Abouzeid Marian, Elzalabany Manal K, Nuwayhid Iman, Jabbour Samer
The Lancet-American University of Beirut Commission on Syria, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
Alfred Deakin Institute for Citizenship and Globalisation and Centre for Humanitarian Leadership, Deakin University, Burwood, Australia.
Confl Health. 2021 Dec 14;15(1):92. doi: 10.1186/s13031-021-00384-3.
The volume of health-related publications on Syria has increased considerably over the course of the conflict compared with the pre-war period. This increase is largely attributed to commentaries, news reports and editorials rather than research publications. This paper seeks to characterise the conflict-related population and humanitarian health and health systems research focused inside Syria and published over the course of the Syrian conflict.
As part of a broader scoping review covering English, Arabic and French literature on health and Syria published from 01 January 2011 to 31 December 2019 and indexed in seven citation databases (PubMed, Medline (OVID), CINAHL Complete, Global Health, EMBASE, Web of Science, Scopus), we analyzed conflict-related research papers focused on health issues inside Syria and on Syrians or residents of Syria. We classified research articles based on the major thematic areas studied. We abstracted bibliometric information, study characteristics, research focus, funding statements and key limitations and challenges of conducting research as described by the study authors. To gain additional insights, we examined, separately, non-research publications reporting field and operational activities as well as personal reflections and narrative accounts of first-hand experiences inside Syria.
Of 2073 papers identified in the scoping review, 710 (34%) exclusively focus on health issues of Syrians or residents inside Syria, of which 350 (49%) are conflict-related, including 89 (25%) research papers. Annual volume of research increased over time, from one publication in 2013 to 26 publications in 2018 and 29 in 2019. Damascus was the most frequently studied governorate (n = 33), followed by Aleppo (n = 25). Papers used a wide range of research methodologies, predominantly quantitative (n = 68). The country of institutional affiliation(s) of first and last authors are predominantly Syria (n = 30, 21 respectively), the United States (n = 25, 19 respectively) or the United Kingdom (n = 12, 10 respectively). The majority of authors had academic institutional affiliations. The most frequently examined themes were health status, the health system and humanitarian assistance, response or needs (n = 38, 34, 26 respectively). Authors described a range of contextual, methodological and administrative challenges in conducting research on health inside Syria. Thirty-one publications presented field and operational activities and eight publications were reflections or first-hand personal accounts of experiences inside Syria.
Despite a growing volume of research publications examining population and humanitarian health and health systems issues inside conflict-ravaged Syria, there are considerable geographic and thematic gaps, including limited research on several key pillars of the health system such as governance, financing and medical products; issues such as injury epidemiology and non-communicable disease burden; the situation in the north-east and south of Syria; and besieged areas and populations. Recognising the myriad of complexities of researching active conflict settings, it is essential that research in/on Syria continues, in order to build the evidence base, understand critical health issues, identify knowledge gaps and inform the research agenda to address the needs of the people of Syria following a decade of conflict.
与战前时期相比，叙利亚冲突期间与健康相关的出版物数量大幅增加。这种增长主要归因于评论、新闻报道和社论，而非研究出版物。本文旨在描述叙利亚冲突期间在叙利亚境内发表的与冲突相关的人口、人道主义健康及卫生系统研究。
作为一项更广泛的范围综述的一部分，该综述涵盖2011年1月1日至2019年12月31日发表并被七个引文数据库（PubMed、Medline（OVID）、CINAHL Complete、Global Health、EMBASE、Web of Science、Scopus）收录的关于健康与叙利亚的英文、阿拉伯文和法文文献，我们分析了聚焦于叙利亚境内健康问题以及叙利亚人或叙利亚居民的与冲突相关的研究论文。我们根据所研究的主要主题领域对研究文章进行分类。我们提取了文献计量信息、研究特征、研究重点、资金说明以及研究作者所描述的开展研究的主要局限性和挑战。为了获得更多见解，我们分别审查了报告实地和业务活动的非研究出版物，以及关于叙利亚境内第一手经历的个人反思和叙述。
在范围综述中确定的2073篇论文中，710篇（34%）专门关注叙利亚人或叙利亚境内居民的健康问题，其中350篇（49%）与冲突相关，包括89篇（25%）研究论文。研究年发表量随时间增加，从2013年的1篇增加到2018年的26篇和2019年的29篇。大马士革是研究最频繁的省份（n = 33），其次是阿勒颇（n = 25）。论文使用了广泛的研究方法，主要是定量方法（n = 68）。第一作者和最后作者的机构所属国家主要是叙利亚（分别为n = 30、21）、美国（分别为n = 25、19）或英国（分别为n = 12、10）。大多数作者具有学术机构所属关系。最常研究的主题是健康状况、卫生系统以及人道主义援助、应对措施或需求（分别为n = 38、34、26）。作者描述了在叙利亚境内开展健康研究时一系列背景、方法和行政方面的挑战。31篇出版物介绍了实地和业务活动，8篇出版物是对叙利亚境内经历的反思或第一手个人叙述。
尽管研究叙利亚冲突地区人口、人道主义健康及卫生系统问题的出版物数量不断增加，但仍存在相当大的地理和主题差距，包括对卫生系统的几个关键支柱（如治理、融资和医疗产品）的研究有限；伤害流行病学和非传染性疾病负担等问题；叙利亚东北部和南部的情况；以及被围困地区和人口。认识到在活跃冲突地区进行研究的诸多复杂性，继续在叙利亚开展研究至关重要，以便建立证据基础、了解关键健康问题、识别知识差距并为研究议程提供信息，以满足叙利亚人民在经历十年冲突后的需求。
