“We will never give up”: A qualitative study of ethical challenges Syrian health workers face in situations of extreme violence

Active conflict settings present challenging operating environments for humanitarian health organizations and workers. An emerging feature of some conflicts is direct violence against health workers, facilities, and patients. Since the start of the war in 2011, Syria has endured extreme and deliberate violent attacks on health facilities and workers. This paper reports findings from a qualitative study that examined the lived experiences of Syrian humanitarian health workers facing extreme ethical challenges and coping with moral distress. In-depth interviews were carried out with 58 front-line health workers in northern and southern Syria. Participants described a number of ethical and operational challenges they experienced while providing services in extreme conditions, as well as strategies used to cope with them. The complex intersection of personal and organizational challenges is considered, and findings are linked to key ethical and humanitarian principles. Practical recommendations and action steps are provided to guide humanitarian health organizations. This article is protected by copyright. All rights reserved.