Revamping a Collapsed Kidney Care System: The ESKD Dialysis Program in Syria

Years of political turmoil, conflicts, and mismanagement in Syria led to a catastrophic situation in all aspects of life including population health. The political change that occurred in December 2024 brought hopes for reform and prosperity. In this article, the authors report the findings on the status of the ESKD dialysis facilities in the country from a Syrian Ministry of Health committee charged with improving kidney care. The committee identified major problems in all aspects of care. About one fourth of the surveyed 116 facilities had no physicians, and none of them had a peritoneal dialysis program. Only 36% of the facilities had adequate water treatment systems, and only 42% of the available machines were assessed to be in good condition. Most buildings had structural problems. Shortages of disposable supplies and essential medications were noted in all the government facilities. No electronic records system for patients care and supplies inventory existed. The reported number of patients was about 6000 with an estimated prevalence of 300 patients per million population. The proportion of patients who receive dialysis three times a week was 22%. The reported prevalence of hepatitis C was 15% (range 0%-100%). Three percent of the patients were <18 years of age, and 7% were over 70 years. Diabetics constituted 29% of patients. Solutions to these problems are discussed. The authors prioritize a "do no harm" approach and recommend first addressing dangerous building structural problems, water treatment quality issues, infection control gaps, and workforce quantitative and qualitative shortages.