Ethical Decision-Making in Situations of Extreme Violence: A Case Study of Syria

AUTHOR AFFILIATION: Courtland Robinson, Johns Hopkins Bloomberg School of Public Health, United States, court.robinson@jhu.eduA team from the Johns Hopkins Bloomberg School of Public Health, the Johns Hopkins Berman Institute of Bioethics, the International Rescue Committee (IRC) and the Syrian American Medical Society (SAMS), undertook a project to understand the ethical challenges that international and local organizations face in providing health care during the Syrian conflict. The project, funded by R2HC, sought to provide guidance to health providers working in situations of extreme violence and to increase organizational capacity to address their ethical challenges. The project had four components: 1) a systematic literature review of relevant ethics and humanitarian principles and strategies; 2) interviews with 34 organizational managers from humanitarian health organizations working in Syria; 3) in-depth interviews with 58 front-line workers providing health care services in Syria; and 4) workshops with humanitarian health organization managers and line staff in Gaziantep, Turkey and Amman, Jordan. Results from the project offer recommendations and guidelines on ethical decision-making for organizations providing or supporting health services in violent contexts. Recommendations are that humanitarian health organizations should: 1) commit to addressing key ethical issues that they are likely to face; 2) embrace ethical and humanitarian principles and disseminate them throughout the organization; 3) provide training and support in ethics to staff; 4) create structures within the organization to aid decision-making and adopt a framework for addressing ethical challenges, recording the process of decision, and sharing the results; and 5) Provide psychosocial and other forms of support to staff who must make ethically challenging decisions