SAMS Research Digest – January, 2025

We are delighted to share the current issue of our dedicated research newsletter. This periodic publication aims to keep you informed about our recent research efforts, providing valuable insights, scholarly articles, and updates on Syrian public health.

Accessing Breast Cancer Care in a Protracted Conflict: Perspectives from Northwest Syria

About the Study

Women with breast cancer in northwest Syria face numerous challenges in accessing care, especially in the context of prolonged conflict. These barriers are often tied to sociocultural norms, gender dynamics, and financial limitations. In collaboration with Yale University and the London School of Hygiene & Tropical Medicine (LSHTM), SAMS investigated the experiences of these women. This study, led by Manar Marzouk with the support of three local female data collectors and supervision by Dr. Aula Abbara, involved data from women who accessed care at the SAMS Oncology Centre in Idlib in 2022.

Key Findings:

• Sociocultural Barriers: Social norms significantly impact breast cancer care in Syria.
• Gender & Communication: Gender roles influence communication between patients and healthcare providers.
• Social Consequences: Women face protection issues and social repercussions related to their diagnosis.
• Peer Support & Faith: Faith and peer support play an important role in easing patient suffering.
• Localized Care: Localizing cancer services in northwest Syria helps mitigate many access challenges.

Conclusions
While improvements in breast cancer care have been made, significant gaps remain—particularly the lack of radiotherapy, which forces many women to travel to Turkey for treatment. Our findings highlight the need for greater support for women with breast cancer and their families. This study serves as a foundation for future research in northwest Syria and other conflict-affected regions.

Published in: Social Science & Medicine
Marzouk M, Hamze M, Debel J, et al. “Accessing breast cancer care in a protracted conflict: qualitative exploration of the perspectives of women with breast cancer in northwest Syria.” Social Science & Medicine. Published online September 21, 2024. DOI: [10.1016/j.socscimed.2024.117364] (https://doi.org/10.1016/j.socscimed.2024.117364)

Quantifying the Effects of Attacks on Health Facilities in Northwest Syria: A Case Time Series Study from 2017 to 2019

About the Study

This study, funded by ELRHA and conducted in collaboration with Berkeley University and Johns Hopkins University, examines the impact of attacks on healthcare facilities and their effects on health consultations at SAMS health centers located in the Aleppo, Hama, and Idlib governorates. Between March 2017 and December 2019, we employed a case time series design to differentiate the specific impacts of these attacks from general disruptions caused by conflict.

Key Findings:

• Health Service Utilization: Attacks on healthcare facilities led to significant declines in outpatient visits, trauma consultations, and facility births.
• Outpatient & Trauma Services: Outpatient consultations dropped by 51% (RR 0.49) and trauma consultations fell by 38% (RR 0.62) the day after an attack, with lasting effects up to 37 and 20 days, respectively.
• Facility Births: Births decreased by 23% (RR 0.77) on the second day after an attack, with reductions continuing for 42 days.

Conclusions

• Accountability and Legal Protections: This study provides strong evidence that attacks on healthcare facilities cause sustained disruptions in healthcare delivery, which infringes on the fundamental right to health. These findings can support efforts to enhance legal protections and hold perpetrators accountable.
• Humanitarian Response: The insights from this study offer a clear estimate of the magnitude and duration of service disruptions following attacks, enabling healthcare providers and humanitarian organizations to better plan and build resilience into their response activities.

Published in:  BMJ Global Health
Burbach R, Tappis H, Abbara A, et al.”(Previously in pre-print) Quantifying the effects of attacks on health facilities on health service use in Northwest Syria: a case time series study from 2017 to 2019.” BMJ Global Health. 2024;9(9):e015034. DOI: [10.1136/bmjgh-2024-015034] (https://doi.org/10.1136/bmjgh-2024-015034)

Exploring Relationships Between Conflict Intensity, Forced Displacement, and Healthcare Attacks in Syria (2016–2022)

About the Study
Throughout the Syrian conflict, attacks on healthcare facilities have violated International Humanitarian Law (IHL), contributing to healthcare system collapse and the forced displacement of over 7.2 million people. This retrospective analysis, conducted in collaboration with data from SAMS, Uppsala Conflict Data Project, and OCHA Türkiye, aims to assess the relationships between healthcare attacks, general conflict intensity, and forced displacement from 2016 to 2022.

Key Findings

• Link Between Conflict and Healthcare Attacks: Conflict events were significantly associated with healthcare attacks during the same week (IRR: 1.14, 95% CI 1.12–1.17).
• Healthcare Attacks Triggering Conflict: Healthcare attacks increased the risk of further conflict events by up to 1.44 times (95% CI 1.08–1.91) in the following week.
• Impact on Displacement: Healthcare attacks were also significantly associated with increased displacement, with effects lasting up to three months following the attacks.

Conclusions

• Violation of IHL: Findings highlight that healthcare facilities are not protected as they should be under IHL, with attacks often preceding an escalation of general conflict in the same areas.
• Displacement and Healthcare: Healthcare attacks are significantly associated with forced displacement, reinforcing the need for accountability and international response to prevent these violations.
• Healthcare in Conflict Tactics: This study presents a framework suggesting how healthcare attacks can become part of broader conflict strategies, emphasizing the critical role of healthcare infrastructure in conflict settings. The findings reaffirm the need to hold perpetrators accountable for these attacks and to protect the right to healthcare.

Published in:  BMC Conflict and Health
Tarnas MC, Hamze M, Tajaldin B, Sullivan R, Parker DM, Abbara A. Exploring relationships between conflict intensity, forced displacement, and healthcare attacks: a retrospective analysis from Syria, 2016–2022. Confl Health. 2024;18(1):70. doi:10.1186/s13031-024-00630-4

We’re pleased to share three infographic reports highlighting the impact of SAMS services in Northwest Syria in 2024. These reports provide a snapshot of the work being done to support health and well-being in conflict-affected communities.

Comprehensive Healthcare Services (Jan- Dec 2024)

Dental Care Services (Jan- Dec 2024)

Mental Health Support (Jan- Dec 2024)