Attacks on Medical Education

Islamic University of Gaza. Photo: Mahmoud Al-hams - Agence France-Presse (AFP)

www.ifmsa.org 1 IFMSA Imprint The International Federation of Medical Students’ Executive Board Associations (IFMSA) is a non-profit, non-governmental Carlos Acosta (Brazil), Hana Lučev (Croatia), Frida organization representing associations of medical students Vizcaíno (Mexico), Batool Alwahdani (Jordan), Amela Hamidović (Serbia), Satria Nur Sya’ban worldwide. IFMSA was founded in 1951 and currently (Indonesia) maintains 137 National Member Organizations from 127

Contributors countries across six continents, representing a network of Marian Sedlak (Slovakia), Aikaterini Dima (Greece), more than 1.3 million medical students. Abdulaziz Tibar (Libya), Haytham Sughayer (Palestine), Natalia Babenko (Ukraine), Alaa IFMSA envisions a world in which medical students unite Abusufian E. Dafallah, Hafsa Abdurahim Moalm Hassan (Sudan), Dana Shubat (Syria), Francisco for global health and are equipped with the knowledge, Enrique Machado Toro (Venezuela), Abdullah skills and values to take on health leadership roles locally M. Bahaisami (Yemen), Faisal Abdulatef Ali (Yemen), Ahmed S. Maknoon (Yemen), Basheer M. and globally, so to shape a sustainable and healthy future. Almashgari (Yemen) IFMSA is recognized as a nongovernmental organization Layout Design within the United Nations’ system and the World Health Fahmi Kurniawan (Indonesia) Organization; and works in collaboration with the World

Cover Medical Association. Mahmoud Al-hams - Agence France-Presse (AFP)

Publisher International Federation of Medical Students’ Associations (IFMSA) This is an IFMSA Publication Notice © 2017 - Only portions of this publication All reasonable precautions have been International Secretariat: may be reproduced for non political and taken by the IFMSA to verify the information c/o Academic Medical Center non profit purposes, provided mentioning contained in this publication. However, the Meibergdreef 15, J0-208 the source. published material is being distributed without warranty of any kind, either 1105AZ Amsterdam, The Netherlands Disclaimer expressed or implied. The responsibility for This publication contains the collective Phone: +31 2 05668823 the interpretation and use of the material views of different contributors, the opinions Email: [email protected] herein lies with the reader. expressed in this publication are those of Homepage: www.ifmsa.org the authors and do not necessarily reflect Some of the photos and graphics used in the position of IFMSA. this publication are the property of their respective authors. We have taken every The mention of specific companies or consideration not to violate their rights. of certain manufacturers’ products does not imply that they are endorsed or recommended by the IFMSA in preference to others of a similar nature that are not Contact Us mentioned. [email protected]

2 International Federation of Medical Students’ Associations (IFMSA) Introduction Page 4

Disclaimer Page 5

Contents Methodology and Time Frame Page 6

Country profiles 1. Libya Page 8 2.Palestine Page 11 3. Ukraine Page 14 4. Sudan Page 16 5. Syria Page 18 6. Venezuela Page 21 7. Yemen Page 25

Conclusion Page 29

References Page 31 www.ifmsa.org

www.ifmsa.org 3 Attacks on Medical_ Education

ART. 18. — Civilian hospitals organized to give care to the wounded and sick, the infirm and maternity cases, may in no circumstances be the object of attack, but shall at all times be respected and protected by the Parties to the conflict. - IV. Geneva Convention relative to the protection of civilian persons in time of war. 12 August 1949

An attack on any civilian is an attack against their attention on health workers, facilities, and humanitarian principles, against the very health systems as structures ensuring access to core values we collectively strive to preserve health care for populations. This makes perfect as medical professionals, as citizens of our sense since the vast majority of attacks on health countries, as human beings. Last decade care target these objects. Health workers are witnessed an increasing occurrence of armed the cornerstone of the provision of health care and violent conflicts, different in their nature - without human resources for health, there is and scope. However, conflicts of today are very no health care at all. Yet, health workforce must different from violent clashes of the past. The be built, raised, and educated. Without the proportion of civilian victims has increased from education for health care, we skip the first and 5 percent at the start of the century to more than the foremost condition for strong and resilient 90 percent in the conflicts of the 1990s. This shift health systems. After all, medical education is has been caused by numerous factors, including an integral component of every health system. an approach to war conflicts, technological The process of raising future health professionals advance, change in fighting strategies, a spread is a pivotal condition of the sustainable health of non-state armed groups, and retraction from workforce. Hence, any interference with medical international norms and agreements covering education naturally impacts the ability of a the way how wars are fought. health system to effectively deliver health care to its communities. The impact of wars and violence on health care is far-reaching. Whenever a patient, a The aim of this report is to explore an impact of nurse, a doctor, a medical student, or any other violence on medical education, with its specific component of a health care system is attacked, components, such as education facilities, be it threats or actual violence, it has not only teaching hospitals, libraries, professors, direct consequences for the affected and their medical students and all other directly related health but also on the health of the served components. This document also had an populations, causing ripples across the delivery additional goal - through work on this report we of healthcare. Basic human rights are broken, desired to empower medical students to take a the faith in justice fades away. lead in research and advocacy related to attacks on health care. These passionate individuals Rhetorics concerning the issue of attacks on and their organisations took the first step to health care services usually focus the majority of become champions in the protection of health 4 International Federation of Medical Students’ Associations (IFMSA) services in their communities. The collection of information and data connected to this project Disclaimer often meant for students to leave their duties _ behind, to sacrifice their time and energy for the project, to spend hours by researching often very inaccessible or unclear reports. They were driven The International Federation of Medical Students’ Associations (IFMSA) envisions a world in which by their passion and underlying commitment to medical students unite for global health and are shed a light on the invisible suffering of medical equipped with the knowledge, skills, and values education in conflict zones. to take on health leadership roles locally and globally. Founded in 1951, it is one of the world’s The Attacks on medical education is a pilot project oldest and largest student-run organizations. It of IFMSA and its national member organisations represents, connects and engages every day with in this area. We invite you to read this report, to an inspiring and engaging network of 1.3 million reflect on its findings, and to engage with IFMSA medical students from 137 national member and its member organisations to work together organizations in 127 countries around the globe. to explore and research attacks on health care To empower medical students and their national & together with the future of health workforce. local organisations, the country parts of this report An impact of violence of any kind on health were researched and written independently by structures will have far-reaching consequences our national member organisations, which are properly credited and mentioned in respective for health systems, and as doctors of the future, country parts. The IFMSA has been created we will face and meet these challenges. Hence, by its members, and it relies on its members to our dedication and motivation to work with all work and report on events in line with values of the stakeholders to end the attacks on health medical professionals - truthfulness, objectiveness, care, in all their forms. Only through multilateral and authenticity. As IFMSA, we understand that and interprofessional collaborations, we especially in war conflicts as well as in a violent environment, it is innately challenging for all parties transform rhetorics into reality, we transform involved to separate and dissociate personal recommendations to policies, we transform this experience, especially when their families have era into a safer and peaceful future for us all. been directly affected by horrible crimes. However, this report required our student members to do so. Marian Sedlak Hence, the country reports are to be recognized IFMSA Liaison Officer for Human Rights and as the work of the particular national member organisation and not of the IFMSA. Peace Issues As enshrined in IFMSA Constitution, the Federation pursues its aims without political, religious, social, racial, national, sexual or any other discrimination; the Federation promotes humanitarian ideals among medical students and so seeks to contribute to the creation of responsible future physicians; and the Federation respects the autonomy of its members. This report aims to present findings of our member organisations in line with IFMSA Constitution, and no other incentives should be perceived in this paper.

www.ifmsa.org 5 Methodology_ and Time Frame

When selecting countries suitable for this The data was collected by IFMSA member report, we have mapped and contacted IFMSA organisations from December 2017 to March member organisations in countries covered by 2018. The country profiles covered by this report 2016 Safeguarding Health in Conflict Coalition have diverse time frames, reflecting different report, and we added few countries with an lengths of conflicts and specific situations in ongoing violent conflict with a possibility of particular countries. For every country, the time attacks on medical education. IFMSA does not period covered in the section is specified by the have member organisations in several of the date of the number of schools before the conflict, countries covered by the 2016 report, therefore and the date when the up-to-date number of we were not able to include these chapters in medical schools was recorded. our paper. Countries were provided with the standard information note and data collection guideline, which served as a template to unify the frame of this research. Due to significant differences in work of our member organisations, situations in countries, nature of conflicts, and access to data and information, we have explained specific methodologies of research in every country chapter. Apart from Venezuela, all the countries included in ‘’Attacks on medical education’’ report have been also covered in 2017 Safeguarding Health in Conflict annual report. IFMSA report expands the understanding of attack on healthcare by adding a unique aspect of medical education, opening a brand new area of possible consequences of attacks on healthcare services on health systems and their sustainability.

6 International Federation of Medical Students’ Associations (IFMSA) COUNTRY REPORTS_

www.ifmsa.org 7 1. Libya

This 1.section Libya was written by members of the Libyan Medical

Students & Young Doctors This section was written by Associationmembers (LMSA-Libya), of the Libyanwith full creditsMedical at Students the end &of Young this section.Doctors Association (LMSA- Libya), with full credits at the The insurgency in Libya started in end of this section. 2011 as a part of the Arab Spring protests.The insurgencyThis turmoil in Libya directly started led toin the2011 period as a partwhich of isthe often Arab describedSpring as protests.the ‘’First LibyanThis turmoil Civil War’’,directly including led to an the international period which militaryis oftenintervention. described This as theconflict ''First ultimatelyLibyan led C ivilto War'',the eviction including and an international military death of Muammar Gaddafi, the intervention. This conflict formerultimately Libyan leader.led to Thethe war eviction left Libyaand in a verydeath complicated of Muammar and deficientGaddafi, situation, the formera breeding Libyan groundleader. for Thevarious war leftarmed Libya and in a rebel verygroups. complicated Soon andafter, deficient the situation, a breeding ground for instability and violence spread ▉ - Fully operating: Zawia, Benghazi, Tripoli and Misrata Universities various armed and rebel across the country, leading up ⬤ - Partially operating: Sirte University groups. Soon after, the to further deterioration which ▲- Non-operating school: None instability and violence spread resulted into the second escalation across the country, leading up of armedto further conflict deterioration in 2014. which Theseresulted violent conflictsinto the affectedsecond interruption in medical education postponed a graduation the wholeescalation country, of armed including conflict the in 2014. of thousands of future medical doctors, which resulted into a

higher health education system. In significant delay of supply of fresh doctor graduates for Libyan These violent conflicts affected thepublic whole health country, system. including the higher health education system. In additionaddition to already to already documented documented attacks on health care services, the medical education system in the attackscountry on health suffered care fromservices, outbreaks the ofAlmost hostilities the sameas well. situation Several repeated medical inschools, 2014, whenincluding the universitiesrenewed in medicalMisrata education and Benghazi, system inwere the shut escalationdown in the of period violence of February forced medical- December universities 2011. The in closureTripoli, was countrymostly suffered induced from by outbreaks nearby fights of andZawia army andoperations. Misrata This to ceaseinterruption their operationsin medical education for the period postponed of a hostilitiesgrad uationas well. of Several thousands medical of future Julymedical to November doctors, which 2014. resulted into a significant delay of supply of schools,fresh including doctor graduates universities for Libyan in public health system. Misrata and Benghazi, were shut Country profile: downAlmost in the the period same of situation February repeated in 2014, when the renewed escalation of violence forced medical universities in Tripoli, Zawia and MisrataMethodology: to cease Data,their operationsinternal information for the period and of Julyinterviews to November of - December2014. 2011. The closure Libyan Medical Students & Young Doctors Association (LMSA- was mostly induced by nearby Libya) and its members. fightsCountry and army profile: operations. This 8 InternationalMethodology: Federation Data, of Medical internal Students’ information Associations and (IFMSA)interviews of Libyan Medical Students & Young Doctors Association (LMSA-Libya) and its members.

Number of medical schools before the conflict Province of Zawiya: started (January 2011): 5 medical schools The situation in the province of Zawiya was mostly - Zawia, Benghazi, Tripoli, Sirte and Misrata similar to Tripoli university (distance between Universities University of Tripoli and University of Zawiya Number of operating medical schools now is approximately 50km). The interference of (February 2018): 5 medical schools - Zawia, violence with medical education mostly copied Benghazi, Tripoli, and Misrata Universities the pattern described in the province of great working fully, Sirte University partially operating. Tripoli. Number of enrolled students before the conflict Province of Misrata: and in present time: No official data available. As for all other medical faculties, February According to approximate estimations of LMSA- of 2011 was a critical date for the University Libya, there can be around 18850 medical of Misrata as well. Protests in Misrata were students enrolled in all medical schools in Libya. exceptionally violent, and many of them were The comparison of students numbers before and suppressed by brutal force. The city was under after conflict did not drastically change, but this the siege of Gaddafi’s forces for six months, number had oscillated in between of violent which had a substantial impact on the continuity periods (students taking breaks or unable to of medical education. The University paused its access their education for various reasons). operation from February 2011 till December Case studies: 2011. In reaction to urgent need of health workers and medical support, many medical students Province of great Tripoli: volunteered in field hospitals and improvised When the Libyan revolution started in February healthcare facilities. 2011, the university paused its operations due to Province of Sirte: the unstable situation in the country and general insecurity about its future. It shortly resumed its Situation of Sirte was slightly different from other activities (March 2011), however, the majority provinces. Since Sirte was the stronghold of of residing students did not return for their Gaddafi’s regime, February 2011 events did not education, mostly due to their will to express influence education as much as in other cities. solidarity with friends and family members who With a small one-week pause in February 2011, were arrested, injured or killed during protests the university operated fully till August 2011. In and violence. Another interruption of education September, the armed conflict entered Sirte and started off in August 2011, this time because of the university operations were ceased till the end the ongoing military operation to liberate the city of 2011, restored in early 2012. of Tripoli, and resumed in December 2011. Due In the spring of 2015, the so-called Islamic State of to these disturbances in continuity of medical Iraq and the Levant (ISIL) took control of Sirte and education, the administration of the University forced universities to shut down their operations. obliged students to re-do the whole academic In reaction, a majority of health students who year. were able to leave the city did so, and they joined other universities to complete their education and degrees. This led to an unproportional increase

www.ifmsa.org 9

Province of Benghazi: Similar to other cities, education was paused from February till November 2011. A relatively calm period was interrupted in June 2014, with onset of conflict between local militias and Marshal Hafter forces. This period of violence affected the whole city, including the university, till August 2015. During this period, the majority of students joined other universities to supplement their theoretical and practical lectures.

Conclusion: To summarise, attacks on medical education in Libya were mostly represented by numerous, repeated and prolonged barriers to access medical education. In addition to accessibility and continuity issues, war conflicts left indelible scars on infrastructure and facilities, crucial for raising a future of Libya's health workforce. An unstable environment, combined with direct physical and emotional consequences of of students in other universities around Libya. In Contributors:violence and conflicts, have left deep impressions in medical students' minds. Mechanisms which aimed to cope with closures of certain schools posed an unproportional increase of demands on the rest of 2016, the library of Sirte’s university was burned Abdulazizmedical education Tibar facilities, - National which naturally Officer influenced on several Human of their capacities connected to a standard down and significant portion of its furniture was mode of their operations. Setbacks in medical education will definitely have an impact on the public health Rightssector andin Libya, Peace however, at LMSAthese potential Libya consequences must be explored and researched further, to destroyed as well. In December 2016, the city prevent any harm towards the population of this country. was liberated by Libyan army and the medical Marian Sedlak - IFMSA Liaison Officer for Contributors: university started to restitute its activities. HumanAbdulaziz Rights Tibar - Nationaland Peace Officer on Issues Human 2017/2018Rights and Peace at LMSA Libya Marian Sedlak - IFMSA Liaison Officer for Human Rights and Peace Issues 2017/2018 Province of Benghazi: Contact details: Contact details:

Similar to other cities, education was paused LibyanLibyan Medical Medical Students &Students Young Doctors & Association (LMSA-Libya) from February till November 2011. A relatively ContactYoung person: Doctors Abdulaziz TibarAssociation - National Officer on Human Rights and Peace at LMSA Libya; [email protected] calm period was interrupted in June 2014, with (LMSA-Libya) onset of conflict between local militias and Contact person: Abdulaziz Marshal Hafter forces. This period of violence Tibar - National Officer on affected the whole city, including the university, Human Rights and Peace till August 2015. During this period, the majority at LMSA Libya; norp.lmsa@ of students joined other universities to supplement gmail.com their theoretical and practical lectures. Conclusion:

Attacks on medical education in Libya were

mostly represented by numerous, repeated and prolonged barriers to access medical education. In addition to accessibility and continuity issues, 2. Palestine war conflicts left indelible scars on infrastructure and facilities, crucial for raising a future of Libya’s health workforce. An unstable environment, combined with direct physical and emotional consequences of violence and conflicts, have left deep impressions in medical students’ minds. Mechanisms which aimed to cope with closures of certain schools posed an unproportional increase of demands on the rest of medical education facilities, which naturally influenced several of their capacities connected to a standard mode of their operations. Setbacks in medical education will definitely have an impact on the public health sector in Libya, however, these potential consequences must be explored and researched further, to prevent any harm towards the population of this country.

10 International Federation of Medical Students’ Associations (IFMSA) 2. Palestine

Comment [2]: Islamic University of This section was written by Gaza after bombardments. Photo: Mahmoud Al-hams - Agence France- members of the International Presse (AFP) Federation of Medical Students’ Associations - Palestine (IFMSA- Palestine), with full credits at the end of this section. Palestine has a relatively short history of education in the medical field. The first medical school was opened in 1994, and since then, three additional schools have started their operations. In reflection to current geopolitical situation and the character of demographics, the needs of the health system present a very The IslamicIslamic University University in Gaza started of Gaza its operations after bombardments. in 2006. On 29 December Photo: Mahmoud 2008, the university Al- was complex and unique task bombedfor in hamssix air strikes- Agence as part France-Presse of the „„Operation (AFP) Cast Lead‟‟ offensive in December 2008 and January medical education in Palestine. 2009.The The attack destroyed the university‟s laboratories as well as damaging the central library and computer facilities (1). Some sources state that approximately 74 laboratories were destroyed in this very nature of healthcare servicesattacks (3). in Palestine is quite fragmented Country profile: The United Nations Fact-Finding Mission on the Gaza Conflict examined this attack, and it stated in its between governmental, privatereport that ''itNumber also saw theof medicaldestruction causedschools at the before Islamic theUniversity conflict and in started other university (2012): buildings and those run by NGOs (e.g.that were destroyed or damaged. These were civilian, educational buildings and the Mission did not find any informationAl-Quds about their University use as a military in Abu facility Dis, or their East contribution Jerusalem, to a military West effort Bank; that might Al- have Doctors Without Borders;made themNajah a legitimate University target in the in eyesNablus, of the WestIsraeli armedBank; forces'' Al-Azhar (4). The University University has in been Palestine Red Crescent Society),bombed again in 2014, causing further destruction of already fragile facilities (5). Gaza city, Gaza Strip; Islamic University in Gaza city, Gaza international bodies (e.g. Accessthe to medicalStrip education: UN and its agencies), andPalestinian medical students constantly face difficulties to access their clinical training. The most critical issue is related to the process of obtaining permits to train at Jerusalem hospitals (for students of Al-Quds 1 Number of operating medical schools now (2018): Same as religious institutions . OftenUniversity), which have numerous departments and specialities not available anywhere in the rest of the unpredictable, the political andregion. Theabove permits are of two types - standard and restricted permit. Standard permit allows students to access hospitals in Jerusalem at all times, and is automatically renewed every 6 months. Restricted safety situation in the country alsopermit, in contrast,Number allows of students enrolled to access students hospitals before in Jerusalem the conflict only during and specific in presenthours during a presents a significant challengeday, and also needs to be renewed more often than a standard permit. Of course, a student can be fully denied anytime: type of Approximately a permit as well. The 4000, procedures numbers for students do not to oscillateobtain these due permits to theare very for sustainable and strategiccomplicated prolonged, and bureaucratic but in theirmostly core stablenature. In stage addition, of there insecurity are reports in of the deliberate country. delays in approach towards medicalprocesses, often forcing students to wait for their decisions about permits for hours, even days (6). education. The contribution Case studies: below aims to summarise the Attacks on medical education: most important issues connected to safety of medical education Violence against higher education institutes, including medical in the country, access to medical faculties, is present in the whole history of the region’s conflict, education, and daily situations naturally rising during times of sudden escalation of violence. medical students have to cope UNESCO examined an impact of conflict during its escalation with. between 7th of July and 26th of August 2014. In its findings,

www.ifmsa.org 11 it states that ‘’there was a failure to protect permit. Standard permit allows students to education from attack during the 50-day crisis’’. access hospitals in Jerusalem at all times, and is Higher education institutes, including medical automatically renewed every 6 months. Restricted schools, ‘’were directly targeted during the permit, in contrast, allows students to access hostilities, sustaining significant injury and loss hospitals in Jerusalem only during specific hours of life among staff and student populations, as during a day, and also needs to be renewed well as damage to vital infrastructure, including more often than a standard permit. Of course, a buildings and equipment. Such attacks have student can be fully denied any type of a permit as had a devastating impact on access to higher well. The procedures for students to obtain these education and have implications for long-term permits are very complicated and bureaucratic development’’2. in their core nature. In addition, there are reports of deliberate delays in processes, often forcing The Islamic University in Gaza started its students to wait for their decisions about permits operations in 2006. On 29 December 2008, for hours, even days. the university was bombed in six air strikes as part of the ‘‘Operation Cast Lead’’ offensive in Students who were not able to obtain permits December 2008 and January 2009. The attack or access these rotations felt that they were at destroyed the university’s laboratories as well a learning disadvantage6. Variety in training as damaging the central library and computer opportunities and learning styles is also facilities. Some sources state that approximately important to equip medical students with abilities 74 laboratories were destroyed in this attacks3. to adapt to different local and practical contexts of hospital and healthcare management. The United Nations Fact-Finding Mission on the Gaza Conflict examined this attack, and it stated Issues with access to medical education are in its report that ‘’it also saw the destruction caused also related to checkpoints procedures. These at the Islamic University and in other university problems also include arbitrary permit rejections, buildings that were destroyed or damaged. long wait times, delays and mistreatment of These were civilian, educational buildings and medical students at checkpoints. The time the Mission did not find any information about needed to pass the checkpoint is very often their use as a military facility or their contribution unpredictable. The majority of medical students to a military effort that might have made them a from Al-Quds University felt that their education legitimate target in the eyes of the Israeli armed and quality of life had been strongly negatively forces’’4. The University has been bombed again affected by their experience trying to access in 2014, causing further destruction of already these hospital training sites (6). fragile facilities5. Access to medical education: Conclusion: Palestinian medical students constantly face difficulties to access their clinical training. The The situation of attacks on medical education most critical issue is related to the process of in Palestine reflects the image of its prolonged obtaining permits to train at Jerusalem hospitals conflict and insecurity. The medical faculty of the (for students of Al-Quds University), which have Islamic University in Gaza was bombed several numerous departments and specialities not times in the span of 6 years, with every attack available anywhere in the rest of the region. The further damaging already fragile university permits are of two types - standard and restricted buildings. This prolonged and repeated 12 International Federation of Medical Students’ Associations (IFMSA) destruction made medical education for students in Gaza irrealizable. Access to medical education was not compromised only in terms of physical destruction of facilities. Palestinian students face struggles obtaining permits to access training hospitals. Failure to obtain these permits (or the most suitable type of permit) leaves students with diminished options for their medical training, which is crucial especially for specialties which are not available in any other location in Palestine. Even when they obtain permits, students can expect another set of obstacles related to checkpoints procedures, including arbitrary permit rejections, long wait times, delays and mistreatment of medical students at checkpoints. Although the history of medical education in Palestine is quite short, it had and still has to overcome several challenges related to intermittent armed conflict and its consequences. Unquestionably, attacks on medical education add new scars on the face of Palestine’s medical education. Contributors: Haytham Sughayer - President of IFMSA- Palestine

Contact details: Contact details: The International Federation of Medical Students' Associations - Palestine (IFMSA-Palestine) Contact person: Haytham Sughayer, President of IFMSA-Palestine, ifmsa- [email protected] // [email protected]

The International Federation of Medical Students’ Associations - Palestine (IFMSA- Palestine)

Contact person: Haytham Sughayer, President of IFMSA-Palestine, [email protected] // [email protected]

3. Ukraine

This section was written by members of www.ifmsa.org 13 the Ukrainian Medical Students Association (UMSA), with full credits at the end of this section.

The hostilities in the east of Ukraine started in April 2014 when an armed conflict between the self-declared Donetsk and Luhansk People's Republics and Ukraine started. Events were preceded by Euromaidan protests, the fall of Ukrainian president and the annexation of Crimea by the Russian Federation. The Ukrainian military reported intensive movement of troops and equipment from Russia into the separatist-controlled parts of eastern Ukraine. However, the Russian leadership ▉ - Old locations of Donetsk and Luhansk Medical universities has consistently rejected both accusations ⬤ - New locations of Donetsk and Luhansk Medical universities of participation in hostilities and the supply ▲- Simferopol Medical Academy of weapons to the insurgents.

Contact details: The International Federation of Medical Students' Associations - Palestine (IFMSA-Palestine) Contact person: Haytham Sughayer, President of IFMSA-Palestine, ifmsa- [email protected] // [email protected]

3. Ukraine 3. Ukraine This section was written by This section was written by members of members of the Ukrainian the Ukrainian Medical Students AssociationMedical (UMSA), Students with fullAssociation credits at the end (UMSA),of this section. with full credits at the end of this section. The hostilities in the east of Ukraine started The hostilities in the east of in April 2014 when an armed conflict betweenUkraine the self started-declared in DonetskApril 2014 and Luhanskwhen People's an armed Republics conflict and between Ukraine started. theEvents self-declared were Donetskpreceded andby EuromaidanLuhansk protests, People’s the fall ofRepublics Ukrainian presidentand and theUkraine annexation started. of Crimea Events by the Russianwere precededFederation. by The Euromaidan Ukrainian military protests,reported theintensive fall ofmovement Ukrainian of troops andpresident equipment and fromthe annexationRussia into ofthe separatistCrimea-controlled by the Russianparts Federation.of eastern Ukraine.The However, Ukrainian the Russianmilitary leadershipreported ▉ - Old locations of Donetsk and Luhansk Medical universities has consistently rejected both accusations intensive movement of troops ⬤ - New locations of Donetsk and Luhansk Medical universities of participation in hostilities and the supply ▲- Simferopol Medical Academy of weaponsand toequipment the insurgents. from Russia into the separatist-controlled parts of eastern Ukraine. However, the Russian leadership has consistently in significant academic difficulties for both students and rejected both accusations of teachers. participation in hostilities and Country profile: the supply of weapons to the insurgents. Methodology: Data, internal information and interviews of Ukrainian Medical Students Association (UMSA) members, The political situation affected all Student Scientific Societies members, official Universities institutions of the region, including websites and social media. higher education. Two medical Universities were closed for one Number of medical schools before the conflict started (April semester until they were moved 2013): 23 medical schools to other cities located out of the Number of operating medical schools now (March 2018): conflict area and were both 22 medical schools according to the official data reopened at the beginning of 2015. Another Medical University Number of enrolled students before the conflict and in in Simferopol, Crimea remained present time: No precise data available. The number of on an annexed territory. Although students enrolled in Luhansk and Donetsk Medical Universities no material damage to people decreased from about 8000 to 5000 during the conflict. About or facilities was reported, the 6000 students were enrolled in Simferopol Medical University interruption in education resulted in 2013, now this number stands at 3600.

14 International Federation of Medical Students’ Associations (IFMSA) Case studies: there. The Simferopol University was not moved 3. Ukraine to any other city. However, the government plans Donetsk: to re-open it in Kherson city. After military operations began in April 2014 Conclusion: the semester concluded on time but the next one was delayed. There was a gap in the education Summarizing, medical education and medical process for half a year. From December 2014 students in Ukraine found themselves in the on, the University temporarily moved to 4 cities middle of a political conflict, resulting in the (Kramatorsk, Slaviansk, Mariupol, Liman). The loss of a semester for two medical schools and number of students and teachers was extremely great decreases in the numbers of international low in the beginning. In 2016 there were 1000 and local schools in all 3 faculties that were students and 294 teachers. Now this number affected. This exerted a subsequent effect in the stands at about 3000 students. There is still a public health sector and the country’s economy. University on an occupied territory, however, Evidently, the future of medical schools is closely their diploma has no value in Ukraine. The related to political conditions, although the Donetsk University plans to move back as soon safety of students and teachers should never be effect in the public health sector and the country‟s economy. the mentioned military conflict had a great as the war ends. in impactdoubt. on the medical education of the country despite the taken measures. The decrease in the number of local and international students affects both the public health sector and economy of the country. Lugansk: Contributors:Evidently, tThe future medical schools is closely related to political conditions, although the safety of students and teachers should never be in doubt. The University was also closed for 1 semester NataliaContributors: Babenko - Local Officer on Human after the beginning of military operations in RightsNatalia andBabenko Peace, - Local OfficerOdessa on Human Rights and Peace, Odessa

May 2014. Before 2014, the number of students Contact details: was about 8000, in 2018 the number is less Ukrainian Medical Students Association (UMSA) Anastasiya Petrenko, President of UMSA, than 2000. Most of the students entered other [email protected] universities of Ukraine. From January 2015, Lugansk University started working in the city

of Rubizhne, which is located in an unoccupied Contact details: territory near Lugansk. Diplomas are fully accepted in Ukraine. There is still an University Ukrainian Medical Students Association (UMSA) on an occupied area controlled by the local Anastasiya Petrenko, President of UMSA, president@ government, but Ukraine does not accept the ukrmsa.com

diploma.

Simferopol:

After the occupation of Crimea, the University was renamed by Russian government into a Medical Academy. It now operates and the diploma is only recognized in Russia. About 400 international students left the University that 4. Sudan time, many of them entering other universities of Ukraine. Currently, about 3600 students study This section was written by members of the Medical Students International Network-Sudan (MedSIN-Sudan), with full credits at the end of this section.

Sudan has been experiencing www.ifmsa.org 15 political instability and armed conflicts in the regions of Darfur, South Kordofan and Blue Nile State for a few decades now. More than 1,000 effect in the public health sector and the country‟s economy. the mentioned military conflict had a great impact on the medical education of the country despite the taken measures. The decrease in the number of local and international students affects both the public health sector and economy of the country. Evidently, tThe future medical schools is closely related to political conditions, although the safety of students and teachers should never be in doubt.

Contributors: Natalia Babenko - Local Officer on Human Rights and Peace, Odessa

Contact details: Ukrainian Medical Students Association (UMSA) Anastasiya Petrenko, President of UMSA, [email protected]

4. Sudan

This section was written by 4.members Sudan of the Medical Students International Network-Sudan This(MedSIN-Sudan), section was withwritten full credits by membersat the end of theof this Medical section. Students International Network-Sudan (MedSINSudan-Sudan), has been with fullexperiencing credits at thepolitical end of thisinstability section. and armed orconflicts in education in the-related regions protests. of Darfur, Exact data on how these incidents involved medical students are not Sudanavailable.South Kordofanhas With been65 and medical Blueexperiencing Nile schools State located geographically in 17 states of Sudan, it is important to address politicalhowfor asuch instabilityfew attacksdecades and and now. armed barriers More conflicts tothan access and continue medical education are affecting medical students inand 1,000the communities regions university ofaround. studentsDarfur, Southwere Kor arrested,dofan and 15 Blue killed Nile and State more for than a fewCountry450 decades injured, profile: now. including More than medical 1,000 Numberand health of medical sciences schools students, before in thethe conflictperiod 2009-2012,started (from mostly date approximately 37 medical ⬤ - Schools with recorded incidents 2010):in demonstrations on campus schools or in education-related protests. Number of operating medical Number of enrolled students before the conflict and in present schoolsExact data now on (on how date these Feb incidents 2018): 65 medicaltime: (no schools official statistics available) Numberinvolved of enrolledmedical studentsstudents beforeare the conflict and in present time: (no official statistics available) Summary of incidents and their details: not available. With 65 medical Summaryschools located of incidents geographically and their indetails: Universities/Medical Schools with incidents and reports of Universities/Medical17 states of Sudan, Schools it is important with incidents attacks and reportsare from of attacksall states are aroundfrom all Sudanstates aroundand in Sudan particular, and in particularto address, Darfur, how suchNyala attacks & Al- Fasherand universities,Darfur, Nyala South & andAl-Fasher North universities,Kordofan universities, South and Khartoum North university,barriers toAl -Ahliaaccess university, and continue Kasala & KordofanAl-Gadareef universities, universities. Khartoum These attacksuniversity, took Al-Ahlia place inuniversity, university campuses,medical educationand no disaggregated are affecting evidence Kasala was &taken Al-Gadareef to quantify universities. the involvement These of attacks medical took students place in thesemedical events. students Therefore and communities, in our findings inwe university refer to a campuses,diverse group and of no students disaggregated from various evidence specialities, was with undisputed, yet not measurable participation of medical students. around. taken to quantify the involvement of medical students in these

events. Therefore, in our findings we refer to a diverse group FromCountry October profile: 2010 to May 2012, several clashes occurred between students supporting rival political movements that left at least 20 students ofinjured, students one from of them various critically, specialities, at Nyala with University. undisputed, Later yetin 2012,not studentNumber protests of medicalin University schools of Khartoum measurable over theparticipation killing of ofDarfuri medical students students. turned violent after involvementbefore the ofconflict armed started forces (from and the incident resulted in 140 students arrested, 180 injured and date 2010): approximately 37 From October 2010 to May 2012, several clashes occurred discontinuation of education for 4 months,between which directlystudents affected supporting its medical rival political faculty. movements A similar incidentthat left 2 yearsmedical later schools in 2014 also caused a temporary closing of the faculty for 3 months. 2015 also witnessed a at least 20 students injured, one of them critically, at Nyala tragic attack after a student was shot dead by armed forces amidst riots in University of Khartoum, one of Number of operating medical University. Later in 2012, student protests in University of the casualties amongst other dozens who were injured and arrested. The protests were organised by a schools now (on date Feb 2018): local Darfur students association, aimingKhartoum to shed a overlight onthe unequal killing ofaccess Darfuri to students'students rights,turned butviolent these protests65 medical soon schoolsturned violent after interventionsafter involvement of security forces. of armed The incidentsforces and resulted the incident in discontinuation resulted of education for 4 months7. in 140 students arrested, 180 injured and discontinuation of education for 4 months, which directly affected its medical Attacks also targeted professors, researchers and campus speakers perceived to be undertaking 16controversialInternational research Federation or of makingMedical Students’anti-government Associations remarks.(IFMSA) According to the African Centre for Justice and Peace Studies, on 24th November 2011, the National Intelligence and Security Services (NISS) raided the offices and arrested members of an AIDS education and prevention group located at Al Gezira University. The only reason was that the group had carried out a survey on the prevalence of HIV and AIDS. The members of the group were released on the same day, but all reports, findings and data related to their research were confiscated and the Director-General of the Ministry of Health suspended the research8.

Another report mentions five students of the University of Khartoum, who were arrested and detained by NISS without a reason on 13th of April 2016 at Khartoum Dental Hospital. They only accompanied an injured friend to the hospital. The students were released later in June 20169.

Conclusion: faculty. A similar incident 2 years later in 2014 education in Sudan. However, we can observe also caused a temporary closing of the faculty that attacks on medical education, its leadership, for 3 months. 2015 also witnessed a tragic facilities, and medical students themselves, have attack after a student was shot dead by armed immense implications. A temporary, but repeated forces amidst riots in University of Khartoum, discontinuation of education has delayed and one of the casualties amongst other dozens who affected academics and training in many medical were injured and arrested. The protests were schools in Sudan. In affected schools, students organised by a local Darfur students association, now graduate after 7 years or more, instead of aiming to shed a light on unequal access to a normal period of 6 years. In the past, similar students’ rights, but these protests soon turned delays have been reported in Liberia10 and violent after interventions of security forces. The Iraq11 with significant long-term consequences incidents resulted in discontinuation of education onConclusion: healthcare delivery. The effects on the 7 In summary, the lack of monitoring and reporting frameworks, data collection mechanisms, and research for 4 months . sustainabilityon this topic makes of it theproblematic country’s to uncover health the real workforcescale of attacks on medical education in Sudan. cannotHowever, be we predicted.can observe that The attacks psychological on medical education, setback its leadership, facilities, and medical Attacks also targeted professors, researchers and students themselves, have immense implications. A temporary, but repeated discontinuation of education experiencedhas delayed and affectedby medical academics students and training asin many a resultmedical schoolsof in Sudan. In affected schools, campus speakers perceived to be undertaking sStudents now graduate after 7 years or more, instead of a normal period of 6 years. In the past, similar Comment [3]: Is it all schools or only unstable learning environment and frequent those affected by conflicts? controversial research or making anti-government delays have been reported in Liberia (4) and Iraq (5) with significant long-term consequences on attackshealthcare has delivery. a detrimentalThe effects on theeffect sustainability on students’of the country's health workforce cannot be remarks. According to the African Centre for predicted. The psychological setback experienced by medical students as a result of unstable learning motivation and performance. Ultimately, Justice and Peace Studies, on 24th November environment and frequent attacks has a detrimental effect on students' motivation and performance. inhibitingUltimately, inhibitingthe accessthe access of medical medical students students to education toinduces a chain of events that affect 2011, the National Intelligence and Security much needed health services in conflict-affected populations. Unstable and volatile environment in the educationcountry, naturally induces influencing a chainthe area of currentevents and thatfuture affectmedical professionals, opens a space for Services (NISS) raided the offices and arrested muchinfluencing needed and recruitment health servicesof medical studentsin conflict-affected by various armed and ideological groups, directly members of an AIDS education and prevention opposing the moral and ethical values of doctors-to-be (6). populations. Unstable and volatile environment group located at Al Gezira University. The only in Resources:the country, naturally influencing the area of reason was that the group had carried out a 1. Sudan [Internet]. Protectingeducation.org. 2018 (accessed on 16 March 2018). Available from: current http://www.protectingeducation.org/countryand future medical professionals,-profile/sudan opens a survey on the prevalence of HIV and AIDS. The 2. ACJPS, Sudan Human Rights Monitor October-November 2011 (ACJPS, 2011) space for influencing and recruitment of medical members of the group were released on the same 3. Safeguarding Health in Conflict Coalition. Impunity must end: attacks on health in 23 countries in studentsconflict by variousin 2016 . armed(accessed and onideological February 10, 2017) Available at: day, but all reports, findings and data related to https://www.safeguardinghealth.org/sites/shcc/files/SHCC2017final.pdf groups,4. Challoner, directly K. opposingR., & Forget, theN. (2011). moral Effect and of ethicalcivil war on medical education in Liberia. their research were confiscated and the Director- values ofInternational doctors-to-be Journal12 . of Emergency Medicine, 4(1), 6. Available at: General of the Ministry of Health suspended the https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3051893/ 5. Barnett-Vanes, A., Hassounah, S., Shawki, M., Ismail, O. A., Fung, C., Kedia, T., ... & Majeed, A. 8 research . Contributors:(2016). Impact of conflict on medical education: a cross-sectional survey of students and institutions in Iraq. BMJ open, 6(2), e010460. Available at: Another report mentions five students of the Alaa Abusufianhttp://bmjopen.bmj.com/content/6/2/e010460 E. Dafallah - SCOME Regional Assistant for Africa6. Gadher, D.; Corke, J. (2017, February 5). British medics studying in Sudan flock to join Isis. University of Khartoum, who were arrested and Available at: https://www.thetimes.co.uk/edition/news/british-medics-studying-in-sudan-flock-to- detained by NISS without a reason on 13th of Hafsa Abdurahimjoin-isis-80vcjvkcj Moalm Hassan - National Officer on Human Rights and Peace April 2016 at Khartoum Dental Hospital. They AikateriniContributors: Dima - IFMSA Liaison Officer for Medical Alaa Abusufian E. Dafallah - SCOME Regional Assistant for Africa only accompanied an injured friend to the EducationHafsa Abdurahim Issues Moalm Hassan - National Officer on Human Rights and Peace hospital. The students were released later in June Aikaterini Dima - IFMSA Liaison Officer for Medical Education Issues

9 2016 . Contact details: Contact details:

MedicalMedical Students' Students’ International International Network- Sudan (MedSIN-Sudan) Conclusion: ContactNetwork-Sudan details: ElTahir (MedSIN-Sudan) Abdelrahman, President of MedSIN-Sudan, medsin- [email protected] In summary, the lack of monitoring and reporting Contact details: ElTahir frameworks, data collection mechanisms, and Abdelrahman, President of . research on this topic makes it problematic to MedSIN-Sudan, medsin-sudan@ uncover the real scale of attacks on medical ifmsa.org

www.ifmsa.org 17

5. Syria 5. Syria This section was written by Thismembers section of was the writtenSyrian by Medical members ofStudents’ the Syrian Association Medical Students' (SMSA- AssociationSyria), with (SMSA full credits-Syria), at withthe endfull creditsof this section.at the end of this section.

SyriaSyria wentwent through through profound profound changes sincechanges 2011 since - a 2011civil conflict - a civil that conflict turned intothat turnedarmed intoclashes armed and clashes caused and the worst humanitarian crisis of the 21st century,caused leavingthe worst more humanitarian than 450,000 martyrscrisis of behind, the 21st and century, causing leavinga colossal destructionmore than 450,000in the martyrscountry‟s infbehind,rastructure, and causingincluding a colossalschools, hospitals,destruction universities, in the and houses.country’s infrastructure, including schools, Countryhospitals, profile:universities, and houses. Methodology: Official governmental resources,Country profile:verified media pages, human resources (including medical ▉ - Fully operating: Aleppo, Tishreen, Al-Andalus, Hama, Al-Baath, studentsMethodology: and teachers) contactedOfficial in Kalamoon, Syrian Private and Damascus Universities universities.governmental resources, verified ⬤ - Partially operating: none media pages, human resources ▲- Non-operating school: Al-Furat Number(including of medicalmedical schools students before and the conflict started (2011): 9 teachers) contacted in universities. Number of operating medical schools nowgeographical (2018): 8 areas. Al-Baath, Aleppo and Al-Kalamoon came NumberNumber of enrolledof medical students schools before theback conflict to andfunction in present after onetime: semester Before: 18000, while After: Al-Furat 16200 was 75% before the conflict started destroyed and citizens have fled from the city; it has been Before the conflict, Syria had 9 operating medical schools. After the first year, Al-Furat university, Al- K(2011):alamoon 9 university, Al-Baath universitydysfunctioning and Aleppo university since then. paused their operations due to the circumstancesNumber of inoperating their geographical medical areas. Some Al-Baath, Private Aleppo universities and Al-Kalamoon which camehave backbeen to opened function afterin Syria schools now (2018): 8 after 2000, had to stop education at their original buildings (mostly situated in suburbs of Damascus or Daraa-highway) Number of enrolled students and rented schools or buildings in the city center of Damascus. before the conflict and in present Medical students attended their classes in alternative buildings time: Before: 18000, After: in the city center, while they were not able to reach the original 16200 buildings of the university in Kafr-Ali area. Before the conflict, Syria had 9 Although public universities still function, in case of missiles, operating medical schools. After mortals, bombings or any other attack, students automatically the first year, Al-Furat university, pause their education for one day at a time. In 2013, a major Al-Kalamoon university, Al-Baath explosion took place in Aleppo university which caused university and Aleppo university the death of 226 people including 83 students, at the first paused their operations due day of mid-term exams. The reaction was that all the Syrian to the circumstances in their 18 International Federation of Medical Students’ Associations (IFMSA) universities paused their education process for Science school, on March 28th 2013 - a three days due to what happened in Aleppo destructive missile was thrown randomly and university. Students from the destroyed university shrapnels reached the students’ cafeteria where of Al-Furat had a possibility to continue (transfer) students spend their breaks. The death toll their studies to either Damascus, Aleppo or reports vary from 12 to 17 people, with many Tishreen university. Therefore, ministry of higher injured. The perpetrator of this attack remained education increased the number of accepted unknown as no party claimed the responsibility students in medical schools from 700 per year for the attack 13,14. Most of the photos shared

(before conflict) to 1000 students per year. With Lecturingback then theatre were in notDamascus related university: to destruction of incoming students from Aleppo, Al-Furat and Al- Onfacilities, February but 6th to 2015,injuries several and sufferingmortars (number of students. not defined) were thrown at the biology building in Baath universities, numbers of students in faculty DamascusThe place university of cafeteria which causedwas fixeddestruction later inand lecturing it halls. No injuries of students were noted, as of medicine of Damascus university raised to theyfunctions were emptynormally at the in presenttime, but days. damage to furniture and walls has been severe. Classrooms were approximately 1300-1500 students per year. partially fixed later. Perpetrators remain unknown as no party adopte Lecturing theatre in Damascus university: Case studies: Major destruction in Al-Furat university: Al-Furat university colleges are based in Deir Ezzour and Raqqa. Those two cities have been shelters for civilians in 2011, eventually, they became targets in the next years of war conflict. Attacks were random, leading to profound destruction in some parts of university facilities, and less in other parts. The whole city of Deir Ezzour was destroyed, every building and bridge was damaged, burnt or torn down. The Lecturing hall at Damascus University after the February d the attack. responsibility lies on the shoulders of all fighting 6th 2015 attacks. Source: Yawmiat Kazifat Hawin team groups, but the major destruction was done by On February 6th 2015, several mortars (number foreign forces and ISIS. not defined) were thrown at the biology Students’ Cafeteria attack in Damascus building in Damascus university which caused university: destruction in lecturing halls. No injuries of students were noted, as they were empty at the time, but damage to furniture and walls has been severe. Classrooms were partially fixed later. Perpetrators remain unknown as no party adopte d the attack.

Faculty of Science, Damascus university, after the March 28th 2013 attack. Source: Yawmiat Kazifat Hawin team

Lecturing theatre in Damascus university: www.ifmsa.org 19 On February 6th 2015, several mortars (number not defined) were thrown at the biology building in Damascus university which caused destruction in lecturing halls. No injuries of students were noted, as they were empty at the time, but damage to furniture and walls has been severe. Classrooms were partially fixed later. Perpetrators remain unknown as no party adopte

d the attack. enrollments in the receiving faculties and creating a burden for the unprepared infrastructure. Direct attacks on lecturing theater and student gathering areas such as cafeterias and halls led to deaths, injuries, destruction of infrastructure and a large number of students not returning to their studies. Overall, the losses created by the war greatly impacted education as well, and the human cost of attacks on medical education in Syria is yet to be discovered. 3. Karouny, M. (2013, January 15). Explosions kill 83 at Syrian university as exams begin. Reuters.

Available at: https://www.reuters.com/article/us-syria-crisis/explosions-kill-83-at-syrian-university-as-

exams-begin-idUSBRE90E0V820130115 Lecturing hall at Damascus University after the Contributors: AleppoFebruary university, 6th students’ 2015 gatheringattacks. Source:hall: Yawmiat JanuaryKazifat 15th 2013,Hawin the team most brutal attack with a destructive missileContributors: on Aleppo University is noted. It was DanaDana Shubat Shubat - President - President of SMSA of SMSA an exam day, and all students were in one place waiting for their exams to start. This caused a huge loss; 83 victimsAleppo and university, hundreds of students’ injured students gathering and hall:bystanders. All Contact the universities details: in the country were Contact details: forced to pause their operation, and exams were postponed. This incident represents a breaking point in Syrian Medical Students' Association (SMSA-Syria) the SyrianJanuary crisis 15th for students2013, the as mostmany brutalstudents attack paused with their a education after this attack, and many fled Contact person: Dana Shubat, President of SMSA, after thedestructive loss of friends missile and on family Aleppo members. University It was ais verynoted. tragic day for Syrian people and it was followed [email protected] by minor attacks on other universities in the week after. Perpetrator remains unknown as no party It was an exam day, and all students were in claimed the attack (3). one place waiting for their exams to start. This

caused a huge loss; 83 victims and hundreds Conclusion: Formatted: Font: 12 pt, Bold, Font of injured students and bystanders. All the color: Blue The 2011 Syrian outbreak and the subsequent civil war left a significant mark on medical education. One medicaluniversities school has in still the not country resumed were operation forced and tothe pause remaining 8Syrian were forced Medical to temporarily Students’ cease Association their (SMSA- operations.their operation,Some private and faculties exams had were to postponed.resume operations This inSyria) different locations for safety reasons. Largeincident numbers represents of students a had breaking to transfer point universities, in the Syrian causing a significant increase in the number of enrollmentscrisis forin thestudents receiving as manyfaculties students and creating paused a burdentheir forContact the unprepared person: infrastructure. Dana Shubat, Direct President of attacks on lecturing theater and student gathering areas such SMSA,as cafeterias [email protected] and halls led to deaths, injuries,education destruction after of infrastructure this attack, and and a largemany number fled after of students not returning to their studies. Overall, the lossesthe losscreated of byfriends the war and greatly family impacted members. education It was as well. a very tragic day for Syrian people and it was

followed by minor attacks on other universities in

the week after. Perpetrator remains unknown as Resources: 15 1. Dehghanpisheh,no party claimed B.(2013, the March attack 28).. Mortar attack on University of Damascus kills at least 12. The Washington Post. Available at: https://www.washingtonpost.com/world/middle_east/mortar -attack-on- universityConclusion:-of-damascus-kills-at-least-12/2013/03/28/b713b018-97c3 -11e2-97cd- 3d8c1afe4f0f_story.html?utm_term=.7178c39d66d8The 2011 Syrian outbreak and the subsequent 2. Holmes, O. (2013, March 28). Mortar strike kills 15 in Damascus University: state media. Reuters. civil war left a significant mark on medical Available at: https://www.reuters.com/article/us-syria-crisis-students/mortar -strike-kills-15-in-damascus- universityeducation.-state-media One-idUSBRE92R0E020130328 medical school has still not resumed operation and the remaining 8 were forced to temporarily cease their operations. Some private faculties had to resume operations in different locations for safety reasons. Large numbers of students had to transfer universities, causing a significant increase in the number of

20 International Federation of Medical Students’ Associations (IFMSA)

6. Venezuela 6. Venezuela

This section was written by members of the Federación Venezolana de Sociedades Científicas de Estudiantes de Medicina (FEVESOCEM), with full credits at the end of this section.

▉ - Fully operating

⬤ - Partially operating

▲- Non-operating

Venezuela went through one of the worst health sciences, who provided first aid service civil conflicts of the last decades in 2017. This during these protests. The marches began a Venezuela went through one of the worst civil conflicts of the last decades in 2017. This situation started situationin April and started culminated in April around and culminatedAugust of that around year. Theseries conflict of rulingswas marred by the by Supreme barricades, Court tear of gas Justice Augustcanisters, of and that clashes year. betweenThe conflict demonstrations was marred and security(Tribunal state Supremoforces; these de wereJusticia) the scenesthat caused that a bymarked barricades, the day-to tear-day gasof Venezuela canisters, in thisand period. clashes status quo change in the decision making abilities between demonstrations and security state of the National Assembly. forces;The marches these beganwere onthe April scenes 4, 2017, that withmarked some the episodes more violent than others, and left 123 dead During these conflicts, all of the Venezuelan day-to-dayuntil July 30, of includingVenezuela two in students this period. of health sciences, who provided first aid service during these universities were stopped due to their problems The marches began on April 4, 2017, with some and the challenges that made it impossible to episodes more violent than others, and left 123 continue classes: principally access to them, dead until July 30, including two students of including all the schools of medicine in the

www.ifmsa.org 21 protests. The marches began a series of rulings by the Supreme Court of Justice (Tribunal Supremo de Justicia) that caused a status quo change in the decision making abilities of the National Assembly.

countryDuring these (15 conflicts, in total).all of the ManyVenezuelan attacks universities occurred were stopped dueNumber to their problems of enrolled and the students before the conflict challenges that made it impossible to continue classes: principally access to them, including all the againstschools of medicalmedicine in schools,the country (15during in total). classes, Many attacks against occurred againstand medicalin present schools, time: during No official data available. students,classes, against even students, against even againstthe principal the principal headquarter headquarter of the RedBased Cross country on officethe (1).internal data of FEVESOCEM 16 of the Red Cross country office . Venezuela - approximately 9500 before the conflict, approximately 6500 after the conflict

Case studies:

Threats / intimidation of medical personnel of

the Central Hospital of San Cristóbal during protests:

During the month of April and May several

threats were reported against the personnel of the Central Hospital of San Cristóbal, Táchira

state, because the National Guards forbade Picture: Doctors with arms crossedtreating during thethe march wounded of during social protests, doctorsintimidating on May 22nd, some 2017 in doctors who attended these Picture: Doctors with arms crossed during Caracas, Venezuela. Source: Jamez42 wounded youth, despite the multiple protests the(https://commons.wikimedia.org/wiki/File:Medic_Protesters_Venezuela_20 march of doctors on May 22nd, 2017 in 17.jpg#filelinks),that took place in the hospital, this intimidation Caracas,https://creativecommons.org/licenses/by Venezuela. -sa/4.0/legalcode did not stop.

Source: Jamez42 (https://commons. Tear gas pumps near the Del Valle maternal wikimedia.org/wiki/File:Medic_Protesters_ and child hospital on 04/20/2017:

Venezuela_2017.jpg#filelinks), https:// The use of tear gas bombs by the Bolivarian creativecommons.org/licenses/by-sa/4.0/ National Police and the Bolivarian National legalcode Guard in Longaray and the Intercomunal Country profile: Avenue of El Valle affected the patients of El

Valle Children’s Maternity Hospital. Gases ShortCountry methodology: profile: seeped into hospital facilities affecting workers, Short methodology: 17 1.1.- ContactingContacting medical studentsmedical for their students testimonies of forthe attacks, their interviews mothers with students and newborns . testimonies of the attacks, interviews with Detention of the professor of medical school students of the Universidad Central de Venezuela, MD 2. Investigations on the internet Óscar Noya, on 04/20/2017: 3. Search reports Oscar Noya is a doctor and professor at the Central University of Venezuela (UCV). He 4. Register information works continuously for the population that Number of medical schools before the conflict lives in the upper Orinoco. Through the Twitter started (April 2017): 15 social network it was possible to know that in the afternoon of Thursday, April 20, Dr. Oscar Number of operating medical schools now Noya was arrested, when participated in the (February 2018): 14 protest. Moya was helping people affected by tear gas in Santa Monica, Caracas.

22 International Federation of Medical Students’ Associations (IFMSA) In various sources it was stated that the journalist with the Trade Union of Graphic Arts of the Magda Gibelli - who was with Noya at the time State of Mérida (Sagem) ) and the Federation of of his arrest - indicated that they were one block University Centers (FCU) agreed on a calendar away from the Cristo Rey school, when suddenly of protests to demand the defense of Venezuelan some GNB officials came and stopped him higher education, among these, the closure of without saying a word. They insulted him and several avenues this Wednesday, a 24-hour kicked him continuously. He only told them that strike on Thursday and a bang on Friday19. he had no weapons, that he was a doctor and Murder of Paul Moreno, member of first aids father of three children. Noya provided a series and medicine student on 05/18/2017: of recommendations to people who had to get into the Guaire River to escape the effect of tear The Deputy of the National Assembly, Juan gas bombs by GNB officials18. Pablo Guanipa, confirmed this Thursday May 18 the death of a young man in Maracaibo Detention of medical team: 2 residents of named Paúl René Moreno, 24 years old. traumatology of the Hospital “Dr. Patrocinio Peñuela Ruiz” on 05/16/2017: “We report with deep sorrow the death of Paúl Moreno (24) another Venezuelan young On May 16 2017, two traumatology residents man assassinated by the dictatorship of of the Dr. Patrocinio Peñuela Ruiz were arrested Nicolás Maduro in Maracaibo,” the deputy for having served students who were protesting told Parliament on his Twitter account @ and were injured by pellets at the hands of the JuanPGuanipa. National Guard, the doctors did not obey the rules of the National Guard and therefore were He explained that Moreno “was a medical taken handcuffed outside the Hospital. student, he helped those affected in the demonstrations, and he was vilely run over Shooting and burning of auditorium of medicine with a white Hilux van escorted by motorized of the Universidad de Los Andes and two vehicles. Today they killed a Green Cross in vehicles at the hands of police and collectives Maracaibo.” Paúl Moreno was a volunteer and on 05/18/2017: was studying a year of medicine,” deputy José A peaceful protest by university workers Manuel Olivares also declared. The University and students turned violent on Wednesday of Zulia said that the incident occurred in the when collectives and police officers attacked line of armed forces. Moreno was transferred demonstrators and bystanders on avenues in to Adolfo Pons Hospital, presented with a skull, Mérida, leaving several wounded. multiple rib fractures and a femur fractures. Witnesses commented that Moreno was sitting The action began around 10 o’clock in the on the sidewalk, when he was rammed by the morning, after an Intergremial Assembly of truck. Commissions of the CICPC and GNP workers of the Universidad de los Andes (ULA) are in place collecting information of criminal was held in an auditorium of the Faculty of interest20. Medicine of the same house of studies. There, the Association of Teachers (Apula), the Shots, siege inside the facilities of the school Association of Employees (Aeula), the Union of of health sciences “Dr. Francisco Battistini Professionals and Technicians (Siprula) and the Casalta” of the Universidad de Oriente, loss of Union of Workers of the ULA (Soula), together university autonomy on 05/24/2017:

www.ifmsa.org 23 Within the facilities of the school of health officials. sciences “Dr. Francisco Battistini Casalta” of the A broad banner was extended at the main Universidad de Oriente, in Ciudad Bolívar in the entrance of the building, where on 05/06/2017 Bolívar state, were fired at, by the hands of the it was attacked by toxic gases, which affected National Guard and collectives, with was total those who remained in custody and the staff of loss of university autonomy resulting from this the institution. fact; in addition, injuries by buckshot were noted. From its account on the Twitter social network, Shots, siege inside the facilities of the deanship the international medical organization explained of medicine of the Universidad de Oriente, that “the emblem of the Red Cross indicates murder of one nursing student on 05/24/2017: protection to the injured, the personnel that assist The deputy to the National Assembly, José them and the place where they are assisted. Manuel Olivares, reported on Wednesday May Respect the emblem.” 24 the death of nursing student Augusto Pugas, Since that Friday night and early Saturday after receiving a bullet in the head during the morning, the La Candelaria sector was the scene protests in the state of Bolivar. of strong clashes between military officials and “Augusto Puga, another young man who was anti-government shock groups that took one of murdered by the dictatorship, has just passed the popular sectors23. away. Enough to kill the future. We accompany Contributors: his family in this pain” said the parliamentarian on his Twitter account @joseolivaresm. According FranciscoContributors: Enrique Machado Toro - President of Francisco Enrique Machado Toro - President of FEVESOCEM to deputy Tony Geara, the student was in the FEVESOCEM deanship’s facilities of the UDO Bolívar when he Contact details: was hit by the projectile21. Federación Venezolana de Sociedades Científicas de Estudiantes de Medicina (FEVESOCEM) Tear gas pumps inside the “Dr. Héctor Nouel Contact person: Francisco Enrique Machado Toro, President of Joubert” Hospital on 05/31/2017: FEVESOCEM, [email protected] // [email protected] The Bolivarian National Police launched tear gas bombs against Dr. Héctor Nouel Joubert Contact details: Hospital, located in Ciudad Bolívar in Bolívar state, which affected hospitalized patients and Federación Venezolana de Sociedades they had to be evicted22. Científicas de Estudiantes de Medicina (FEVESOCEM) Attack against the Red Cross building in Caracas on 06/10/2017: Contact person: Francisco Enrique Machado7. Yemen Toro, President of FEVESOCEM, The headquarters of the Red Cross organization, [email protected] // located in the La Candelaria sector in Caracas, [email protected] section was hoisted its international flag on the front of the written by members of building, as a symbol of protection for patients, the National Association of Medical staff and the building where it operates, after it Students - Yemen was the target of a bomb tear gas thrown during (NAMS- Yemen), with clashes between protesters and National Guard full credits at the end of this section. 24 International Federation of Medical Students’ Associations (IFMSA) Number of medical schools before the conflict started (2013): 7 Number of operating medical schools now (2018): 6 Number of enrolled students before the conflict and in present time: (no official statistics available)

“Since 2014, ongoing conflict between government and nongovernmental forces has produced a severe humanitarian crisis. The clashes have destroyed public infrastructure and services, like hospitals and schools, blocked access to basic supplies and forced 3 million people from their homes. 22.2 million People — 75 percent of the country‟s population — are in desperate need of humanitarian aid, including food, water and medicine“ (1).

“Nearly half of all health facilities are non-functional - An estimated 10.4 million people lack access to basic healthcare, including 8.8 million living in severely under-served areas. Medicine and medical Contributors: Francisco Enrique Machado Toro - President of FEVESOCEM

Contact details: Federación Venezolana de Sociedades Científicas de Estudiantes de Medicina (FEVESOCEM) Contact person: Francisco Enrique Machado Toro, President of FEVESOCEM, [email protected] // [email protected]

7. Yemen

This section was written by members of 7.the Yemen National Association of Medical Students - Yemen (NAMS-This Yemen), section with fullwas credits at the endwritten of this by memberssection. of the National Number of Associationmedical schoolsof Medical before the Studentsconflict -started Yemen (NAMS- Yemen), with (2013): 7 full credits at the end of this section. Number of operating medical schools now (2018):Number 6 of medical Number of enrolledschools beforestudents the before the conflict startedand (2013)in : 7 present time: (no official statistics Number of operating available) medical schools now “Since 2014, (2018)ongoing: 6 conflict Number of enrolled students before the conflict and in present time: (no official statistics available) between government and According to WHO, more than 1,900 out of 3,507 health nongovernmental forces has “Since 2014, ongoing conflictfacilities between in government 16 governorates and nongovernmental are either forces non-functional has produced aor severe produced a severe humanitarian humanitarian crisis. The clashespartially have functioning. destroyed public An estimatedinfrastructure 30,000 and services, dedicated like hospitals local and crisis. The clashesschools, have blocked destroyed access tohealth basic workerssupplies whoand forced play the3 million largest people role infrom ending their thishomes. outbreak 22.2 million public infrastructurePeople and — 75 services, percent of thehave country‟s not beenpopulation paid — theirare in salaries desperate for need nearly of humanitarian 10 months aid, and including like hospitalsfood, and water andschools, medicine“ (1).operational costs in more than 3,500 health facilities are not blocked access to basic supplies paid. Between 19 March and 15 July, reported deaths and and forced 3“Nearly million half ofpeople all health facilitiesinjuries are from non -healthfunctional facilities - An estimated in Yemen 10.4 reachedmillion people 8,389 lack andaccess to from their homes.basic 22.2healthcare, million including 56,130 8.8 million respectively. living in severely Given underthat -onlyserved 45 areas. per Medicinecent of healthand medical People — 75 percent of the facilities are functioning, the actual figures are likely to be country’s population — are in higher”25. desperate need of humanitarian aid, including food, water and At the beginning of the second decade of the 21st century, medicine“24. medical education in Yemen was undergoing a process of standardizing curriculum in seven medical schools that “Nearly half of all health facilities are present throughout the country to ensure quality and to are non-functional - An estimated promote a new generation of doctors that are equipped with 10.4 million people lack access knowledge and skills to serve their community. However, to basic healthcare, including these efforts have ceased due to the internal conflict that 8.8 million living in severely has affected the educational process in many ways. During under-served areas. Medicine the days of the conflict, most of the medical schools stopped and medical supplies/materials operating because of insecurity and damage to their buildings are in chronically short supply. or damage to infrastructures. www.ifmsa.org 25 Case studies: however, the main obstacle to perform a more detailed study is a very poor security situation Hadhramout: and violent armed conflict. Hadhramout University College of Medicine Al Hudaydah: (HUCOM) is a medical school situated in Hadhramout province south of Yemen. It is Faculty of medicine and health sciences in Al

considered one of the governmental local students‟Hudaydah number attending UniversityHUCOM increased withstopped a total number ofoperating students (893, and theafter next term 907)being respectively. targeted On the other hand, atmost ofthe the foreign end doctors of have 2015.not come back. Students medical schools that adopt innovative medical Aden:could not continue their studies. One of the curricular modules such as problem-based Aden University College of Medicine, the medical school situated in Aden, the temporary capital of learning (PBL). Due to the security instability and Yemen,reasons, stopped operating besides for seven months an at theongoing beginning of the conflictarmed on 26 of Marchconflict, 2015, when Houthis attacked the city. The total number of students in the year 2015/2016 was 1236, and in the year damage to infrastructure, it stopped operating 2017/2018was is that1552 according a large to the university part records. of The the total numbercollege of students buildingswho cannot continue their studies due to security instability is approximately 40, for unknown reasons. We know that there is for six months at the beginning of the conflict in somewas damage destroyed. to the infrastructure The of the students college in various were buildings, transferred and damage to medicalto laboratories, teaching and training materials, however, the main obstacle to perform a more detailed April 2015 when al-Qaida took over Al Mukalla studyother is a very colleges,poor security situation including and violent armed the conflict. Faculty of Medicine

city. This situation led most of the foreign Al Hudaydah:at Sana’a University. There was a drop in Faculty of medicine and health sciences in Al Hudaydah University stopped operating after being targeted professors and students to flee the country. In the at the end ofnumber 2015. Students ofcould studentsnot continue their afterstudies. One the of the reasons,crisis, besides and an ongoing a armed conflict, was that a large part of the college buildings was destroyed. The students were same year, the total number of students was 846 transferredsignificant to other colleges, decrease including the Faculty in of Medicinethe numberat Sana'a University. of There foreign was a drop in the number of students after the crisis, and a significant decrease in the number of foreign students from according to the university records which was otherstudents countries. from other countries.

considered less than previous years. However, Comment [3]: Destruction of Al Hudaydah University. 2015. in the following two years (2016\2017), when Source: https://www.youtube.com/watch?v= al-Qaida slowly moved out of the area, which kir_RsTJvhM&feature=youtu.be led to security stability, and thanks to this relative stability, medical students were attracted to resume their studies in HUCOM. As the result, students’ number attending HUCOM increased with a total number of students (893, and the

next term 907) respectively. On the other hand, most of the foreign doctors have not come back. Taiz:Destruction of Al Hudaydah University. 2015. The University of Taiz, College of Medicine, closed after Houthi militias started the war on the city of Taiz. TheSource:se battles lasted for approximatelyhttps://www.youtube.com/watch?v=kir_ seven months, during which the college fell under their control. By Aden: this time, the Faculty of Medicine opened three programs to prepare students for the completion of the academicRsTJvhM&feature=youtu.be year 2015-2016 in Jordan, in the city of Ibb, and the city of Taiz. Then, after the liberation of the Aden University College of Medicine, the medical school situated in Aden, the temporary Taiz: capital of Yemen, stopped operating for seven The University of Taiz, College of Medicine, months at the beginning of the conflict on 26 of closed after Houthi militias started the war on the March 2015, when Houthis attacked the city. The city of Taiz. These battles lasted for approximately total number of students in the year 2015/2016 seven months, during which the college fell under was 1236, and in the year 2017/2018 is 1552 their control. By this time, the Faculty of Medicine according to the university records. The total opened three programs to prepare students for number of students who cannot continue their the completion of the academic year 2015- studies due to security instability is approximately 2016 in Jordan, in the city of Ibb, and the city of 40, for unknown reasons. We know that there is Taiz. Then, after the liberation of the University some damage to the infrastructure of the college of Taiz, it returned to function in its own camps. in various buildings, and damage to medical It also opened a program in Al-Hoban district laboratories, teaching and training materials, in the province of Taiz along with the academic 26 International Federation of Medical Students’ Associations (IFMSA) education in the university building. So far, the escaped the country and the others stopped educational process continues in the university teaching because the college stopped providing building, alongside an educational program them with salaries. Nevertheless, some of outside the city in Alhoban for those who could them continued teaching in college camps as not enter the city. Additionally, the program also volunteers. The college continued its operations resumed its course in the Faculty of Medicine in regardless of the airstrikes, the security instability, the city of Ibb. and the damage to the infrastructure with the lack of fuel and electricity, which was powered Some of the main reasons which led to the by solar energy. The college of medicine closure of the College of Medicine in Taiz were: in Sana’a received students from different 1. Lack of security due to the control of Houthi provinces such as Taiz, Dhamar, and Al-Hudida. militias over the university; Hence, overcrowding of the classes arose as a significant problem. Some batches had reached 2. Destruction of many laboratories and a number of 355 students in one class. Students buildings especially in the Faculty of from the Al-Hudida had their medical school hit Medicine; by an airstrike and was out of function, leading 3. Displacement of many teachers as well as the them to open a branch of their college in Sana’a cutting the university budget by the Houthi University. militias in Sana’a. The overcrowding of classes, the lack of salaries The challenges and difficulties of resuming the for teachers who worked and work in more than educational process: one university to compensate for their livings, the damaged infrastructure, and the airstrikes 1. Damage to many laboratories; near the teaching hospitals have all affected 2. Displacement of teachers as well as the the quality of medical education in Sana’a inability to pay their salaries on a regular University College of Medicine. basis; Challenges: 3. Low university budget; Due to security issues, problems with electricity 4. Security challenges and communication, we were unable to get access to some colleges, thus we do not have a Programs were opened in Alhoban for those complete picture of Yemen’s medical schools. It who could not enter the city because of the siege was very difficult to verify reports of attacks. imposed by the Houthi militias. Sana’a: Conclusion: Sana’a University College of Medicine stopped Similarly to Syria, the humanitarian crisis in operating at the beginning of the conflict for Yemen has resulted in significant impairments two months from March 2015 until May 2015, to medical education. The closing of a medical because of a security instability and some school due to the destruction of infrastructure damage to infrastructure. However, it regained and the temporary pause in operations of 4 its function shortly afterwards. In regard to the other medical schools for several months resulted teaching staff, some professors and doctors in ongoing problems. Large number of students were transferred, for which receiving institutions

www.ifmsa.org 27 had been unprepared. Faculty staff stopped Conclusion receiving payments or they were significantly _ lowered, thus forcing them to compensate by teaching in multiple occasions to provide for themselves and their families; however, many continued to teach on a voluntary basis. Direct attacks on the infrastructure were also noted including hospitals and university buildings.

Contributors: Abdullah M. Bahaisami - President of NAMS- Yemen Faisal Abdulatef Ali - NAMS-Yemen Vice President Internal Ahmed S. Maknoon - National Officer on Medical Education Abdullah M. Bahaisami - President of NAMS-Yemen BasheerFaisal Abdulatef M. Almashgari Ali - NAMS -- YemenSCOPH Vice assistant President Internal Ahmed S. Maknoon - National Officer on Medical Education Basheer M. Almashgari - SCOPH assistant Contact details: Contact details: National Association of Medical Students - Yemen (NAMS- Yemen) Contact person: Abdullah M. Bahaisami, President of NAMS- Yemen, [email protected]

National Association of Medical Students - Yemen (NAMS- Yemen) Contact person: Abdullah M. Bahaisami, President of NAMS-Yemen, nams-yemen@ifmsa. orgConclusion:

As evidenced by the present report, a multitude of incidents resulting in disturbances to medical education were recorded, varying in nature and extent. These disturbances concern the initiation, continuation and conclusion of medical studies and range from direct attacks to teaching locations such as Al-Furat and Damascus Universities in Syria, or the attacks against faculties in Venezuela, to indirect attacks inhibiting students‟ access to medical education, such as the obstruction to obtaining permits noted in Palestine, effectively excluding Palestinian students, or the cease of operations across multiple faculties in Libya. The attacks have largely taken the form of barriers to access, rather than targeted strikes. Obstructions to access medical education differ in their causes, nature and length. In the vast 28 majorityInternational of countries Federation presented of Medical in this Students’ report, Associationsthe sole presence (IFMSA) of violent conflict and disturbances posed a significant challenge for medical students to enter their schools. Direct violence, insecure environment, damaged infrastructure, fear of risking their lives and safety, or sympathy with their families and friends - these are several reasons contributing to restrained access to medical education.

However, the number of direct assaults towards medical education facilities can be undervalued. Several member organisations mentioned the lack of monitoring frameworks and absence of disaggregated data as a potential reason of such attacks going unnoticed. Without disaggregated data, it is almost impossible to quantify the rate of attacks on health care with medical education components as direct or indirect targets. In many cases, a violent conflict or prolonged civil disturbances, leading up to disturbances in electricity supply, internet connection or access to information, turned research into a problematic, and sometimes even impossible task.

In most cases, nationwide political conflicts have been responsible for collateral damage inflicted upon educational institutes. In some cases, however, educational institutes have been the primary target, with an aim to deter the learning process and the operation of health systems. This has been the case on multiple occasions in Venezuela, where attacks have been reported against medical teams, medical students, healthcare facilities and individual health practitioners. Conclusion_

As evidenced by the present report, a multitude electricity supply, internet connection or access to of incidents resulting in disturbances to medical information, turned research into a problematic, education were recorded, varying in nature and sometimes even impossible task. and extent. These disturbances concern the In most cases, nationwide political conflicts initiation, continuation and conclusion of have been responsible for collateral damage medical studies and range from direct attacks inflicted upon educational institutes. In some to teaching locations such as Al-Furat and cases, however, educational institutes have Damascus Universities in Syria, or the attacks been the primary target, with an aim to deter against faculties in Venezuela, to indirect the learning process and the operation of health attacks inhibiting students’ access to medical systems. This has been the case on multiple education, such as the obstruction to obtaining occasions in Venezuela, where attacks have permits noted in Palestine, effectively excluding been reported against medical teams, medical Palestinian students, or the cease of operations students, healthcare facilities and individual across multiple faculties in Libya. The attacks health practitioners. have largely taken the form of barriers to access, rather than targeted strikes. Obstructions Another type of interference with medical to access medical education differ in their education are individual or repeated causes, nature and length. In the vast majority interruptions in its continuity. Of approximately of countries presented in this report, the sole 128 medical schools from 7 countries followed presence of violent conflict and disturbances in this report, 22 had to pause their operations posed a significant challenge for medical for shorter or longer period of time. However, if students to enter their schools. Direct violence, we exclude universities from Sudan (65 schools) insecure environment, damaged infrastructure, and Ukraine (23 schools), where we focused on fear of risking their lives and safety, or sympathy a small portion of facilities which were directly with their families and friends - these are several affected by particular disturbances, data reasons contributing to restrained access to presented highlights 40 medical schools from 5 medical education. countries, with 22 forced shutdowns, accounting for 55% of medical schools from Libya, Palestine, However, the number of direct assaults towards Syria, Venezuela, and Yemen. In Libya and medical education facilities can be undervalued. Yemen, all reported medical schools in these Several member organisations mentioned the countries ceased their operations during some lack of monitoring frameworks and absence of period of the conflict. In Syria, almost half of disaggregated data as a potential reason of such medical schools paused their operations in the attacks going unnoticed. Without disaggregated first year of the conflict, resuming their operations data, it is almost impossible to quantify the rate months (or years) later. Similar discontinuations of attacks on health care with medical education occured in all the countries in our report, but components as direct or indirect targets. In predominantly in Yemen, Ukraine and Sudan. many cases, a violent conflict or prolonged Out of 22 medical schools that were forced civil disturbances, leading up to disturbances in www.ifmsa.org 29 to pause education (according to our data), 19 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. A large portion of students 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 students 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. Above all, a large portion of medical students either chose or was forced to indefinitely pause their education. Attacks on medical education harbor 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. Moreover, the effect of conflict on medical students and academic staff remains in question and must also be studied to explore its subsequent factoring effect in health services. The International Federation of Medical Students’ Associations remains committed to this task, and will continue to explore and report on attacks on medical education. Medical students are on the forefront of protection of health services, and through our work on local, national and global level we aim to contribute to the momentum to safeguard the future of healthcare for all. Aikaterini Dima and Marian Sedlak IFMSA Liaison Officer for Medical Education Issues & Liaison Officer for Human Rights and Peace Issues

30 International Federation of Medical Students’ Associations (IFMSA) References_ 1 Kerr Winter, B., Salamma, R. A. M., & Qabaja, K. A. (2015). Medical education in Palestine. Medical teacher, 37(2), 125-130. 2 United Nations Education and Scientific Organization (UNESCO) Ramallah Office. (2015, January). Briefing Presentation: Rapid Assessment of Higher Education Institutions in Gaza. Available at: https://www.humanitarianresponse.info/sites/www.humanitarianresponse.info/ files/assessments/Briefing%20Presentation%20-%20Rapid%20Assessment%20of%20Higher%20 Education%20Institutions%20in%20Gaza.pdf 3 Habeeb, A.; Newman, M. (2009 February 16). Rebuilding the Islamic University of Gaza. Available at: https://electronicintifada.net/content/rebuilding-islamic-university-gaza/8068 4 Goldstone, R. (2009). Human rights in Palestine and other occupied Arab territories. Report of the United Nations Fact Finding Mission on the Gaza Conflict. 5 Dearden, L. (2014, August 2). Israel-Gaza conflict: University hit as Palestinians endure more than 200 strikes in 24 hours. Independent. Available at: https://www.independent.co.uk/news/ world/middle-east/israel-gaza-conflict-university-hit-as-palestinians-endure-more-than-200-strikes-in- 24-hours-9644243.html 6 Shahawy, S., & Diamond, M. (2016). Attitudes of Palestinian medical students on the geopolitical barriers to accessing hospitals for clinical training: a qualitative study. Conflict and health, 10(1), 5. 7 Sudan [Internet]. Protectingeducation.org. 2018 (accessed on 16 March 2018). Available from: http://www.protectingeducation.org/country-profile/sudan 8 ACJPS, Sudan Human Rights Monitor October-November 2011 (ACJPS, 2011) 9 Safeguarding Health in Conflict Coalition. Impunity must end: attacks on health in 23 countries in conflict in 2016. (accessed on February 10, 2017) Available at: https://www.safeguardinghealth. org/sites/shcc/files/SHCC2017final.pdf 10 Challoner, K. R., & Forget, N. (2011). Effect of civil war on medical education in Liberia. International Journal of Emergency Medicine, 4(1), 6. Available at: https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC3051893/ 11 Barnett-Vanes, A., Hassounah, S., Shawki, M., Ismail, O. A., Fung, C., Kedia, T., ... & Majeed, A. (2016). Impact of conflict on medical education: a cross-sectional survey of students and institutions in Iraq. BMJ open, 6(2), e010460. Available at: http://bmjopen.bmj.com/content/6/2/e010460 12 Gadher, D.; Corke, J. (2017, February 5). British medics studying in Sudan flock to join Isis. Available at: https://www.thetimes.co.uk/edition/news/british-medics-studying-in-sudan-flock-to-join- isis-80vcjvkcj 13 Dehghanpisheh, B.(2013, March 28). Mortar attack on University of Damascus kills at least 12. The Washington Post. Available at: https://www.washingtonpost.com/world/middle_east/ www.ifmsa.org 31 mortar-attack-on-university-of-damascus-kills-at-least-12/2013/03/28/b713b018-97c3-11e2-97cd- 3d8c1afe4f0f_story.html?utm_term=.7178c39d66d8 14 Holmes, O. (2013, March 28). Mortar strike kills 15 in Damascus University: state media. Reuters. Available at: https://www.reuters.com/article/us-syria-crisis-students/mortar-strike-kills-15- in-damascus-university-state-media-idUSBRE92R0E020130328 15 Karouny, M. (2013, January 15). Explosions kill 83 at Syrian university as exams begin. Reuters. Available at: https://www.reuters.com/article/us-syria-crisis/explosions-kill-83-at-syrian-university- as-exams-begin-idUSBRE90E0V820130115 16 Timeline of the 2017 Venezuelan protests. Available at: https://en.wikipedia.org/wiki/Timeline_ of_the_2017_Venezuelan_protests 17 Bombas lacrimógenas afectaron a pacientes del Materno Infantil de El Valle. (2017 April 20). El Nacional. Available at: http://www.el-nacional.com/noticias/sociedad/bombas-lacrimogenas- afectaron-pacientes-del-materno-infantil-valle_178304 18 Arrestado médico y profesor de la UCV Oscar Noya, quien prestaba asistencia médica a manifestantes en Santa Mónica. (2017, April 20). Available at: https://www.aporrea.org/ actualidad/n307299.html 19 Policías y colectivos hirieron a universitarios y dañaron instalaciones de la ULA en Mérida. (2016, May 18). Available at: http://runrun.es/nacional/actualidad/262348/policias-y- colectivos-hirieron-a-universitarios-y-danaron-instalaciones-de-la-ula-en-merida.html 20 Barboza, A. Chávez, M. (2017, May 18). Murió arrollado Paúl Moreno de 24 años en Maracaibo. Available at: http://www.panorama.com.ve/sucesos/Murio-arrollado-Paul-Moreno- de-24-anos-en-Maracaibo-20170518-0107.html Video available at: https://www.youtube.com/ watch?v=CoUt0qN3y1s 21 Daniel Barboza, A. (2017, May 24). Falleció Augusto Puga tras recibir disparo en la cabeza en Bolívar: Diputado Olivares. Available at: http://www.panorama.com.ve/sucesos/Fallecio-Augusto- Puga-tras-recibir-disparo-en-la-cabeza-en-Bolivar-Diputado-Olivares-20170524-0108.html 22 Social media reports of the incident available here: https://www.scoopnest.com/es/user/ ReporteYa/869968517847764992-31may-lacrimogenas-por-la-peb-afecta-pacientes-del-hospital- dr-hector-nouel-joubert-ciudadbolivar-gedv86 23 Méndez Lárez, I. (2017, June 11). VIDEO+FOTOS Cruz Roja iza su bandera tras ataque de lacrimógenas en La Candelaria #11Jun. Available at: http://www.elimpulso.com/noticias/ nacionales/videofotos-cruz-roja-iza-bandera-tras-ataque-lacrimogenas-la-candelaria-11jun 24 Cogan, A. (2018, January 2018). Quick facts: What you need to know about the crisis in Yemen. Mercy Corps. Available at: https://www.mercycorps.org/articles/yemen/quick-facts-what-you- need-know-about-crisis-yemen 25 UN OCHA. 2018. Yemen - crisis overview. Available at: http://www.unocha.org/yemen/about- ocha-yemen

32 International Federation of Medical Students’ Associations (IFMSA) Algeria (Le Souk) Egypt (IFMSA-Egypt) Kuwait (KuMSA) Saint Lucia (IFMSA-Saint Lucia) Argentina (IFMSA-Argentina) El Salvador Latvia (LaMSA) Senegal (FNESS) Armenia (AMSP) (IFMSA-El Salvador) Lebanon (LeMSIC) Serbia (IFMSA-Serbia) Aruba (IFMSA-Aruba) Estonia (EstMSA) Lesotho (LEMSA) Sierra Leone (SLEMSA) Australia (AMSA) Ethiopia (EMSA) Libya (LMSA) Singapore (AMSA-Singapore) Austria (AMSA) Fiji (FJMSA) Lithuania (LiMSA) Slovakia (SloMSA) Azerbaijan (AzerMDS) Finland (FiMSIC) Luxembourg (ALEM) Slovenia (SloMSIC) Bangladesh (BMSS) France (ANEMF) Malawi (UMMSA) South Africa (SAMSA) Gambia (UniGaMSA) Belgium (BeMSA) Malaysia (SMMAMS) Spain (IFMSA-Spain) Georgia (GMSA) Bolivia (IFMSA-Bolivia) Mali (APS) Sudan (MedSIN) Germany (bvmd) Bosnia & Herzegovina Malta (MMSA) Sweden (IFMSA-Sweden) Ghana (FGMSA) (BoHeMSA) Mexico (AMMEF-Mexico) Switzerland (swimsa) Greece (HelMSIC) Bosnia & Herzegovina – Mongolia (MMLA) Syrian Arab Republic (SMSA) Republic of Srpska (SaMSIC) Grenada (IFMSA-Grenada) Montenegro (MoMSIC) Taiwan - China (FMS) Brazil (DENEM) Guatemala Morocco (IFMSA-Morocco) Tajikistan (TJMSA) Brazil (IFMSA-Brazil) (IFMSA-Guatemala) Nepal (NMSS) Thailand (IFMSA-Thailand) Bulgaria (AMSB) Guinea (AEM) The Netherlands (IFMSA NL) The Former Yugoslav Republic Guyana (GuMSA) Burkina Faso (AEM) of Macedonia (MMSA) Nicaragua (IFMSA-Nicaragua) Haiti (AHEM) Burundi (ABEM) Tanzania (TaMSA) Nigeria (NiMSA) Honduras (IFMSA-Honduras) Cameroon (CAMSA) Togo (AEMP) Norway (NMSA) Hungary (HuMSIRC) Canada (CFMS) Trinidad and Tobago (TTMSA) Oman (MedSCo) Iceland (IMSA) Canada – Québec Tunisia (Associa-Med) Pakistan (IFMSA-Pakistan) (IFMSA-Québec) India (MSAI) Turkey (TurkMSIC) Palestine (IFMSA-Palestine) Catalonia - Spain (AECS) Indonesia (CIMSA-ISMKI) Turkey – Northern Cyprus Panama (IFMSA-Panama) Chile (IFMSA-Chile) Iran (IMSA) (MSANC) Paraguay (IFMSA-Paraguay) China (IFMSA-China) Iraq (IFMSA-Iraq) Uganda (FUMSA) Peru (IFMSA-Peru) China – Hong Kong Iraq – Kurdistan Ukraine (UMSA) (AMSAHK) (IFMSA-Kurdistan) Peru (APEMH) United Arab Emirates (EMSS) Colombia (ASCEMCOL) Ireland (AMSI) Philippines (AMSA-Philippines) United Kingdom of Great Costa Rica (ACEM) Israel (FIMS) Poland (IFMSA-Poland) Britain and Northern Ireland Croatia (CroMSIC) Italy (SISM) Portugal (ANEM) (SfGH) Cyprus (CyMSA) Jamaica (JAMSA) Qatar (QMSA) United States of America Czech Republic (IFMSA-CZ) Japan (IFMSA-Japan) Republic of Moldova (ASRM) (AMSA-USA) Democratic Republic of the Jordan (IFMSA-Jo) Romania (FASMR) Uruguay (IFMSA-URU) Congo (MSA-DRC) Kazakhstan (KazMSA) Russian Federation (HCCM) Uzbekistan (Phenomenon) Denmark (IMCC) Kenya (MSAKE) Russian Federation – Republic Venezuela (FEVESOCEM) Dominican Republic (ODEM) Korea (KMSA) of Tatarstan (TaMSA) Yemen (NAMS) Ecuador (AEMPPI) Kosovo - Serbia (KOMS) Rwanda (MEDSAR) Zambia (ZaMSA)

www.ifmsa.org medical students worldwide www.ifmsa.org 33