Institute for War and Peace Reporting | Giving Voice, Driving Change

Doctors Resent Compulsory Placements

Doctors and dentists in Syria have criticised a recently-amended law that obliges new graduates to work in rural communities. They argue that the requirement does not ensure better healthcare, and nor does it improve the skills of young doctors.

Since 1967, new graduates from medical, dental and pharmacy school have been required to serve two years in a rural community practice. Those with a particular specialism are exempted, as are practitioners working in the public sector and for non-government organisations like the Syrian Red Crescent.

The government amended this law in early April, introducing a requirement that doctors practice further away from big urban centres than is now the case.

According to the health ministry’s website, 47 per cent of doctors were located in rural areas in 2006, and 90 per cent of rural residents had access to healthcare.

However, Health Minister Maher Husami was recently quoted by the SANA news agency as saying many areas still needed doctors.

He said the amended law “provides proper medical care to all people in the countryside”.

Husami added that this compulsory period of service is not intended as a way of allowing doctors to “train or learn” on people in the countryside; that, he said, would be “unacceptable”.

Echoing the sentiments of many in the profession, a 31-year-old intern at the University Clinic in Damascus agreed that while many rural areas needed better healthcare, sending out doctors to practice on their own did not ensure better care, as they needed additional support such as nursing staff and medical equipment.

“If the doctor doesn’t have enough drugs and equipment and cannot provide certain treatments in the village, people will still have to go to the city,” he said. “The impact of compulsory service is then minimal.”

Being forced to work in the countryside is also detrimental to young medics’ finances, as people in these areas often cannot afford to pay for treatment, said the intern.

He said government should recompense such doctors with one-off payments or subsidies when they complete their term of service.

“Medicine is a private business, so it isn’t right to force doctors to work somewhere if they don’t want to,” said a 55-year-old podiatrist at a clinic in Harasta, on the outskirts of Damascus.

She said that while many areas lack proper health services, others are overcrowded with doctors and pharmacists.

A 34-year-old dentist from Damascus expressed concern that inexperienced practitioners may not offer the best quality of care.

“That’s unfair for the people,” he said.

Medics who refuse to serve the compulsory period face harsh penalties which may include closure of their clinics and fines of between 25,000 and 50,000 lira, or 500 to 1,000 US dollars.

A fifth-year medical student in Damascus compared the requirement with conscripted military service and argued that it hindered the professional development of young doctors.

"Why should I go to a distant village to practice?” he asked. “How can I build my skills early in my career when I’m far removed from the latest [medical] advances?"

(Syria News Briefing, a weekly news analysis service, draws on information and opinion from a network of IWPR-trained Syrian journalists based in the country.)

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