Syria Research Group (SyRG), Co-hosted by the London School of Hygiene and Tropical Medicine and Saw Swee Hock School of Public Health, London, United Kingdom.
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
PLoS One. 2022 Nov 4;17(11):e0277215. doi: 10.1371/journal.pone.0277215. eCollection 2022.
COVID-19 highlighted the importance of meaningful engagement between communities and health authorities. This is particularly challenging in conflict-affected countries such as Syria, where social protection and food security needs can hinder adherence to non-pharmaceutical interventions (NPIs) and vaccine uptake. This study explored community perspectives of COVID-19 and health authority responses across the three main areas of control in Syria, i.e. Syrian government-controlled areas (GCA), autonomous administration-controlled areas (AACA), and opposition-controlled areas (OCA).
We conducted a qualitative study, interviewing 22 purposively-sampled Syrians accessing health services in AACA, GCA, or OCA in 2021 to provide approximately equal representation by governance area and gender. We analysed data thematically using deductive and inductive coding.
Interviewees in all areas described how their fears of COVID-19 and willingness to adhere to NPIs decreased as their local COVID-19 epidemics progressed and NPIs disrupted access to household essentials such as work and food. Community-level responses were minimal and ad hoc, so most people focused on personal or household protective efforts and many mentioned relying on their faith for comfort. Misinformation and vaccine hesitancy were common in all areas, linked to lack of transparency from and mistrust of local health authorities and information sources.
The COVID-19 pandemic has increased health actors' need to engage with communities to control disease spread, yet most NPIs implemented in Syria were inappropriate and adherence decreased as the pandemic progressed. This was exemplified by lockdowns and requirements to self-isolate, despite precarious reliance on daily wages, no subsidies for lost income, individual self-reliance, and mistrust/weak communication between communities and health authorities. We found minimal community engagement efforts, consisting entirely of informing with no efforts to consult, involve, collaborate, or empower. This contributed to failures of health actors to contextualise interventions in ways that respected community understandings and needs.
COVID-19 凸显了社区与卫生当局之间进行有意义互动的重要性。在叙利亚等受冲突影响的国家，这一点尤其具有挑战性，因为社会保护和粮食安全需求可能会阻碍非药物干预措施（NPI）和疫苗接种的实施。本研究探讨了叙利亚三个主要控制领域（叙利亚政府控制区（GCA）、自治管理区（AACA）和反对派控制区（OCA））的社区对 COVID-19 及其卫生当局应对措施的看法。
我们进行了一项定性研究，在 2021 年采访了 22 名在 AACA、GCA 或 OCA 接受卫生服务的有目的地抽样的叙利亚人，以提供大致相等的按治理区域和性别代表。我们使用演绎和归纳编码对数据进行主题分析。
所有地区的受访者都表示，随着当地 COVID-19 疫情的发展和 NPI 中断了他们获得家庭必需品（如工作和食物）的机会，他们对 COVID-19 的恐惧和遵守 NPI 的意愿下降了。社区层面的反应很少，也很临时，因此大多数人都专注于个人或家庭的保护措施，许多人提到依靠自己的信仰来获得安慰。所有地区都普遍存在错误信息和疫苗犹豫，这与当地卫生当局和信息来源缺乏透明度以及缺乏信任有关。
COVID-19 大流行增加了卫生行为者控制疾病传播的需要，但在叙利亚实施的大多数 NPI 都是不适当的，随着疫情的发展，遵守率下降。这表现在封锁和自我隔离的要求上，尽管依靠每日工资不稳定，没有对失去的收入进行补贴，个人自力更生，以及社区和卫生当局之间的不信任/沟通不畅。我们发现，社区参与的努力非常少，完全是通知，而没有努力咨询、参与、合作或赋予权力。这导致卫生行为者未能以尊重社区理解和需求的方式对干预措施进行背景化。
