Table 2

Themes, challenges and mitigation approaches

ThemesPrimary challengesManagement/mitigation approaches
Conflict
  • Extensive/indiscriminate weapons use against civilians resulting in overwhelming numbers of injuries.

  • Triage; deciding whose injury could benefit the most from sparse supplies and time.

  • Coordinating with other hospitals to refer casualties via social media.

Targeting
  • Targeted bombing of facilities requiring protection for health-worker, patients and assets.

  • Extensive weapons use against civilians raising constant concerns for family safety.

  • Working in basement levels and using tunnels for access.

  • Fortifying and hiding facilities.

  • Decentralising facilities and patients.

  • Sleeping at facilities.

Besiegement
  • Severe human resource shortages.

  • Telemedicine.

  • Task shifting to junior health-workers and medical students.

  • Working across medical specialties.

  • Building capacities through training.

  • Severe medical consumables shortages.

  • Medicines and pharmaceuticals shortages.

  • Severe fuel and electricity shortages.

  • Smugglers brought some medical supplies.

  • Sterilising and reusing disposable medical consumables.

  • Making blood bags and serums.

  • Using manual devices whenever possible instead of electric devices.

  • Using energy from ‘home-made’ fuel, solar power, rechargeable batteries and lid lights.

Chronic risk
  • Severe physical risk to health-workers and their families.

  • Long chaotic hours in very difficult conditions.

  • Feeling valued and working as part of a team.

  • Finding small joys in life and ways to maintain hope.