Nephrology workforce shortages are
a global issue, particularly acute in low- and middle-income countries. These challenges
are exacerbated in regions experiencing prolonged conflicts. In Syria, the
nephrology workforce has faced dramatic shifts since the conflict began in
2011. The war has inflicted serious damage on the healthcare system, reducing the
availability of nephrologists to care for patients with kidney-related conditions.
1. Impact on Patient Care: The dwindling number of nephrology
professionals has created substantial barriers for patients in need of dialysis
and other kidney treatments. In conflict-stricken regions like Northwest Syria,
about 850 individuals rely on hemodialysis services; however, the fragile healthcare
infrastructure struggles to sustain these services effectively. Many dialysis centers
function without proper physician oversight, and the overall quality of care
has suffered due to resource shortages and insufficiently trained staff.
2. Challenges in Training and Retention: The conflict has
not only caused a decline in experienced nephrologists but also disrupted
medical education and training programs. A significant number of healthcare professionals
have left the country, while those remaining work amid dangerous conditions
with minimal support. This has widened the gap in training new nephrology specialists,
worsening the workforce crisis. Although initiatives to establish training
programs for nephrologists in conflict zones are underway, obstacles like limited
funding and the necessity to adopt innovative methods, such as telemedicine and
remote learning, persist.
3. Infrastructure Damage: The ongoing conflict has severely damaged
healthcare facilities, with many kidney transplant centers shutting down. The remaining
operational facilities are concentrated mainly in Damascus, which restricts access
for patients from other areas. Moreover, the number of kidney transplants
performed has dropped significantly, with reports indicating a 60% decline
during the early years of the conflict.
4. Limited Access to Medications: Patients who have
undergone kidney transplants require lifelong immunosuppressive medications to
prevent organ rejection. However, the war has disrupted supply chains, making
it difficult for patients to obtain these essential drugs. Many patients resort
to purchasing medications out of pocket or relying on relatives abroad to send
them.
5. Lack of a Deceased Donor Program: Despite legislative initiatives
aimed at establishing a deceased donor program, its implementation remains ineffective.
The system continues to rely predominantly on living donors, which fails to satisfy
the increasing demand for transplant procedures. Limited public awareness and low
acceptance rates of organ donation exacerbate challenges in launching a viable deceased
donor program.
6. Economic Challenges: Syria's deteriorating economic conditions
have made healthcare inaccessible for a significant portion of the population. Dialysis
remains substantially more expensive than immunosuppressive therapy, yet many individuals
are unable to afford either option. This financial hardship contributes to higher
rates of morbidity and mortality among those suffering from kidney disease.
7. Psychological and Social Impact: The ongoing conflict has
fostered a deeply traumatic environment affecting both patients and healthcare
professionals. Nephrologists must shoulder not only clinical responsibilities
but also the psychological toll inflicted by war, as their patients experience
additional health complications linked to stress and instability within their surroundings.
This study aimed to collect data on
the challenges encountered by nephrologists in Syria, pinpoint deficiencies within
the structure of the nephrology specialty, and propose future solutions to enhance
the field, ultimately contributing to the advancement of nephrology in the
country.
