������

One of the many challenges over the coming months and years will be to rebuild Syria’s health system, obliterated by over a decade of , chronic neglect, and the of the health workforce.

The and politicisation of Syria’s healthcare infrastructure mirrors that of the country at large, with multiple, autonomous health systems operating in parallel, each with a distinct set of stakeholders and funders within its respective geopolitical region. While the repatriation of forcibly displaced healthcare workers is critical to rebuilding Syria’s health system, there is on how this can be feasibly accomplished.

Meanwhile, the medical needs on the ground are immense.

In just over two weeks following the overthrow of the Assad regime, Syrian physicians are raising alarm over and among the thousands of newly-liberated prisoners, many of whom had been starved in detention.

As Syrian refugees return and are continually displaced within Syria, we can expect similar warnings of food- and , from non-communicable diseases and disability, and , particularly among survivors of torture.

Already, are responding. The impulse by many will be to convene medical humanitarian missions to meet these needs. These short-term deployments of clinicians who overwhelmingly practice in the Global North typically last one to a few weeks and range in scope from general primary care to dentistry and specialised surgical practice.

Over the course of the conflict, medical missions have been organised by Syrian diaspora-led and other groups as a means of maintaining engagement and awareness for both diaspora Syrians and international volunteers. The Syrian American Medical Society () and MedGlobal have been amongst the most prominent in leading these, with an increased emphasis on providing specialist care.

In the case of SAMS, they have supported medical missions to Jordan, Lebanon, and elsewhere, where they not only provide specialist care to Syrian refugees, but also to host populations in need, working in close collaboration with local health facilities and universities.

‘Do no harm’

While there is a role for medical missions in Post-Assad Syria, these must be strategic and intentionally integrative. Their overarching goal must be to strengthen, rather than replace, Syria’s existing health infrastructure, or else run the risk of violating the most revered tenet of the Hippocratic Oath to “first, do no harm.”

Dating back to the , humanitarian medical missions are rooted in European Christian imperialism. While the practice has since evolved, it remains predicated on a fundamental power imbalance between Global North and South actors. The funding and manpower for such missions tend to be concentrated in cities like Geneva and New York, while the priorities of the communities they aim to serve remain, perhaps inadvertently, neglected.

In some instances, international clinician volunteers, though well-intentioned, will not speak the same language as the populations they treat or understand the cultural context, and a lack of interpreters further widens the communication gap.

The population health impact of short-term medical missions has long been debated in the medical literature. This care model, potentially effective at addressing imminent needs in acute emergencies, is not well adapted for the increasingly nature of conflicts in the 21st century.

The problem, in part, lies in how these missions are evaluated. To date, there have been only a examining their efficacy, and there are no formal guidelines outlining best practices. As a result, they’re often guided by good intentions and altruism, rather than data. Some argue that the benefit is greater for the volunteer than the recipients of care and that the resources spent on such often-expensive trips would be better used to support local health practitioners.

Sustainable solutions

As a physician who has participated in these missions – specifically caring for Syrian refugees forcibly displaced in Lebanon – I can personally attest to the feeling of immediate gratification when helping the patient in front of you, who seemingly has no other options for medical care. But the question we do not ask ourselves enough is: what happens to this person a month from now when I’m no longer here?��This is particularly important for missions which include procedures or surgical interventions – though increasingly remote follow-up is possible.

Yet despite these shortcomings, if implemented thoughtfully, medical missions can play a significant and valuable role in strengthening Syria’s health system. By leveraging the existing community health workforce within Syria, as well as utilising medical missions as a means of both reintegrating exiled Syrian healthcare workers and training early-career Syrian doctors, medical relief agencies have a unique opportunity to heal, rather than simply mend.��This can be seen through the work of the David Nott Foundation which focuses on tailored, predominantly surgical courses in conflict settings, using a approach.

Globally, there is supporting the role of community health workers in providing critical health services in protracted conflict and displacement settings. Recognising their role in reducing health disparities, the World Health Organisation (WHO) has called for into community health worker programs, specifically within fragile settings.

In Syria, as in countless where medical missions are common, there is a growing cadre of community health workers who have worked to fill the gaps left by the decimated health workforce. For instance, in Northwest Syria, of successful “skill substitution”, wherein tasks previously ascribed to physicians are effectively implemented by non-physician actors, for patients requiring dialysis.

While there are sparse data on the effectiveness of community health worker-led initiatives in Syria, into local health systems and normalising their roles are key to their success. Herein lies the opportunity for medical missions.

Harnessing the skills of local experts

Rather than assembling teams of European and North American physicians to volunteer in Syria over the coming months, medical relief agencies should instead invest in the advancement and retention of the Syrian community health workers already on the ground, as well as support forcibly displaced healthcare workers to return and participate in these missions.

As health professionals who have experienced first-hand the weaponisation of healthcare in Syria, their participation and leadership are essential to ensure that medical needs, particularly those related to torture and gender-based violence, are addressed effectively, sustainably, and in a socio-culturally sensitive manner.

Syrian medical students and junior doctors should be included in these missions, both to support their training and contribute to reconstituting medical education infrastructure.

These missions must necessarily be conducted in coordination with existing hospitals, clinics, and other healthcare facilities, to which medications, equipment, and supplies should be directly donated. Medical organisations within the Syrian diaspora, including SAMS and others,��have worked tirelessly over the past fourteen years to train Syrian healthcare workers and provide medical relief in areas of Syria where they were permitted to work. Together with Syrian health facilities that remain operational, these organisations are well-positioned to oversee and evaluate these missions.

International health organisations should mobilise their resources in support of this ongoing work, led by local and diasporic healthcare workers, to limit duplication of efforts and optimise impact.

The brutal destruction of Syria’s health system offers an opportunity to re-envision the outdated medical mission model into one that is focused on integration, education, and sustainability. There is no one more capable than the thousands of Syrian nurses, doctors, pharmacists, community health workers, technicians, and other allied healthcare professionals to lead these missions and spearhead the reconstruction of Syria’s health system. Let them.

Dr. Sasha Fahme is a physician and global health researcher who lives and works between Beirut, Lebanon and New York City, USA. Her research focuses on the syndemic impact of conflict and forced displacement on women's health in humanitarian settings.

Follow her on Twitter: @SashaFahme

Have questions or comments? Email us at:��editorial-english@newarab.com

Opinions expressed in this article remain those of the author and do not necessarily represent those of ������, its editorial board or staff.