Mervat Alhaffar, Aseel Hamid, Yazan Douedari, Natasha Howard

Summary

Introduction The Syrian conflict, which has resulted in massacres, displacements, destruction of infrastructure and illegal targeting of health facilities and personnel mainly by the Syrian government and its allies, is in its 10th year. This study explored women’s lived experiences in health, both as health workers and service users, in areas controlled by the Syrian Opposition (OCA).

Methods We chose a qualitative study design, with 20 in-depth interviews conducted remotely via WhatsApp and Messenger with purposively selected Syrian women (i.e. 15 health workers, 5 service users). We analyzed the data using interpretive phenomenological analysis.

Results Anxiety, fear and horror affected women’s daily work and well-being. Work overload and insecurity were major challenges for female health workers, who also had household and caregiving responsibilities. Coping mechanisms included: (1) normalization of death; (2) acceptance of God’s will; and (3) focus on controllable issues such as the provision of health services while accepting the reality of insecurity and death. Conflicts have contributed to changing social norms and expectations, and women have become key actors in health care delivery, although this has not directly translated into greater decision-making authority. Structural biases (eg lack of maternity leave) and gender-based violence (eg increased harassment and child marriage) have disproportionately affected women.

Conclusion This is a first effort to amplify the voices of women in policy and health systems research on the Syrian conflict. Women have become key healthcare providers in OCAs, but remain underrepresented in decision-making. Although conflict-related social transformation, the increased role and demand for female health workers can be seen as positive for women’s empowerment, the reality is complex and the long-term implications are unclear.

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