As a result of armed and violent civil conflicts, direct and indirect incidents have targeted medical education's components including medical schools and faculties, teaching hospitals, libraries, professors and medical students across several countries located in Africa, Asia, Europe and South America.

These attacks were outlined in a pilot report of the International Federation of Medical Students’ Associations (IFMSA) entitled Attacks on Medical Education, published last month. 

"Attacks on medical education harbour great danger to the sustainability of health systems and healthcare delivery and on occasion have significantly affected it by destruction of infrastructure and by decline of human resources, future and present," says the IFMSA report, which covers attacks on medical education in seven countries, including Libya, Palestine, Ukraine, Sudan, Syria, Venezuela and Yemen in the period from December 2017 to March 2018.

Besides exploring the impact of armed conflict and prolonged civil disturbances on medical education, the IFMSA report also aimed at empowering medical students to take a lead in research and advocacy related to attacks on healthcare. 

Attacks overview

The range of incidents reported includes direct attacks on teaching locations such as Al-Furat University and Damascus University in Syria; attacks against medical faculties in Venezuela; indirect attacks inhibiting students’ access to medical education, such as the obstruction to obtaining permits noted in Palestine, effectively excluding Palestinian students; or the shutting down of operations across multiple faculties in Libya, for up to eleven months in 2011 and six months in 2014. 

In most cases, nationwide political conflicts have been responsible for collateral damage inflicted upon medical educational institutions. In most cases the attacks have taken the form of barriers to access rather than targeted strikes.

But medical educational institutions have also been the primary target, with an aim to deter the learning process and the operation of health systems and the number of targeted attacks may be underrated because of a lack of monitoring and reporting.

For example, attacks have been reported against medical teams, medical students, healthcare facilities and individual health practitioners on multiple occasions in Venezuela. 

Twenty-two out of the approximately 128 medical schools from seven countries followed had to pause their operations for short or long periods of time. 

Some 55% of medical schools located in Libya, Palestine, Syria, Venezuela and Yemen were forced to shut down and about 86% of them resumed once conflicts were resolved or confined. 

"This proves that a drive for education is stronger than violence and war, but on the other hand, it also shows that despite strong efforts, some schools still remain closed," the IFMSA report says.

The number of direct assaults towards medical education facilities can be undervalued because of the lack of monitoring frameworks and the absence of disaggregated data which makes such attacks go unnoticed, according to the IFMSA report.

Impact of attacks

"Whenever a patient, a nurse, a doctor, a medical student, or any other component of a healthcare system is attacked, be it threats or actual violence, it has not only direct consequences for the affected and their health but also on the health of the served populations, causing ripples across the delivery of healthcare," the IFMSA report indicated. 

In many cases, a violent conflict or prolonged civil disturbance led to disturbances in electricity supply and internet connection which turned research into a problematic, and sometimes even impossible task, the IFMSA report pointed out.

A large number of students from medical schools that were forced to close were given the opportunity to resume their studies in other faculties, resulting in disproportionate numbers of enrolled students that faculties were not originally prepared for. 

"Such increase of student numbers posed a significant challenge not only for the infrastructure and material equipment of these ‘compensating’ universities, but also for the capacity of human resources for medical education, including teachers and administrative personnel," the report says. 

"Above all, a large portion of medical students either chose or was forced to indefinitely pause their education." 

Thus, the effect of conflict on medical students and academic staff “remains in question and must be studied to explore its subsequent factoring effect in health services", the report concludes.

The way forward

"The attacks on medical education have a shocking effect on healthcare services as they affect the development of physician workforces, which are already under troubling and serious shortages," Morad Ahmed Morad, a professor of medicine at Tanta University, Egypt, told University World News.

For example, Arab African states currently suffer a shortage of medical doctors: on average there are only 0.8 doctors per 1,000 people, according to Global Health Observatory data. 

Direct violence, an insecure environment and damaged medical infrastructure resulting from attacks have also led to increases in the migration rate of doctors and health practitioners, Morad added. 

One of the negative economic implications of medical brain drain was highlighted in the 27 April Mo Ibrahim Foundation reportentitled Ibrahim Forum Report 2018: Public service in Africa, which revealed that Africa loses about US$2 billion a year due to doctors’ migration. 

Morad called for the establishment of a virtual observatory for safe medical campuses (VOSMC) as a tool for contributing to the development of a safe and secure learning and working environment at medical schools and teaching hospitals as well as for medical university staff and students. 

VOSMC could serve as a monitor for attacks against medical institutions as well as a central resource on universities' safety assessment and risk analysis mechanisms, protection measures at universities, best practices for medical campus safety, and systems designed to keep students and staff informed during emergencies, Morad suggested.

"VOSMC could provide expertise in the development, implementation and acquisition of standard safety and security-related medical university practices, procedures and resources," Morad said.