A World Health Organization (WHO) psychological assessment survey taken by more than 200 Syrian health workers measuring the effects of secondary exposure to extremely stressful events found that doctors residing in Syria are at a high risk of suffering from secondary stress. This is partly related to direct attacks on medical workers and facilities. As of the end of October 2017, 485 attacks on 325 separate health facilities were reported and 841 medical personnel were killed since the beginning of the conflict in Syria. Between January and July 2017, more than 62 attacks hit 43 health facilities. Attacks on health have been systematic to the extent that local communities are now demanding that healthcare facilities be located as far away from residential areas, fearing that they will be targeted. Healthcare workers who survive armed attacks carry vivid and often traumatic memories that are a risk factor for acute psychological distress. A nurse working at a health facility in Idlib described her experience when the hospital came under attack in late September 2017, saying: “We couldn’t see anymore. The ceiling began to collapse over us. I reached the child I was treating and leaned under the examination table to protect him. At that time, the child began to scream from fear. Our hospital provides medical services to the civilian population, there is no military object near it…we were attacked still.”

Healthcare workers who survive armed attacks may feel constant fear and worry for their lives and for the safety of their patients and facilities. Dr. Tennari, the director of a clinic in Idlib which was subjected to a double-tap attack on 20 October 2015, said: “When I am in the hospital, I feel like I am sitting on a bomb. It is only a matter of time before it explodes. It is wrong! A hospital should not be attacked.” Experiencing a violent attack triggers different responses. Abulaman, who still works as a doctor in northern Syria, describes how the war changed his relationship with his family: “Many days we can’t speak to our families when we get home, because of what we see at work. We can’t look at our children without thinking ‘What if this happens to them?’” Another health worker quit his job following a September 2017 attack on a hospital in rural Aleppo, stating: “Since the day that the hospital was attacked, I left my job. I have suffered … Now I sit alone, away from people. I have constant fear. That day is unforgettable.” Another doctor, who now resides in Turkey, says Syrian health workers bear psychological scars ranging from anxiety to depression and insomnia.

Psychosocial support activities such as seminars, workshops and trainings have been developed and implemented. Earlier this year, WHO trained hundreds of health workers in Turkey and northern Syria to help them identify and treat common psychological conditions. Other humanitarian organizations conduct regular psychosocial support sessions for their medical staff and volunteers. Such activities are important and needed. However, the roots of the problem continue to be the systematic targeting of civilians and civilian infrastructure, especially healthcare facilities. It is time that more is done to protect these medical workers and ensure accountability for their attackers in Syria. The international community must issue arrest warrants against perpetrators of crimes committed in Syria and against those that provide them with military, financial and diplomatic support.