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Most news about the Middle East tends to involve either oil, religious conflict, terrorism or war – and often all of the above. But you don’t hear much about health care, or about how the region’s recent turmoil has affected its health care systems.

At Unite for Sight’s recent Global Health & Innovation Conference, Michael Brennan, past president of the American Academy of Ophthalmology and an expert on the region, gave an overview of the health care systems in countries like Iraq, Syria and Libya, and the challenges they’ve faced since the Arab Spring. You can view the presentation below.

In an interview after his presentation (also included below), Dr. Brennan focused on Syria, describing a situation that has grown particularly dire. “In Syria, many physicians have left the country,” he says. “Beyond that, there’s been physical destruction of the infrastructure: hospitals have been bombed, clinical facilities and medical supplies are limited, government authorities have been unwilling, probably in some cases, to extend services outside their direct control. Non-governmental organizations have been limited in crossing the border. Beyond that there’s the political uncertainty: physician leadership doesn’t really know who is going to be in charge of the health care system in the short term, and certainly not in the long term. So some of the interconnections for patient referrals, for care both in clinical situations and hospital environments, are very compromised. Beyond this, the various relief organizations are challenged in attempting to provide the right sort of services at the border for refugees from Syria.”

Brennan says that global health organizations face the same dilemma as outside governments when considering how to support the Syrian health system in the current crisis: who exactly should receive that support? “The opposition is multi-faceted and has different interests, and it has been very difficult for them to come to common ground,” he explains. These elements range from the original rebels hoping to bring down the government, to expatriates returning to Syria hoping to become leaders after the regime falls, to radical Islamist groups – including those related to Al Qaeda – maneuvering for power. “So when one says ‘help the opposition against the regime’ – which opposition are you talking about?”

Yet Brennan says that some organizations are finding ways to make a difference. “International Medical Corps has a very active facility and a support base on two fronts, both in Jordan, on the border, and in Lebanon,” he says. “They do sustaining support, they do public health, they do community medicine for a variety of refugee conditions.”

And in spite of the turmoil in countries like Syria, Brennan sees some positive trends in the region. “One of the really encouraging things I’ve witnessed in Iraq, over almost 10 years now, is the transformation of the health care system there from a very male-dominant, non-integrated system, focusing on large central hospitals, to a much more women-directed health care system. Obstetrics and gynecology are probably the best example. And the medical profession in Iraq has been very eager to engage globally.”

As for health professionals from other nations who might want to visit and engage with their counterparts in the Middle East, he offers some advice: “There are times and places where one should not be, and it’s wise that you always have a sponsoring organization. And your host or hostess physician should be one of the partners to make sure that your visit is rewarding and safe. I’m not going to minimize or deny that there are some cultural differences. The adult male in the Middle Eastern world has a heritage of being superior in position, and there was a carry-over in the medical system.

“But it is definitely changing, and so I’m counting on the next generation of men and women to resolve some of the traditional gaps. Women were always encouraged to practice medicine, but they were never allowed to lead in medicine, and that’s where the change is occurring.”

An interview with Michael Brennan

Medicine in the Middle East – Post Arab Spring: a presentation by Michael Brennan