Những thách thức trong việc cung cấp giáo dục và đào tạo cho nhân viên y tế trong bối cảnh xung đột kéo dài: Tập trung vào các khu vực không do chính phủ kiểm soát ở tây bắc Syria
Tóm tắt
Không có nhân viên y tế (HCWs), việc cung cấp dịch vụ y tế và nhân đạo ở Syria không thể được duy trì cả trong hiện tại lẫn giai đoạn hậu xung đột. Xung đột kéo dài đã dẫn đến sự di cư của hơn 70% lực lượng nhân viên y tế. Những người còn lại làm việc trong điều kiện nguy hiểm với các nguồn lực hạn chế và một hệ thống y tế đã bị tàn phá bởi xung đột kéo dài. Đối với nhiều nhân viên y tế, đặc biệt là những người ở các khu vực không do chính phủ kiểm soát (NGCAs) của Syria, giáo dục đại học và đào tạo sau đại học đã bị gián đoạn với rất ít cơ hội để tiếp tục. Trong bài báo này, chúng tôi khám phá những sáng kiến hiện có ở tây bắc Syria tại cả cấp độ đại học và sau đại học cho các nhân viên y tế không phải bác sĩ. Kết luận: Các thách thức đối với giáo dục nhân viên y tế ở tây bắc Syria có thể được chia thành 1. Tổ chức (lãnh đạo và quản lý y tế địa phương, phối hợp và hợp tác giữa các bên liên quan, cạnh tranh giữa các bên liên quan và ngân sách không đủ.) 2. Chương trình (thiếu sự công nhận hoặc chứng nhận các bằng cấp, không đủ không gian vật lý cho việc giảng dạy, sự di cư của giảng viên ảnh hưởng đến việc giảng dạy và đào tạo, ưu tiên bác sĩ hơn nhân viên không phải bác sĩ, nhân viên y tế được đào tạo không chính thức.) 3. Có liên quan đến hệ thống y tế (sự chính trị hóa hệ thống y tế, nhu cầu y tế của dân số đang thay đổi, các cuộc tấn công liên tục vào hệ thống y tế.) Các chiến lược có thể thực hiện tại địa phương gồm có quỹ đặc biệt là chìa khóa để hỗ trợ việc giữ chân nhân viên y tế và khôi phục trở lại trong quá trình tái thiết hậu xung đột.
Từ khóa
Tài liệu tham khảo
World Health Organization. Guide to Health Workforce Development in Post-Conflict Environments. World Health Organization; 2005.
Fouad FM, Sparrow A, Tarakji A, et al. Health workers and the weaponisation of health care in Syria: a preliminary inquiry for the lancet –American University of Beirut Commission on Syria. Lancet. 2017;6736(17):1–11. https://doi.org/10.1016/S0140-6736(17)30741-9.
Physicians for Human Rights. Medical Personnel are Targeted in Syria. https://phr.org/our-work/resources/medical-personnel-are-targeted-in-syria/. Published 2019.
Physicians for Human Rights. A Map of Attacks on Health Care in Syria. Physicians for Human Rights. The Destruction of Hospitals – A Strategic Component in Regime Military Offensives. https://syriamap.phr.org/#/en/case-studies/5. Published 2019. Accessed 22 July 2019.
Fouad FM, Sparrow A, Tarakji A, et al. Health workers and the weaponisation of health care in Syria: a preliminary inquiry for The Lancet American University of Beirut Commission on Syria. Heal Policy 2516 www.thelancet.com . 2017;390. https://doi.org/10.1016/S0140-6736(17)30741-9.
Ismail S et al. Strengthening Human Resources for Health: Integration of Refugees into Host Community Health Systems.; 2017. http://www.cmimarseille.org/highlights/strengthening-human-resources-health-integration-refugees-host-community-health-systems.
Roome E, Raven J, Martineau T. Human resource management in post-conflict health systems: review of research and knowledge gaps. Confl Health. 2014;8(1):18. https://doi.org/10.1186/1752-1505-8-18.
Abbara A, Blanchet K, Fouad F, Sahloul Z, Coutts A WM. The effect of the conflict on Syrian health system and human resources for health - health in humanitarian crises Centre. World Heal Popul 2015;16(1):87–95. http://crises.lshtm.ac.uk/2016/04/20/aula-abbara-blanchet-karl-f-f-zaher-sahloul-adam-coutts-and-m-wasim-2015-the-effect-of-the-conflict-on-syriais-health-system-and-human-resources-for-health-world-health-populatio/. Accessed 14 July 2017.
World Bank and UNHCR. The Mobility of Displaced Syrians An Economic and Social Analysis.; 2019. https://reliefweb.int/sites/reliefweb.int/files/resources/9781464814013.pdf. Accessed 22 July 2019.
Kherallah M, Alahfez T, Sahloul Z, Eddin KD, Jamil G. Health care in Syria before and during the crisis. Avicenna J Med. 2012;2(3):51–3. https://doi.org/10.4103/2231-0770.102275.
WHO. WHO Gaziantep Field Presence, Turkey (Medical Portable Ventilator Machine)-Availability of Health Equipment Monitored through HeRAMS Tool.; 2020. https://www.humanitarianresponse.info/sites/www.humanitarianresponse.info/files/documents/files/herams_1st_quarter_2020_v2.pdf. Accessed 30 Apr 2020.
Abbara A, Rayes D, Fahham O, et al. Coronavirus 2019 and health systems affected by protracted conflict: the case of Syria. Int J Infect Dis. May 2020. https://doi.org/10.1016/j.ijid.2020.05.003.
Al-Fanar Reporting Team. The Difficulty of Studying Medicine in Times of War — Syria Deeply. News Deeply. https://www.newsdeeply.com/syria/articles/2017/10/30/the-difficulty-of-studying-medicine-in-times-of-war. Published 2017. Accessed 22 July 2019.
Students of Opposition School System ‘Start from Zero’ in Government-Held Aleppo City - Syria Direct.; 2017. https://syriadirect.org/news/students-of-opposition-school-system-‘start-from-zero’-in-government-held-aleppo-city/?fbclid=IwAR2wVlebk1yQM23_47s3unah_NgAn_uZMXOfYaUEDkt6YlHuyN5rFxaT9UE. Accessed 14 Oct 2019.
FAQs. The World Federation for Medical Education. https://wfme.org/accreditation/faqs/. Accessed 9 May 2020.
REACH. North-West Syria Population Overview: November 2018 - Syrian Arab Republic | ReliefWeb.; 2018. https://reliefweb.int/report/syrian-arab-republic/north-west-syria-population-overview-november-2018. Accessed 14 Oct 2019.
Duclos D, Ekzayez A, Ghaddar F, Checchi F, Blanchet K. Localisation and cross-border assistance to deliver humanitarian health services in north-West Syria: a qualitative inquiry for the lancet-AUB Commission on Syria. Confl Health. 2019;13(1):20. https://doi.org/10.1186/s13031-019-0207-z.
UN. Risk grows of ‘catastrophic humanitarian fallout’ in Syria’s Idlib, where 3 million are trapped: top UN officials urge unity in Security Council | UN News. https://news.un.org/en/story/2019/05/1038681. Accessed 23 July 2019.
Abbara A, Rayes D, Khalil M, Kewara M, Tarakji A. Humanitarian catastrophe for civilians in Northwest Syria. BMJ. 2020;368. https://doi.org/10.1136/bmj.m451.
Geneva Foundation for Medical Education and Research. Medical schools, governments, ministries, medical associations : Syria. https://www.gfmer.ch/Medical_search/Countries/Syria.htm. Published 2019. Accessed 22 July 2019.
Sawaf B, Abbas F, Idris A, Al Saadi T, Ibrahim N. Specialty preference and intentions to study abroad of Syrian medical students during the crisis. BMC Med Educ. 2018;18(1):39. https://doi.org/10.1186/s12909-018-1146-x.
Simpson, C. This Is What It Looks Like When Syria Bombs a University - The Atlantic. https://www.theatlantic.com/international/archive/2013/01/syria-bombs-aleppo-university/319456/. Accessed 22 July 2019.
Aleppo’s largest hospital in rebel-held area is “destroyed” | World News | Sky News. https://news.sky.com/story/russian-planes-destroy-syrias-cave-hospital-10604281. Published 2016. Accessed 14 Oct 2019.
Abbara A, Orcutt M, Gabbar O. Syria’s lost generation of doctors. BMJ. 2015;350:h3479. https://doi.org/10.1136/bmj.h3479.
Abdel Nour, Nour; Shahadeh H. Universities of north Syria: Future hindered by crises – Enab Baladi. Enab Baladi. https://english.enabbaladi.net/archives/2019/07/universities-of-north-syria-future-hindered-by-crises/?fbclid=IwAR2_yQJMxVtBAJSVTox3RwUjZGdmz_aSrRU7V5QjEeZLAZXyq7jmLYSAiIA. Published 2019. Accessed 22 July 2019.
Al Nodal Walid NM. A power struggle over education emerges between rival opposition governments in Idlib province - Syria Direct. https://syriadirect.org/news/a-power-struggle-over-education-emerges-between-rival-opposition-governments-in-idlib-province/. Published 2018. Accessed 22 July 2019.
School Detail. World Directory of Medical Schools. https://search.wdoms.org/home/SchoolDetail/F0005502. Accessed 22 July 2019.
Terkawi A, Bakri B, Alsadek A, et al. Child and adolescent health in northwestern Syria: findings from healthy-Syria 2017 study. Avicenna J Med. 2019;9(2):61. https://doi.org/10.4103/AJM.AJM_184_18.
MSF Academy for Healthcare | MSF. https://www.msf.org/academy. Accessed 2 May 2020.
SAMS. SAMS Annual Report 2018.; 2019. https://www.sams-usa.net/wp-content/uploads/2019/06/SAMS-Annual-Report-2018-V5.pdf.
Conducting a colliculum exam for students of midwifery institutes | Idlib Health Directorate. https://ihd-sy.org/en/2019/10/15/conducting-a-colliculum-exam-for-students-of-midwifery-institutes/. Accessed 28 Oct 2019.
Medical Education and Training – الرابطة الطبية للمغتربين السوريين. https://www.sema-sy.org/en/medical-education-and-training/. Accessed 22 July 2019.
The Syrian Board of Medical Specialties (SBOMS) announces the general rating of students for admission to blood and tumors specialties. – موقع مديرية صحة حماه. https://hama-hd.com/en/the-syrian-board-of-medical-specialties-sboms-announces-the-general-rating-of-students-for-admission-to-blood-and-tumors-specialties/. Published 2018. Accessed 22 July 2019.
Development H In H for a and. Hand in Hand for Development and Aid. Annual Report 2018. Publised 2018.
Kaylin J. In the Midst of War, Future Syrian Doctors Trained with Help From Yale Faculty, Students | Yale School of Public Health. https://publichealth.yale.edu/article.aspx?id=13702. Published 2016. Accessed 22 July 22, 2019.
TimesUnion. UAlbany online science courses for refugee Syria medical students. TimesUnion. https://www.timesunion.com/tuplus-local/article/Free-UAlbany-online-science-courses-for-refugee-9194192.php. Published 2016.
WHO | mhGAP. Training creates more support for vulnerable people in Syria. WHO. 2015. https://www.who.int/mental_health/mhgap/syria_story/en/. Accessed 22 July 2019.
Quality Midwifery Care in the Midst of Crisis: Midwifery Capacity Building Strategy for Northern Syria. 2017–2021.; 2017.
The conclusion of the activity of medical education center to train Reproductive Health Providers. | Idlib Health Directorate. https://ihd-sy.org/en/2019/09/15/the-conclusion-of-the-activity-of-medical-education-center-to-train-reproductive-health-providers/. Published 2019. Accessed 28 Oct 2019.
OCHA. Border-Crossing Status | HumanitarianResponse. https://www.humanitarianresponse.info/en/operations/stima/border-crossing-status. Accessed 23 July 2019.
Theodorakopoulou E, Goutos I, Mason K, Ghanem AM, Myers S. London calling Gaza: The role of international collaborations in the globalisation of postgraduate burn care education. Scars Burn Heal. 2019;5:205951311983051. https://doi.org/10.1177/2059513119830519.
Donaldson RI, Mulligan DA, Nugent K, et al. Using tele-education to train civilian physicians in an area of active conflict: Certifying Iraqi physicians in pediatric advanced life support from the United States. J Pediatr. 2011;159(3). https://doi.org/10.1016/j.jpeds.2011.05.003.
Kovacevic P, Dragic S, Kovacevic T, et al. Impact of weekly case-based tele-education on quality of care in a limited resource medical intensive care unit. Crit Care. 2019;23(1):220. https://doi.org/10.1186/s13054-019-2494-6.
UK Aid. Protecting Healthcare in Syria.; 2018. https://assets.publishing.service.gov.uk/media/5ba11d8ae5274a55a85179cd/Research_Report_-_Protection_of_Syrian_Health_Workers__August_2018.pdf.
Barnett-Vanes A, Hassounah S, Shawki M, et al. Impact of conflict on medical education: a cross-sectional survey of students and institutions in Iraq. BMJ Open. 2016;6(2):e010460. https://doi.org/10.1136/bmjopen-2015-010460.
Kerr Winter B, Salamma RM, Qabaja KA. Medical education in Palestine. Med Teach. 2015;37(2):125–30. https://doi.org/10.3109/0142159X.2014.971721.
Atrache S. Losing Their Last Refuge INSIDE IDLIB’S HUMANITARIAN NIGHTMARE.; 2019.
Percival V, Sondorp E. A case study of health sector reform in Kosovo. Confl Health. 2010;4(1):7. https://doi.org/10.1186/1752-1505-4-7.
UOSSM. Syrian Hospitals Surveillance Study.; 2017. https://www.uossm.nl/upload/jaarverslag-2017.pdf.
WMA Resolution on Task Shifting from the Medical Profession – WMA – The World Medical Association. https://www.wma.net/policies-post/wma-resolution-on-task-shifting-from-the-medical-profession/. Published 2019. Accessed 22 July 2019.
اتحادات الطلبة تشرخ الجامعات السورية وتتحول إلى مراكز اعتقال وتعذيب, أخبــــــار. https://archive.aawsat.com/details.asp?section=4&article=715806&issueno=12487#.XU1HfOhKjb0 https://ar.qantara.de/content/قمع-شبيحة-الأسد-لأساتذة. Published 2013. Accessed 15 Oct 2019.
WHO. WHO EMRO | EHA homepage | Emergencies | Entity. http://www.emro.who.int/entity/eha/index.html. Published 2019. Accessed 22 July 2019.
Footer KHA, Clouse E, Rayes D, Sahloul Z, Rubenstein LS. Qualitative accounts from Syrian health professionals regarding violations of the right to health, including the use of chemical weapons, in opposition-held Syria. BMJ Open. 2018;8(8):e021096. https://doi.org/10.1136/bmjopen-2017-021096.
HCiD Resource centre. http://healthcareindanger.org/resource-centre/. Accessed 22 July 2019.