damascus) | DFID’s Urban Crises Programme |
Othman (2018) [59] | First: Not stated Last: Australia | First: independent Last: academic | Evaluates the impact of a six-month programme to address organizational stressors and promote staff-care and social support | Health determinants and risks; health system (workforce) | Not reported | Evaluation research/ Implementation research | Staff working for a psychosocial support organization | Non-government-controlled areas (Idlib) | Not reported |
Perkins (2018) [60] | First: UK Last: Syria | First: academic Last: academic | Reports the incidence of psychological symptoms among school-aged children in Damascus and Lattakia | Health status | Not reported | Cross-sectional study | School children (8–15 years old) | Damascus, Lattakia | Not reported |
Rehman (2018) [61] | First: Austria Last: Germany; Austria | First: academic Last: academic, clinical | Describes the leishmaniasis surveillance control program | Health status | November 2014– February 2016 | Molecular–epidemiologic survey of cutaneous leishmaniasis in sentinel sites | General population (including IDPs) | Northern Syria (Aleppo, Idlib, Hama, Al-Raqqa, and Al-Hasakeh) | USAID & DFID |
Rodriguez-Llanes (2018) [62] | First: Belgium Last: USA | First: academic Last: academic | Reports demographic characteristics of victims of chemical weapons attacks | War strategies / alleged IHL violations; mortality | March 2011–April 2017 | VDC data analysis | Deceased victims of chemical weapons attacks | Non-government-controlled areas (Aleppo, Damascus, Hama, Idlib) | None |
Sawaf (2018) [63] | First: Syria Last: Syria | First: academic Last: academic | Explores medical students’ attitudes and factors affecting their specialty choices and career plans | Health system (workforce) | August 2016 | Self- administered questionnaire | Medical students at three universities in Damascus | Damascus | Syrian Private University |
Sikder (2018) [64] | First: USA Last: Jordan | First: academic Last: independent | Assesses the effectiveness of a multilevel risk reduction intervention in maintaining Free Chlorine Residual in household drinking water | Humanitarian assessment, response or needs | January 2018 | Cross-sectional study using interviews & observations; water quality testing | Chlorination station operators, well owners, households, Methology | Opposition-controlled areas in southern Syria (governorates not specified) | WoS (Amman hub) WASH Sector, UNICEF, UNICEF/NYC and Tufts University |
Sikder (2018) [65] | First: USA Last: Jordan | First: academic Last: UN agency | Examines WASH access and needs in opposition controlled southern Syria | Humanitarian assessment, response or needs | June/July 2016–February 2017 | Cross-sectional household surveys & water quality testing | Households | Opposition-controlled areas (Dara’a, Quneitra) | WoS (Amman hub) WASH Sector |
Turk (2018) [66] | First: Syria Last: USA | First: academic Last: academic | Assesses medical students attitudes toward research | Health system (workforce) | Not reported | Self-administered questionnaire | Medical students at University of Damascus | Damascus | None |
Wong (2018) [67] | First: USA Last: USA | First: academic Last: clinical | Reviews attacks on ambulances | War strategies / alleged IHL violations; health system (service provision) | January 2016–December 2017 | Secondary data analysis on individual attacks reported by SNHR | NA | National | None |
Ahmad (2019) [68] | First: UK Last: UK | First: academic Last: academic | Examines perceptions of married women living in low-income formal and informal neighborhoods in Aleppo on the effects of neighbourhood on their health and well-being | Health determinants and risks | April–June 2011 | Semi-structured interviews | Married women living in informal and low-income formal neighbourhoods | Aleppo | European Commission FP7 programme grants MedCHAMPS and RESCAP-MED |
Abu Salem (2019) [69] | First: Lebanon Last: Lebanon | First: academic Last: academic | Uses VDC data to confirm conflict events and identify fake news in FA-KES, a fake news dataset | Mortality | Not reported | Analysis of news articles and reports on incidence of deaths compared to VDC dataset | General population | National | American University of Beirut |
Alaryan (2019) [70] | First: Syria Last: Syria | First: academic Last: academic | Reports on prescription drug misuse in Damascus and Damascus countryside during the conflict | Health system (medical products) | December 2016–March 2017 | Cross-sectional survey | Community pharmacists | Damascus and Rural Damascus | Not reported |
Alhaffar (2019) [71] | First: Syria Last: Syria | First: academic Last: clinical | Examines prevalence of burnout syndrome among resident physicians in training | Health system (workforce) | July 2018 | Online questionnaire | Resident physicians in training from 12 hospitals in 8 governorates who spent at least one year in a residency program approved by the Syrian Commission of the Medical Specialties. | Damascus, Aleppo, Lattakia, Tartous, Dara’a, Rural Damascus, Hama, Homs | Not funded (self-funded) |
Alhaffar (2019) [72] | First: Syria Last: Syria | First: academic Last: academic | Examines the prevalence of caries and oral health status among school children in Damascus, and associations with socio-economic status | Health status; Health determinants and risks | September–November 2017 | School-based survey (questionnaire and clinical examination) | Seventh-grade school children in 10 randomly selected schools covering Damascus city | Damascus | Not funded (self-funded) |
Alhammoud (2019) [73] | First: Qatar Last: UK | First: clinical Last: clinical | Reports the experience of one field hospital in Aleppo providing treatment of open shaft fractures | Health system (service provision) | July 2011–July 2016 | Retrospective medical record review | Patients with open long bone fractures managed with external fixation | Aleppo | Not reported |
Alothman (2019) [74] | First: Syria Last: India | First: academic Last: academic | Reports on war injury presentations to Hama National Hospital | Health system (service provision) | 2017 | Retrospective medical record review | War injured patients received by Hama National Hospital | Hama | Not reported |
Ballouk (2019) [75] | First: Syria Last: Syria | First: academic Last: academic, government | Examines prevalence of dental caries among school-aged children in Damascus city | Health status | September 2016–January 2017. | School based oral health survey (clinical examination) | School children aged 8–12 years and resident in Damascus city during the study period | Damascus | Not funded (self-funded)d |
Blackwell (2019) [76] | First: USA Last: not stated | First: humanitarian Last: humanitarian | Examines the impact of a cash-based assistance program on women’s empowerment and violence against women | Humanitarian assessment, response or needs; health status | March–August 2018 | Semi-structured interviews | Woman aged 18–59 who received a cash payment over a three-month period | Al-Raqqa | UK Department for International Development (DFID) |
Douedari (2019) [77] | First: UK Last: UK | First: academic Last: academic | Examines perceptions of local health providers and service users regarding health system governance, roles and relationships of institutional actors, and challenges and potential solutions | Health system (governance) | July–August 2016 | Key informant interviews | Health system providers from health directorates, humanitarian NGOs, donors, and service-users | Opposition-controlled provinces (Aleppo, Dara’a, Hama, Idlib, Rural Damascus) | Chevening Scholarships |
Duclos (2019) [78] | First: UK Last: UK | First: academic Last: academic | Examines cross-border humanitarian assistance and the challenges encountered by humanitarian health actors delivering health care in North-West Syria (Turkish border) | Humanitarian assessment, response or needs; health system (service provision) | September 2017 | Mixed methods, including key informant interviews, desk reviews and expert consultations | Humanitarian aid professionals in Turkey-based organizations operating in North-West Syria, WHO-Turkey staff members and members of Syrian health directorates. | North-West Syria | London School of Hygiene and Tropical Medicine, Department of Infectious Disease Epidemiology, and the International Development Research Center (IDRC) |
Falb (2019) [79] | First: USA Last: USA | First: humanitarian Last: humanitarian | Examines associations between depressive symptoms and their potential risk factors (including stressors, intimate partner violence) | Health status; health determinants and risks | March–April 2018 | Cross-sectional survey | Married women who participated in a cash transfer program | Al-Raqqa | UK Department for International Development (DFID) |
Fardousi (2019) [80] | First: Lebanon, UK Last: UK, Singapore | First: academic Last: academic | Examines perspectives of healthcare workers on issues of safety, resource management and handling of mass casualties during siege | Health system (workforce, service provision); war strategies / alleged IHL violations | Not stated | Key informant interviews | Syrian healthcare workers and service users who experienced siege in Aleppo in 2016 or Ghouta (Rural Damascus) in 2013–2017 | Aleppo, Rural Damascus | Chevening Scholarships |
Fradejas-Garcia (2019) [81] | First: Spain Last: N/A | First: academic | Explores experiences of remote cross-border operations | Humanitarian assessment, response or needs | Not reported | Ethnographic study through interviews | Aid workers and organizations – UN agencies, international NGOs and Syrian NGOs – providing relief assistance to Syria remotely | Turkish border city of Gaziantep | Not reported |
Hallak (2019) [82] | First: Turkey Last: Turkey | First: academic Last: academic | Examines optimal shelter locations for IDPs | Humanitarian assessment, response or needs | December 2017–February 2018 | Needs assessment using focus group discussions, key informant interviews and questionnaire with direct beneficiaries; mathematical modelling | Direct beneficiaries in 26 sub-districts within Idlib | Idlib | Not reported |
Hamid (2019) [83] | First: Syria Last: Syria | First: academic Last: academic | Compares dental and gingival status among children with and without PTSD | Health status | Not reported | Case control study | Children (9–14 years old) who attended psychiatry department (cases) or dental service (controls) | Damascus | Damascus University |
Hamzeh (2019) [84] | First: Syria Last: Syria | First:, academic Last: academic | Assesses knowledge and awareness of diabetes mellitus and its complications and effects of the conflict on care-seeking behavior among diabetes patients in Damascus | Health status; health determinants and risks | August–November 2017 | Questionnaire | Diabetes mellitus patients attending clinics at the four main hospitals in Damascus | Damascus | Not funded |
Jamal (2019) [85]e | First: UK Last: Lebanon | First: academic Last: academic | Examines the UNRWA health system and factors contributing to its resilience and enabling ongoing delivery of services to Palestinian refugees inside Syria during the crisis | Health system (service provision, governance, medical products, workforce) | February–August 2017 | Key informant interviews, group model building sessions | UNRWA clinical and administrative professionals engaged in health service delivery for Palestinian refugees in Syria over the course of the conflict | Damascus, Jaramana (Rural Damascus), City Center Polyclinicf and Aleppo | Wellcome Trust |
Mic (2019) [86] | First: Turkey Last: Turkey | First: academic Last: academic | Examines optimal locations for primary health care centers in Idlib to allow services to the greatest number of people | Humanitarian assessment, response or needs | March–May 2018 | Needs assessment using focus group discussions, key informant interviews and questionnaire with direct beneficiaries; mathematical modelling | Direct beneficiaries in 23 sub-districts within Idlib | Idlib | Çukurova University (Adana, Turkey) |
Mohammad (2019) [87] | First: Syria Last: USA | First: academic Last: academic | Evaluates effectiveness of personalized supervision of residents on improving prescribing for asthma management, and effectiveness of mobile video training for inhaler technique | Health system (service provision) | April–May 2018 | Clinical audits; evaluation of efficacy of video-mobile education | Asthma patients at internal medicine clinic in public hospital in Damascus | Damascus | Not reported |
Muhjazi (2019) [88] | First: Egypt Last: UK | First: UN agency Last: humanitarian | Reports cutaneous leishmaniasis epidemiology over the course of the war | Health status; Health system (information system) | 2007–2010, 2011–2018 | Secondary data analysis of 1) MOH routine surveillance system, 2) EWARS, 3) MENTOR Initiative data | General population | National | Not funded |
Okeeffe (2019) [89] | First: Syria Last: Netherlands | First: humanitarian Last: humanitarian | Describes blast-wound cases admitted to an MSF supported district hospital during the Raqqa military offensive and the first months of the post offensive period. | Health status; Health system (service provision); humanitarian assessment, response, and needs | June 2017–March 2018 | Retrospective chart review | New blast-wound injured cases admitted to MSF-district hospital in Al-Raqqa in the offensive (June–October 2017) or post offensive period (October 2017–March 2018) | Al-Raqqa | Not funded |
Ri (2019) [90] | First: USA Last: USA | First: academic Last: academic | Compares trends of attacks on healthcare and civilian casualites to assess feasibility of using publicly available data on attacks on healthcare facilities to describe population-level violence | Mortality; War strategies / alleged IHL violations | March 2011–November 2017 | Secondary analysis of publicly available data from: VDC (civilian casualties), PHR (attacks on healthcare facilities), UNHCR (registered Syrian refugees) | Civilians | National | Not funded |
Roumieh (2019) [91] | First: Syria Last: Syria | First: academic Last: academic | Assesses prevalence of postpartum depression among Syrian women in Damascus and examines associated risk factors | Health status; Health determinants and risks | January–December 2017 | Cross-sectional questionnaire | Postpartum women attending 8 primary healthcare centers in Damascus | Damascus | Damascus University |
Terkawi (2019) [92] | First: USA, Saudi Arabia Last: Saudi Arabia | First: humanitarian, academic, clinical, thinktank/ research organization Last: academic | Assesses disease burden and clinical presentations of children and adolescents attending a healthcare center in Atmeh district, Idlib | Health status | February–December 2017 | Clinical data analysis | Children and adolescents attending healthcare center in Atmeh district | Idlib | Not funded |
Terkawi (2019) [93] | First: USA, Saudi Arabia Last: Saudi Arabia | First: humanitarian, academic, clinical, thinktank/ research organization Last: academic | Examines health status and barriers to accessing antenatal care among pregnant women in Northwestern Syria | Health system (service provision); health status; health determinants and risks | February–December 2017 | Medical record review; cross-sectional survey | Pregnant women attending healthcare centers in Atmeh district for antenatal care | Idlib | Not funded |
Vernier (2019) [94] | First: Syria Last: UK | First: humanitarian Last: humanitarian | Assesses health status and mortality among IDPs who recently arrived to Ein Issa camp in Al-Raqqa | Health status; mortality; humanitarian assessment, response or needs; health determinants and risks | November 2017 | Cross-sectional survey | IDPs who had arrived at Ein Issa camp since October 2017 | Al-Raqqa | MSF |
Youssef (2019) [95] | First: Syria Last: Lebanon | First: academic Last: academic | Examines the epidemiology of visceral and cutaneous leishmaniases in Lattakia prior to and during the conflict | Health status | 2008–2016 | Registry data analysis | General population | Lattakia | The American Society of Tropical Medicine and Hygiene (ASTMH) assisted with the publication expenses |
Ziveri (2019) [96] | First: Belgium Last: Belgium | First: humanitarian Last: independent | Examines impact of a psychosocial support program on the well-being and agency of Syrian farmers receiving livelihood support | Humanitarian assessment, response or needs | April–August 2017 | Randomized control trial among Syrian farmers | Farming households from ten randomly selected villages who fulfilled inclusion criteria | Not reported | Not funded |