Keywords
northwest Syria - conflict - rheumatic diseases - rheumatologists - health care system
- health care professionals - cost
Introduction
Armed conflicts have devastating effects that often lead to loss of life, injury,
displacement of populations, and destruction of vital infrastructure such as health
care systems. The Syrian war is one of the most tragic humanitarian crises of the
twenty-first century, having begun in 2011 and now entering its 13th year as of March
2024. It has caused millions of people to be displaced, both inside and outside of
Syria, and hundreds of thousands of individuals have lost their lives, become disabled,
or gone missing as a result. It is crucial that we continue to work toward finding
peaceful solutions to conflicts like these to prevent such human suffering in the
future.[1]
The Syrian revolution, which was part of the Arab Spring in 2011, turned into the
largest refugee crisis of modern times. Millions of Syrians were forced to flee their
homes and become refugees in other countries. Additionally, over 6 million people
were internally displaced, and the region suffered from massive destruction. This
destruction affected the essential infrastructure, the health care system, the social
status of the population, and the economy, leading to a growing need for humanitarian
aid from the international community.[1] Unfortunately, the international community failed to prevent the destruction of
health infrastructure, which caused the collapse of Syria's health care system and
left millions of displaced people in dire need of medical assistance.[1]
The ongoing conflict and violence in Syria have had a direct impact on the health
care facilities and workers in the country. The public health care system has been
severely damaged, which has resulted in serious health consequences for the population.[2] These consequences include an increased risk of communicable and noncommunicable
diseases, significant challenges related to maternal and child health, trauma caused
by the conflict, mental health issues, and a large-scale migration of Syrian health
care workers who are seeking to escape the ongoing conflict.[1]
[3] The prolonged conflict in Syria for over 12 years has impacted the diagnosis and
treatment of rheumatic diseases.
There is a shortage of health care professionals specializing in rheumatic diseases
worldwide, particularly in low- and middle-income countries.[4] This issue is more severe in areas affected by long-term conflicts. For instance,
in Syria, the number of doctors has decreased significantly from 11,305 (0.529 doctors
per 1,000 population) in 2010 before the conflict started to 5,889 doctors (0.291
doctors per 1,000 population) in 2018.[5] There has been a significant decrease in the quality of health care services in
many areas due to several factors. These factors include economic pressure caused
by migration, deliberate targeting of health care workers by combatants, and the weakening
of medical education systems. The medical education system is suffering from a mass
exodus of teachers and doctors, destroyed infrastructure, limited resources (including
the internet), shortages of medicines and laboratory tests, disruption of mobility
due to safety concerns, and a shift in focus on health care.
During the Syrian war, there were only 60 rheumatologists available in the country,
which equates to 0.26 doctors per 100,000 people. In Aleppo, a neighboring city in
northern Syria with a population of 4.8 million, there were only five rheumatologists
available, which means there were only 0.1 rheumatologists per 100,000 people. It
is important to note that this information was obtained by personal contact given
lack of documented and accurate data in Syria
The purpose of this study is to discuss the issue of rheumatic diseases during a 2-year
conflict period. It provides an overview of the current health situation regarding
rheumatic diseases, outlines the challenges faced by the health system in this area,
and suggests solutions to improve rheumatology in conflict-affected areas, such as
northwest Syria.
Methods
This study examined rheumatology patients who visited internal medicine outpatient
clinics, which were supervised by one internal medicine physician (corresponding author,
W. Z.), in five hospitals located in northwest Syria. This area is currently under
the control of nonstate forces and the Turkish government, as it has lost all support
from the Syrian government. The study collected baseline demographic data and diagnosis
retrospectively, without any duplication of data, between September 2019 and February
2022, from outpatient clinic records. The patients were diagnosed according to the
latest criteria of the European League Against Rheumatism and the American College
of Rheumatology, which were published on the Web site of the American College of Rheumatology.[6]
This article reviews investigations and drugs that are either available or unavailable
in the northwestern region of Syria. However, it is important to note that the drugs
or investigations may be present in other regions such as areas controlled by the
regime or neighboring regions such as Turkey.
The cost of medical investigations and drugs depends on the purchasing power of patients.
These costs can be categorized as either affordable or nonaffordable. “Affordable”
could be defined as a cost that does not exceed a certain percentage of an individual's
income However, some patients may not be able to afford the expenses of their treatment
and may have to rely on charitable organizations for financial support. In some cases,
patients are forced to take on debt to purchase the necessary medications. The collected
data were analyzed using the Statistical Package for Social Sciences (SPSS v.24; SPSS
Inc., Chicago, IL, United States). The study was approved by the Institutional Review
Board (IRB) at the Idleb Health Directorate. Due to the retrospective nature of the
study and the use of an existing, de-identified dataset that was collected without
explicit research purposes, the requirement for informed consent was waived by the
IRB.
Results
Current Health Status Regarding Rheumatic Diseases
Demographic Characteristics and Rheumatic Disease Diagnoses of the Study Population
A clinic in northwest Syria treated 488 patients with rheumatic diseases over 2 years
(average age, 37.4; 63% female). Connective tissue disorders dominated (25.6%), with
rheumatoid arthritis affecting 8.2% and lupus 1.0%. Osteoarthritis (12.1%) and gout
(5.3%) were common musculoskeletal diagnoses. Seronegative spondyloarthropathies (5.9%)
included axial (3.3%) and peripheral (1.2%) subtypes. Juvenile idiopathic arthritis
(3.1%) and Behcet's disease (11.3%) were notable in pediatric and nonmusculoskeletal
categories. This diverse patient profile highlights the complexity of rheumatic care
in conflict zones. [Table 1] provides a brief overview of demographic information and prevalent diagnoses across
different categories, with emphasis on the context of a conflict zone.
Table 1
Demographic characteristics and rheumatic disease diagnoses of the study population
|
Disease
|
Frequency, n
|
Percent
|
Female, n (%)
|
Male, n (%)
|
Mean age, y
|
|
Total
|
488
|
100
|
309 (63.3)
|
179 (36.7)
|
37.43
|
|
Connective tissue disorders
|
|
Rheumatoid arthritis
|
125
|
25.6
|
102 (81.6)
|
23 (18.4)
|
41.78
|
|
Systemic lupus erythematosus
|
40
|
8.2
|
38 (95)
|
2 (5)
|
31.63
|
|
Systemic sclerosis (scleroderma)
|
|
Diffuse cutaneous systemic sclerosis
|
5
|
1.0
|
5 (100)
|
0 (0)
|
45.40
|
|
Limited cutaneous systemic sclerosis
|
11
|
2.3
|
8 (72.7)
|
3 (27.3)
|
32.73
|
|
CREST syndrome
|
6
|
1.2
|
4 (66.7)
|
2 (33.3)
|
39.50
|
|
Raynaud's disease
|
10
|
2.0
|
6 (60)
|
4 (40)
|
35.60
|
|
Dermatomyositis
|
6
|
1.2
|
3 (50)
|
3 (50)
|
29.83
|
|
Sjogren's syndrome
|
6
|
1.2
|
6 (100)
|
0 (0)
|
42.17
|
|
Mixed connective tissue disease
|
5
|
1.0
|
5 (100)
|
0 (0)
|
28.40
|
|
Antiphospholipid syndrome
|
4
|
0.8
|
4 (100)
|
0 (0)
|
31.75
|
|
Osteoarthritis and related disorders
|
|
Osteoarthritis
|
59
|
12.1
|
45 (76.3)
|
14 (23.7)
|
49.12
|
|
Diffuse idiopathic skeletal hyperostosis (DISH)
|
3
|
0.6
|
5 (100)
|
0 (0)
|
65.33
|
|
Crystal-induced arthropathies
|
|
Gout
|
26
|
5.3
|
7 (26.9)
|
19 (73.1)
|
51.58
|
|
Seronegative spondyloarthropathies
|
|
Axial spondyloarthropathy
|
29
|
5.9
|
6 (20.7)
|
23 (79.3)
|
33.28
|
|
Peripheral spondyloarthritis
|
6
|
1.2
|
4 (66.7)
|
2 (33.3)
|
29.50
|
|
Reactive arthritis
|
6
|
1.2
|
2 (33.3)
|
4 (66.7)
|
25.67
|
|
IBD-associated arthritis
|
3
|
0.6
|
1 (33.3)
|
2 (66.7)
|
25.00
|
|
Psoriatic arthritis
|
3
|
0.6
|
2 (66.7)
|
1 (33.3)
|
38.00
|
|
Fever-associated rheumatic disorders and pediatric disorders
|
|
Adult-onset Still's disease
|
4
|
0.8
|
3 (75)
|
1 (25)
|
31.75
|
|
Familial Mediterranean fever
|
11
|
2.3
|
4 (36.4)
|
7 (63.6)
|
14.45
|
|
Juvenile idiopathic arthritis
|
15
|
3.1
|
4 (26.7)
|
11 (73.3)
|
10.20
|
|
Vasculitides
|
|
Giant cell arteritis
|
1
|
0.2
|
0 (0)
|
1 (100)
|
50.00
|
|
Polymyalgia rheumatica
|
2
|
0.4
|
2 (100)
|
0 (0)
|
67.50
|
|
Takayasu's arteritis
|
4
|
0.8
|
4 (100)
|
0 (0)
|
41.50
|
|
Granulomatosis with polyangiitis
|
4
|
0.8
|
2 (50)
|
2 (50)
|
45.50
|
|
Eosinophilic granulomatosis with polyangiitis
|
1
|
0.2
|
0 (0)
|
1 (100)
|
16.00
|
|
Hypersensitivity vasculitis
|
7
|
1.4
|
3 (42.9)
|
4 (57.1)
|
25.57
|
|
IgA vasculitis
|
6
|
1.2
|
3 (50)
|
3 (50)
|
29.67
|
|
Behcet's disease
|
55
|
11.3
|
18 (32.7)
|
37 (67.3)
|
32.91
|
|
Infections and related arthritides
|
|
Septic arthritis
|
5
|
1.0
|
2 (40)
|
3 (60)
|
41.80
|
|
Viral arthritis (hepatitis A virus)
|
5
|
1.0
|
2 (40)
|
3 (60)
|
24.20
|
|
Tuberculous arthritis
|
2
|
0.4
|
1 (100)
|
1 (100)
|
36.50
|
|
Rheumatic fever
|
1
|
0.2
|
1 (100)
|
0 (0)
|
11.00
|
|
Diffuse pain syndromes
|
|
Fibromyalgia
|
7
|
1.4
|
6 (85.7)
|
1 (14.3)
|
34.86
|
|
Metabolic bone disease
|
|
Osteomalcia
|
1
|
0.2
|
1 (100)
|
0 (0)
|
15.00
|
|
Osteoporosis
|
2
|
0.4
|
2 (100)
|
0 (0)
|
57.50
|
|
Nonrheumatic systemic disorders
|
|
Osteogenesis imperfecta
|
2
|
0.4
|
1 (50)
|
1 (50)
|
16.50
|
Abbreviations: CREST, calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly,
and telangiectasia; IBD, inflammatory bowel disease; IgA, immunoglobulin A.
Medical Staff
In northwestern Syria, where the population is 5.5 million, there are currently only
three adult rheumatology specialists (0.07 rheumatologists per 100,000 people) registered
with the health directorates. It is worth noting that two of them joined the region
after 2021, which means that until the end of 2021, there was only one registered
specialist in rheumatology. Furthermore, there is an unlicensed doctor who practices
rheumatology and has not completed the required training to practice the profession.
Additionally, there is currently no pediatric rheumatologist available in the area.
As a result, many patients with Rheumatologic conditions seek treatment from orthopaedic
or internal medicine specialists, who may lack the necessary expertise in this specialized
field.
Rheumatology Medical Facilities
There is currently no hospital that is exclusively dedicated to the Department of
Rheumatology. However, three hospitals have a rheumatology clinic. One of these clinics
is supervised by an internal doctor, while the other two are supervised by rheumatologists,
who have only recently—less than a year ago—joined the region.
Laboratory and Radiological Investigations
The conflict in northern Syria has had a severe impact on the availability of rheumatology
investigations. Due to the destruction of health care facilities and restrictions
on importing necessary equipment, many of these investigations, including specific
tests for rheumatology conditions, are no longer available. This shortage has resulted
in increased costs for some investigations, making them unaffordable for many patients.
As a result, individuals with rheumatic disease face significant challenges in accessing
the screenings they need, particularly due to financial limitations resulting from
poverty.
Furthermore, the ongoing conflict has caused a deterioration in the quality of certain
investigations. For instance, there is a lack of expertise among radiologists in interpreting
magnetic resonance imaging (MRI) of the sacroiliac joint, which hampers the diagnosis
of various diseases, especially axial spondyloarthropathy. Additionally, the absence
of qualified radiologists capable of performing joint ultrasonography increases the
demands on MRI.
[Table 2] provides a summary of the diagnostic tests currently available for rheumatic disease
in northwest Syria, along with information on the affordability of these tests for
patients. However, it should be noted that accurately counting the number of tests
is a challenge since many of them are conducted in private centers or sent to neighboring
countries.
Table 2
The available rheumatic disease diagnostic test in northwest Syria and its affordability
to the patients
|
Investigation
|
Availability
|
Cost
|
|
General blood tests
|
|
Erythrocyte sedimentation rate (ESR)
|
Available
|
Affordable
|
|
C-reactive protein (CRP)
|
Available
|
Affordable
|
|
Uric acid
|
Available
|
Affordable
|
|
Complement (C4 and C3)
|
Available
|
Affordable
|
|
Cryoglobulins
|
Not available
|
–
|
|
Autoantibodies
|
|
Rheumatoid factor (RF)
|
Available
|
Affordable
|
|
Cyclic citrullinated protein (CCP)
|
Available
|
Nonaffordable
|
|
Antinuclear factor
|
Available
|
Nonaffordable
|
|
Anti-double
stranded DNA (dsDNA)
|
Available
|
Nonaffordable
|
|
Anti-Smith
|
Available
|
Nonaffordable
|
|
Anti-Scl-70/anticentromere
|
Available
|
Nonaffordable
|
|
Anti-Jo-1 (antihistidyl tRNA synthetase)
|
Available
|
Nonaffordable
|
|
Anti-U1-RNP
|
Not available
|
–
|
|
Anti-ribosomal P
|
Not available
|
–
|
|
Antihistone
|
Not available
|
–
|
|
Anti-Ro/SSA
|
Available
|
Nonaffordable
|
|
Anti-La/SSB
|
Available
|
Nonaffordable
|
|
Phospholipid antibodies
|
Available
|
Nonaffordable
|
|
Antineutrophil cytoplasmic antibodies (ANCA)
|
Available
|
Nonaffordable
|
|
HLA typing
|
|
HLA-B27
|
Available
|
Nonaffordable
|
|
HLA-DRB1*04
|
Not available
|
–
|
|
HLA-B5
|
Available
|
Nonaffordable
|
|
HLA-B52
|
Not available
|
Nonaffordable
|
|
Imaging
|
|
Plain radiography
|
Available
|
Affordable
|
|
Computed tomography (CT) scan
|
Available
|
Affordable
|
|
Magnetic resonance imaging (MRI)
|
Available
|
Nonaffordable
|
|
Ultrasonography
|
Available
|
Affordable
|
|
Isotope scanning (technetium-99m)
|
Not available
|
–
|
|
DEXA scan
|
Not available
|
–
|
|
Synovial fluid
|
|
CBC
|
Available
|
Affordable
|
|
Culture
|
Available
|
Affordable
|
|
Crystals
|
Not available
|
–
|
|
Others
|
|
Electromyography (EMG)
|
Available
|
Nonaffordable
|
|
Tissue biopsy
|
|
Lung, kidney, skin biopsy
|
Not available
|
–
|
|
Muscle biopsy
|
Available
|
Nonaffordable
|
Abbreviations: CBC, complete blood count; DEXA, dual-energy X-ray absorptiometry;
HLA, human leukocyte antigen.
Rheumatic Medications
The ongoing conflict in the region has resulted in a shortage of medical supplies,
including generic rheumatology drugs. This is due to the destruction of pharmaceutical
factories and restrictions on the import of these medicines. As a result of this shortage,
the cost of medicines has increased, making them unaffordable for many patients. Regrettably,
most medications for rheumatic diseases are unavailable. There are a few options available
for rheumatology patients, but these are also costly. For instance, methotrexate,
one of the most frequently prescribed medications for such conditions, comes at a
high price. This poses a challenge for many patients living in poverty who depend
on this medication to control their symptoms.
Moreover, the conflict has disrupted the supply chain of medicines, making it difficult
for pharmaceutical companies to distribute their products to the region. Even if medicines
are available, they may become unusable due to the lack of electricity to store these
drugs in warehouses, especially biological drugs. This situation has had a significant
impact on the health of the people in the region, who are struggling to access the
medical care they need.
The unavailability of medications for rheumatic diseases can have severe consequences
for patients suffering from such diseases. Many of these ailments require ongoing
treatment with disease-modifying generic drugs and immunosuppressive drugs to control
symptoms and prevent the disease from progressing. In the absence of these medications,
patients may experience worsening of their symptoms, decreased quality of life, and
an increased risk of complications associated with their condition and may resort
to excessive use of steroids and analgesics (nonsteroidal anti-inflammatory drugs).
It is crucial to ensure that the medicines for rheumatic diseases are both available
and affordable for patients in need. [Table 3] provides a summary of the available medicines in northwest Syria along with the
patients' ability to afford them. However, it should be noted that there is a challenge
in accurately counting these medicines, as most of them are obtained from private
pharmacies or purchased by patients from neighboring countries.
Table 3
The available medicines for rheumatic disease in northwest Syria and its affordability
to the patients
|
Drugs
|
Availability
|
Cost
|
|
Anti-inflammatory agents
|
|
NSAIDs
|
Available
|
Affordable
|
|
Glucocorticoids
|
Available
|
Affordable
|
|
Colchicine
|
Available
|
Affordable
|
|
Analgesics
|
|
Acetaminophen
|
Available
|
Affordable
|
|
Opiates
|
Available
|
Nonaffordable
|
|
Tramadol
|
Available
|
Affordable
|
|
Topical agents
|
Available
|
Affordable
|
|
Nonbiologic DMARDs
|
|
Methotrexate
|
Available
|
Nonaffordable
|
|
Hydroxychloroquine
|
Available
|
Nonaffordable
|
|
Sulfasalazine
|
Available
|
Nonaffordable
|
|
Leflunomide
|
Not available
|
–
|
|
Azathioprine
|
Available
|
Nonaffordable
|
|
Cyclophosphamide
|
Available
|
Nonaffordable
|
|
Mycophenolate mofetil
|
Available
|
Nonaffordable
|
|
Cyclosporine
|
Available
|
Nonaffordable
|
|
Biologic DMARDs[a]
|
|
TNF-α inhibitor
|
Available
|
Nonaffordable
|
|
Ustekinumab
|
Not available
|
–
|
|
Abatacept
|
Not available
|
–
|
|
Belimumab
|
Not available
|
–
|
|
Anakinra/canakinumab
|
Not available
|
–
|
|
Rituximab
|
Available
|
Nonaffordable
|
|
Tocilizumab
|
Not available
|
–
|
|
Tofacitinib
|
Not available
|
–
|
|
Urate-lowering therapy
|
|
Allopurinol
|
Available
|
Affordable
|
|
Febuxostat
|
Available
|
Affordable
|
|
Probenecid
|
Not available
|
–
|
|
Pegloticase
|
Not available
|
–
|
Abbreviations: DMARD, disease-modifying antirheumatic drug; NSAID, nonsteroidal anti-inflammatory
drug; TNF, tumor necrosis factor.
a Storing and transportation conditions may affect the efficacy of these medications
as the electric supply is continuously interrupted.
Discussion
The shortage of rheumatologists in the workforce is a major problem worldwide, especially
in developing countries such as those in the Middle East. According to the Arab League
of Associations for Rheumatology (ArLAR) Research Group (ARCH), the average number
of rheumatologists in Arab countries is only 0.84 per 100,000 people.[7] In the northern region of Syria, there are only 0.07 rheumatologists available for
every 100,000 people. This scarcity is similar to that of certain other countries
such as Nicaragua (0.07 per 100,000 people), Pakistan, Nigeria (0.01 per 100,000 people),
and India (0.01 per 100,000 people). However, this number increases significantly
in developed countries such as France (3.8 per 100,000), the United States (1.78 per
100,000), and the United Kingdom (0.84 per 100,000).[8]
According to this research paper, the most commonly observed joint disease is rheumatoid
arthritis, which contradicts the findings of other published papers in the medical
literature that state that osteoarthritis is the most prevalent arthritis disease.[8]
[9]
[10]
[11]
[12]
[13] The reason for this discrepancy is that in our study, most osteoarthritis cases
were treated by orthopaedic doctors. The average age of patients diagnosed with joint
diseases corresponds to the age ranges reported in medical literature. Additionally,
it has been observed that juvenile idiopathic arthritis is the most frequently occurring
joint disease in the pediatric age group, followed by familial Mediterranean fever.
The prevalence of rheumatic diseases among males and females is consistent with most
studies[9]
[10]
[11]
[13]; however, it has been observed that lupus, rheumatoid arthritis, and other connective
tissue diseases are more prevalent in females. It has been noted that gout and spondyloarthropathy
are more common in males,[9]
[10]
[11]
[13] while Behcet's disease is more common in males in our study than in Istanbul, Turkey.[14] The study observed a rise in the number of cases of scleroderma, without any clear
explanation. Further research is required to understand this trend. On the other hand,
the study found that the number of rheumatic fever cases is lower than in other studies.
This may be because most patients receive diagnosis and treatment from pediatricians,
without being referred to rheumatology clinics.
The burden of musculoskeletal diseases increased significantly between 2000 and 2015.
It is now the second leading cause of disability worldwide.[15] Rheumatic diseases, particularly inflammatory conditions, should not be considered
solely in terms of their physical health effects. These diseases not only elevate
the risk of organ dysfunction but also result in gradual disability and increased
psychological burdens for those affected. As a result, the overall quality of life
is reduced, and financial difficulties arise due to lower income and the increasing
expenses of managing these conditions.[16] Early diagnosis and timely treatment are crucial for patients to maintain their
professional and social engagements, minimize the adverse consequences of the disease,
and preserve their overall well-being. Accordingly, prioritizing early detection and
implementing appropriate therapies can help individuals remain active in their work
and social lives and reduce the negative effects of rheumatic diseases.
The impact of war and displacement on disease activity and quality of life in patients
with rheumatic diseases in northwestern Syria is a complicated and multifaceted issue
that requires careful assessment. The conflict's socioeconomic impacts have also contributed
to the deterioration of the quality of life of patients with rheumatic diseases. Many
have lost their homes, their means of livelihood, and their social support systems,
which can have a significant impact on their mental and physical health.
Depressed mood levels are significantly higher in rheumatoid arthritis, osteoarthritis,
and fibromyalgia patients than in healthy controls, as shown by a systematic review
and meta-analysis.[17] In a cross-sectional study, 20% of those with arthritis had an anxiety disorder,
compared with 13% of those without arthritis.[18] One study on veterans revealed that 94.4% of the cases were attributable to injuries
sustained during war.[20] There is growing evidence in the literature that posttraumatic stress disorder (PTSD),
caused not only by war but also by other factors, may be linked to the development
of autoimmune disorders.[21] Studies have reported a higher prevalence of myofascial pain and rheumatoid arthritis
among U.S. military personnel with PTSD.[22]
[23] A cross-sectional study in Syria revealed high rates of mental health impact: 44%
with likely severe mental disorders and 27% with both severe disorders and full PTSD.[19]
In Syria, 35.2% of the population lives below the poverty line, which is defined as
earning $3.65 or less per day, according to the World Bank.[24] In a recent poll conducted in northern Syria, over half of the surveyed population
earned less than US$100, which is equivalent to less than $3.3 per day on average.[25]
To help rheumatology patients living in conflict-affected areas, specific interventions
are necessary. These interventions should aim to tackle the unique difficulties that
these patients face. Examples of such interventions can include providing mobility
aids to help patients manage their symptoms and creating community-based support networks
that can provide ongoing psychosocial support.
Challenges and Potential Solutions for the Development of Rheumatology in Northwest
Syria
Challenges and Potential Solutions for the Development of Rheumatology in Northwest
Syria
One of the main challenges in the field of rheumatology in northern Syria is the shortage
of human resources to provide medical services, as well as the low number of trainers
available. These concerning statistics could have a negative impact on the quality
of care for rheumatology patients, potentially leading to increased morbidity and
mortality rates. [Table 4] outlines the major challenges faced in the field, along with proposed solutions.
Table 4
Challenges and potential solutions for the development of rheumatology in northwest
Syria
|
Lack of human resources
|
• Training of internists on the specialization of rheumatology
• Launching a training program for resident doctors in rheumatology through the SBOMS[26]
|
|
Migration of rheumatologist
|
• Providing extra salaries or incentives to retain rheumatologists currently working
in northwest Syria
|
|
Lack of training programs
|
• Launching a fellowship program in rheumatology in collaboration with expatriate
doctors
• Activating periodic medical missions for expatriate rheumatologist to northern Syria
• International missions in the field of rheumatology for trainee doctors to neighboring
countries, with the stipulation of their return to northern Syria after the end of
training
|
|
The high cost and the unavailability of most rheumatic investigation
|
• Encouraging governmental medical authorities and nongovernmental medical organizations
to provide these investigations in northern Syria
|
|
Many people do not know that the specialization of rheumatology is independent of
the specialization of orthopaedics
|
• Educating patients in northern Syria about the importance of this specialty in treatment
• Encouraging government medical authorities to refer rheumatology cases to specialized
doctors through the referral system
|
Abbreviation: SBOMS, Syrian Board for Medical Specialties.
SBOMS: Syrian Board of Medical Specialties
SBOMS: Syrian Board of Medical Specialties
The Syrian Board for Medical Specialties (SBOMS)[26] is an academic institution that focuses on training resident doctors in northwestern
Syria. The training takes place in accredited hospitals, and upon completion, doctors
receive a certificate of specialization. The SBOMS program aims to deliver excellent
training to resident doctors in all specialties by specialist doctors and supervisors
located in northern Syria. To address the lack of availability or rarity of certain
specialties, high-quality distance education is utilized. The training was conducted
with the guidance of Syrian doctors who are currently residing outside their home
country. In the field of rheumatology, specialized lectures are conducted regularly,
according to the latest recommendations and scientific methodology. These lectures
aim to fill the gaps in general topics in the specialization. Additionally, there
is a weekly rheumatology clinic, which many residents attend periodically. For complex
consultations, there is online communication available with expatriate rheumatologists
from Qatar, the United States, and Saudi Arabia. This situation highlights the need
to train new local rheumatology doctors to address the shortage of health care personnel
in this field.
At the time of writing this article, SBOMS currently does not offer a specialty in
rheumatology. However, the organization hopes to collaborate with interested partners
in education to open this specialty soon. By highlighting the significance and challenges
associated with this field, SBOMS aims to raise awareness and encourage the development
of the rheumatology specialty.
Conclusions
There is a severe shortage of rheumatologists and medications for rheumatic diseases
in northwestern Syria, despite the high prevalence of such diseases in the region.
Due to the impact of war and displacement on patients with rheumatic diseases in northern
Syria, addressing the issue requires a multifaceted approach. The solution involves
breaking down barriers to health care and medication access, providing human resources,
supporting patients' psychosocial needs, and conducting targeted research. This study
aims to overview the challenges facing this specialization in a war-torn country and
identify critical gaps that need addressing to mitigate their impacts.
