Introduction:
The war in Syria has led to a decline in many aspects of life and services, including the health sector. The government is striving to provide the best possible within the available capabilities. The health sector was not isolated from these challenges and difficulties, as many health facilities and institutions were damaged or destroyed. The health sector paid a heavy price by losing the lives of many of its members. Despite the limited capabilities and damaged infrastructure, it was able to maintain the minimum level of care and treatment for millions of Syrians. Migration outside the country in search of social or financial stability was one of the additional challenges facing the health sector, as travel is the first goal for all new doctors, regardless of the destinations available to them.
Nephrology is a relatively new specialty in the world in general and in Syria in particular, where before the war it represented a ratio of one nephrologist for every 110,000 people. This number has dwindled during the war years, especially in governorates such as Aleppo, Deir ez-Zor and Hama. In this review, we prepared an approximate statistic for the distribution of nephrologists, the distribution of dialysis centers, and the number of patients treated with dialysis in them.
Methods:
We conducted a statistical study that includes the distribution of nephrologists in Syria in terms of specialists and residents under training. We also registered the dialysis centers that provide hemodialysis services for patients with end-stage renal failure, and knew the number of patients treated in them approximately, considering that the number is variable and not fixed.
Results:
We found that most nephrologists are concentrated in the capital Damascus, with a percentage of more than a third of the specialists, while there were governorates such as Deir ez-Zor and Hama, where there were only two specialists compared to a population of more than one million citizens for each. The largest resident training center was at Damascus University, followed by Tishreen University, and the number of trainee nephrologists was approximately 62 doctors, and this number changes due to a number of them dropping out of training due to traveling outside the country. More than 20 nephrologists have emigrated to other countries, which constitutes more than 15% of the total number of nephrologists in Syria. There was an effective health activity of civil society associations in supporting dialysis patients and supporting the health sector in the governorates of Damascus and Homs, where they opened free private centers to provide dialysis sessions, which helped government centers and made it easier for patients to reach treatment centers in terms of geographical distribution as well.
The number of dialysis centers exceeded 60 centers, varying in their capacity for patients, as they receive approximately 4,000 patients weekly at a rate of two sessions per week for each patient, so that the devices operate at their maximum capacity between 4-5 sessions daily, noting continuous malfunctions in the devices due to lack of maintenance and excessive use throughout the day without rest. As for kidney transplant centers, there are 5 centers in the capital Damascus, and a new center was opened in Latakia, which performs approximately 300 kidney transplants annually.
Conclusions:
There is a significant shortage in the number of nephrologists in general in all governorates, especially Hama and Deir ez-Zor. There is also a shortage in the number of doctors trained in kidney specialization, such that some governorates are completely empty. There is also a great pressure on the blood transfusion centers in terms of the number of patients and the lack of available dialysis machines. Also The emigration of doctors (despite their small number) also poses a major challenge to nephrology specialization.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.