One of the worst humanitarian crisis in a generation has been unfolding in Syria over the past 5 years, and making matters worse is a severe shortage of doctors in the war zone as a result of systematic attack on hospitals and aid workers by both the Syrian government and rebel forces.
More than half of Syria’s pre-war population, more than 18 million people, have been killed or forced to flee their homes as a result of the Syrian civil war, according to aid organization Mercy Corps
. There currently are 13.5 million refugees inside Syria and 4.7 million scattered among the neighboring countries of Turkey, Lebanon, Jordan, Iraq, and Egypt. Half of those displaced are under the age of 18 and one-fourth are young females, according to Asli Yalim
, a University of Buffalo PhD student who has been studying the conflict. The civil war also has killed more than 220,000 people and injured countless others, according to Mercy Corp, half of them civilians.
Making matters worse, doctors are in extremely short supply because hospitals and relief organizations are prime targets in the conflict—hospitals and medical staff have been a constant target of regime attacks in Syria since the beginning.
In February, Doctors Without Borders said there were “deliberate attacks” against at least 5 hospitals in northern Syria, and New York-based Physicians for Human Rights put the total number of attacks on Syrian medical facilities at 358, with 726 healthcare professionals killed since the conflict began.
“Syrian forces have systematically attacked the health care system in opposition-held areas,” Donna McKay, MS, executive director of Physicians for Human Rights, said in a statement
. Syria “is among the worst examples of targeting medical care as a weapon of war.”
Telemedicine to the Rescue
Some are combatting the shortage of medical staff with telemedicine.
The US-based Syrian American Medical Society (SAMS) launched a program in 2013 that addressed the shortage of medical staff in Syria with a 3-pronged approach of e-learning programs, telemedicine, and telesurgery. The e-learning initiative helps train physicians within the country; the telemedicine component recruits a global network of specialist physicians who volunteer to be on call and help Syrian physicians via Skype; and the telesurgery aspect allows overseas specialists to supervise complex operations remotely.
“We have cameras inside the hospital looking directly at each patient, so a physician in North America, for example, will be able to observe a patient through the webcam and view the monitor to read the vital signs,” Ahmad Tarakji, MD, president of SAMS, told Computer Weekly
. “He will also be able to communicate with the patient, if he is awake, and/or his family, and with the local physician and nurses.”
A slightly less sophisticated approach, an app called Figure1, does much the same by serving as the Instagram for doctors: Syrian medical staff can post photos of ailments and include basic info so that doctors elsewhere then can help with diagnosis.
The Many Uses of Telemedicine
Telemedicine is “essential for treating Syrian refugees who don't have access to specialist care, let alone the quality, regular follow-ups," Rogy Masri, MD, a doctor stationed at a refugee camp in Northern Lebanon, told Fast Company
Masri said he uses telemedicine for consultation with medical specialists when he sees patients with problems he cannot diagnose. He recalled one case where a refugee walked into his clinic with a skin infection he couldn’t diagnose, but with the help of a specialist he was able to figure out the condition.
Other uses for telemedicine in Syria include psychiatry, continuity of care for patients who must change facilities due to violence, continuous care where there is a shortage of doctors, and staffing particularly dangerous zones where no doctor is safe to tread.
Medical facilities in Syria’s rebel-controlled Aleppo use telemedicine to staff the intensive care unit, for instance. A team of doctors from across the United States, Canada, the United Kingdom, and Saudi Arabia work in shifts to monitor Syrian patients in real-time using three webcams connected to the intensive care unit (ICU). Those supervising the ICU in person move the cameras so remote staff can check the monitors, ventilators and patients themselves.
Of course, all this requires good Internet connectivity, Patrick Gordon, chair of the WGET Forum at the United Nations Office for the Co-ordination of Humanitarian Affairs (UNOCHA), told Computer Weekly.
This is particularly the case when it comes to videoconferencing, a key technology that healthcare workers have been leveraging in Syria.
“Reliable network connectivity is a huge issue for war-torn areas,” real-time communications network provider
Agora.io quoted founder Tony Zhao in a blog post.
Even unreliable connectivity is better than no connectivity, however. For those helping refugees in Syria, telemedicine has been welcomed help. It has enabled medical facilities in war-ravaged areas to keep functioning despite a lack of qualified medical personnel. It also has brought specialist support and improved healthcare operations that would not be possible otherwise.