Introduction: 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. 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. 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. 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.Methods: The details were gathered from the Syrian Society of Nephrology and Hypertension's website, as well as data from public universities.Additionally, nephrologists overseeing hemodialysis centers across different governorates were consulted.Numerous published studies analyzing the situation of nephrology and patients with end-stage renal disease during the Syrian conflict and the refugee countries were also reviewed.
Alanan et al. (Wed,) studied this question.