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The Difficulty of Studying Medicine in Times of War

Years of war and attacks on healthcare have led to a severe lack of doctors in Syria. Amid ongoing fighting and tightening sieges, Syrian medical school students struggle to pass their classes and get practical training, reports Al-Fanar Media.

Written by Al-Fanar Media Reporting Team Published on Read time Approx. 6 minutes
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A damaged wheelchair is seen amid the debris of a rehabilitation center after an Assad regime airstrike over the de-confliction zone in the Eastern Ghouta region of Damascus, Syria, on September 28, 2017. Amar Sab/Anadolu Agency/Getty Images

It was September 2011 when Hasan Raad was admitted to the medical school at al-Baath University in Homs, Syria.

The city was at the center of the uprising that led to Syria’s continuing civil war, and conditions there were already starting to deteriorate, as violence flared between government troops and armed opponents. The university, next to the Baba Amr neighborhood, one of the most affected parts of the city, kept classes going, but had to make accommodations for the many students who found it difficult to attend.

Six years later, Homs is calm, though much of it has been destroyed. Raad didn’t leave the city during the years of fighting, and last month he took the national final exam to graduate from medical school.

“The first year at college was very difficult,” he said. “We weren’t attending classes and we couldn’t do the first-semester exams.”

The war has caused a massive shortage of medical equipment, doctors, medicine and electricity throughout Syria. Physicians for Human Rights, a New York-based nongovernmental organization, estimates that nearly 800 medical personnel have been killed. Over half of Syria’s 30,000 doctors are thought to have left the country since the conflict began. Many medical school students have dropped out.

Hamoud Hamid, dean of the medical school at the University of Damascus, told a local newspaper in May of this year that 100 out of 400 students had left the school. Some 450 students graduated from the university in 2015, according to the official Syrian news agency.

When Raad and his classmates began their studies, the fighting in Homs was intensifying. In November 2011, the government of President Bashar al-Assad began a bombing campaign on rebel-held areas. In early 2012, government troops conducted a month-long siege that quashed a rebel stronghold in the Baba Amr neighborhood.

By the summer of 2012, although parts of Homs were still either under siege or scarred by battle, the situation was improving, and the medical school was able to hold its second-semester exams, despite the disruptions in classes.

“There was a lot of flexibility,” said Raad. “Very few students were attending classes, and professors allowed us to do exams without completing the practical modules.” Students strove to master the required material, he said, but “we were completely on our own.”

In the second year for Raad’s entering class, students who lived in the city could attend classes, but the roads were not secure enough to travel for those living in nearby villages and towns.

To help those who couldn’t attend the exams, Syrian universities temporarily allowed students to pass the school year with a higher number of failed classes.

Students at Syrian universities normally take 12 classes in an academic year. Before the war, the maximum number of classes a student could fail and still pass to the next academic year was four, but in October 2011, a law was passed that allowed students to complete the year with six, and later eight, failed classes. Although the students were allowed to progress, they needed to circle back and complete some of the classes they had failed. An additional summer term was added to help students pass failed classes.

“Students were given opportunities to do more exams,” said Michel Nicola, the administrative vice president at al-Baath University. “Students who were living in besieged areas and couldn’t apply for universities were allowed to register one or two years after their baccalaureate,” Nicola said, referring to the national high-school exit exam.

In another accommodation, students from al-Baath, Aleppo and al-Furat universities were allowed to attend classes at safer campuses during times when their universities were being shelled. Thousands of students from those universities temporarily moved to the capital, Damascus, or to Latakia, on the coast, where classes never stopped, due to the more secure situation in those cities.

“Those exceptions are gradually being removed as the security situation improves in Syria,” said Nicola.

Since last year, the maximum number of classes students could fail was decreased to six and later to five.

Even in Aleppo, where rebel-held sectors suffered devastating bombardments during a four-year siege and the United Nations warned of “a complete meltdown of humanity” as government troops and their allies took back the city last December, university students are now back in their campuses.

In Homs, after the National Hospital became a battlefield in 2012 and later was destroyed, medical students were left without a teaching hospital where they could do their practical training. To keep the development of future doctors moving, the university made agreements with private hospitals in the city to take students for the clinical portion of their education.

Under those conditions, said Raad, “There were two types of students: Some who would take the initiative and connect with doctors for training, and some who just went with the lack of the training the university was suffering from, and did nothing.”

Raad volunteered in the emergency room of a private hospital in the city during the worst years of war, before attending the practical classes that were reopened in his senior year.

Because of the exceptions granted at some universities during the war and variations in curricula, Syria recently introduced standardized final exams that students must pass before graduating in medicine and five other practical majors: architecture, dentistry, informatics engineering, nursing and pharmaceutical studies.

Many students complained about having to pass an additional requirement before graduating. One of the arguments against the test was that the different curricula at different universities didn’t allow students to be on the same knowledge level when they came to take the national exam.

But advocates say the exam has pushed students to learn on their own, despite the disruptions caused by the war.

Maysoun Dashash, head of the higher-education ministry’s Center for Measurement and Evaluation, said in a television interview last May that the standardized tests had “proved to be a safety valve for the student, the university, the teaching programs and the professors.

“The faculties through the crisis period were burdened with teaching responsibilities,” Dashash said. “We need to enforce a self-education culture among our students, and we’re doing so through the standardized exam.”

The national exam was very difficult for Raad, and he said that with his score it would be tough for him to get into the advanced programs he wants, in either cardiac or respiratory medicine.

“My score was worse than I expected. The questions were badly formulated,” Raad said. He wasn’t alone in his disappointment. Only one of nine friends who also took the exam scored an excellent grade, he said.

Local news media reported that the number of students who achieved an excellent score dropped by 89 percent this year, compared with the previous year. More than 500 students out of the 2,432 who took the exam at all of the Syrian medical schools failed it.

Confused by the questions, the students asked the measurement center, which administers the test, for the answer key to try to find out what they had done wrong. But the director of the center said that would be impossible.

With the general low performance on this year’s test, Raad is hoping that the university will lower the requirements for clinical specialties so students will have a better chance at studying in their chosen fields.

Like hundreds of medical students who have left Syria in the past few years to study in Europe, mainly in Germany, going abroad could be an option for Raad – if he could afford it. But in the near future, as a full-time medical resident in Syria, he will be making 30,000 Syrian pounds a month, or less than $70, the bare minimum needed to survive in Syria.

After four or five years of residency, Raad thinks the financial future for doctors in Syria will be better.

“The quantity and the quality of doctors have decreased, with many physicians leaving the country,” Raad said. “With such a shortage, a doctor could still live well in Syria if he makes a bright name.”

This article was originally published by al-Fanar Media and is reprinted here with permission.

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