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ORIGINAL RESEARCH article

Front. Public Health

Sec. Infectious Diseases: Epidemiology and Prevention

Healthcare Providers' Perspectives on Antimicrobial Resistance in Northwest Syria: An Exploratory Qualitative Study

Provisionally accepted
Hussam AlkabbaniHussam Alkabbani1Maysoon DahabMaysoon Dahab1Waseem ZakariaWaseem Zakaria2Ahmad HmaidehAhmad Hmaideh3Nasser AlmhawishNasser Almhawish4Nabil KarahNabil Karah5Aula AbbaraAula Abbara4,6*
  • 1London School of Hygiene & Tropical Medicine, London, United Kingdom
  • 2University of Aleppo Faculty of Medicine, Aleppo, Syria
  • 3Syrian Board of Medical Specialties, Syria, Idlib, Syria
  • 4Syria Public Health Network, London, United Kingdom
  • 5Umea Universitet, Umeå, Sweden
  • 6Imperial College London, London, United Kingdom

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Abstract: Armed conflict contributes to the development of antimicrobial resistance (AMR) through multiple pathways; therefore, understanding healthcare providers' perceptions of AMR is crucial for developing targeted interventions. This qualitative study explored healthcare provider perceptions of AMR in northwest Syria during July-August 2023 - a conflict-affected region - before the fall of the Syrian regime in December 2024. We conducted semi-structured interviews with 17 healthcare providers (11 doctors, 6 pharmacists) working in the region within the preceding five years, primarily from Idlib governorate. Key themes emerging from the interviews focused on healthcare professionals' understanding of AMR, perceived drivers, conflict and natural disaster-related factors influencing AMR, and examples of successful interventions. Frequently cited drivers were the role of pharmacies in dispensing, the availability of over-the-counter antimicrobials, and community insistence on prescriptions. Inadequate microbiology diagnostic capacity in northwest Syria was also a noted factor. These findings highlight the impact of absent or ineffective policies regarding over-the-counter antibiotic dispensing, lack of antimicrobial guidelines (or poor enforcement), and limited access to diagnostics, offering practical insights for contextualized recommendations during the ongoing transition of Syria's health system.

Keywords: Syria, AMR, antimicrobial resistance, Antimicrobial stewardship, conflict

Received: 09 Jul 2025; Accepted: 04 Nov 2025.

Copyright: © 2025 Alkabbani, Dahab, Zakaria, Hmaideh, Almhawish, Karah and Abbara. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Aula Abbara, a.abbara15@ic.ac.uk

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Supplementary Material