Fardousi Nasser, Douedari Yazan, Howard Natasha
Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
BMJ Open. 2019 Sep 4;9(9):e029651. doi: 10.1136/bmjopen-2019-029651.
To explore health-worker perspectives on security, improving safety, managing constrained resources and handling mass casualties during besiegement in Syria.
A qualitative study using semi-structured key informant interviews, conducted remotely over WhatsApp and Skype, and analysed thematically using inductive coding.
Secondary and tertiary health facilities affected by besiegement in Aleppo (from July to December 2016) and Rural Damascus (from August 2013 to February 2018).
Twenty-one male Syrian health-workers and service-users who had experienced besiegement and targeting of their health facilities.
Participants described four related challenges of: (i) conflict-related responses, particularly responding to mass casualties; (ii) targeted attack responses, particularly preventing/surviving facility bombings; (iii) besiegement responses, particularly mitigating severe resource constraints; and (iv) chronic risk responses, particularly maintaining emotional resilience. Mass casualty response involved triage and training to prioritise mortality reduction and available resources, for example those with greatest need and likelihood of survival. Targeting response was largely physical, including fortification, working underground, reducing visibility and services dispersal. Besiegement response required resource conservation, for example, controlling consumption, reusing consumables, low-technology equipment, finding alternative supply routes, stockpiling and strengthening available human resources through online trainings and establishing a medical school in Ghouta. Risk responses included managing safety worries, finding value in work and maintaining hope.
Besieged health-workers were most affected by severe resource constraints and safety concerns while responding to overwhelming mass casualty events. Lessons for targeting/besiegement planning include training staff and preparing for: (i) mass casualties, through local/online health-worker training in triage, emergency response and resource conservation; allowing task-shifting; and providing access to low-technology equipment; (ii) attacks, through strengthened facility security, for example, protection and deterrence through fortification, working underground and reducing visibility; and (iii) besiegement, through ensuring access to internet, electricity and low-technology/reusable equipment; securely stockpiling fuel, medicines and supplies; and establishing alternative supply routes.
探讨卫生工作者对叙利亚被围困期间安全、改善安全状况、管理有限资源及处理大规模伤亡情况的看法。
一项定性研究，采用半结构化关键知情人访谈，通过WhatsApp和Skype远程进行，并使用归纳编码进行主题分析。
阿勒颇（2016年7月至12月）和大马士革农村地区（2013年8月至2018年2月）受围困影响的二级和三级卫生设施。
21名经历过卫生设施被围困和成为袭击目标的叙利亚男性卫生工作者及服务使用者。
参与者描述了四个相关挑战：（i）与冲突相关的应对措施，特别是应对大规模伤亡；（ii）针对性袭击的应对措施，特别是预防/在设施爆炸中幸存；（iii）围困的应对措施，特别是缓解严重的资源限制；（iv）长期风险的应对措施，特别是保持情绪恢复力。大规模伤亡应对包括分诊和培训，以优先降低死亡率并合理分配可用资源，例如那些最有需求且最有可能存活的人。针对性袭击的应对主要是物理层面的，包括设防、在地下工作、降低可见度和分散服务。围困的应对需要节约资源，例如控制消耗、重复使用耗材、使用低技术设备、寻找替代供应路线、储存物资以及通过在线培训加强现有人力资源，并在古塔建立一所医学院。风险应对措施包括管理安全担忧、在工作中找到价值以及保持希望。
被围困的卫生工作者在应对压倒性的大规模伤亡事件时，受严重资源限制和安全担忧的影响最大。针对袭击/围困规划的经验教训包括培训工作人员并做好以下准备：（i）应对大规模伤亡，通过对当地/在线卫生工作者进行分诊、应急响应和资源节约方面的培训；允许任务转移；并提供低技术设备；（ii）应对袭击，通过加强设施安全，例如通过设防、在地下工作和降低可见度来提供保护和威慑；（iii）应对围困，通过确保互联网、电力和低技术/可重复使用设备的供应；安全储存燃料、药品和物资；并建立替代供应路线。
