Active conflict settings constitute challenging operating environments for humanitarian health organisations and workers. An emerging feature of some conflicts is direct violence against health workers, facilities, and patients. Since the start of the war in 2011, Syria has endured extreme and deliberate violent attacks on health facilities and workers. This paper reports on the findings from a qualitative study that examined the lived experiences of Syrian humanitarian health workers facing extreme ethical challenges and coping with moral distress. In-depth interviews were carried out with 58 front-line health workers in north-western and southern Syria. Participants described a number of ethical and operational challenges experienced while providing services in extreme conditions, as well as strategies used to deal with them. The complex intersection of personal and organisational challenges is considered and findings are linked to key ethical and humanitarian principles. Both practical recommendations and action steps are provided to guide humanitarian health organisations.

中文翻译：

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“我们永远不会放弃”：对叙利亚卫生工作者在极端暴力情况下面临的道德挑战的定性研究

活跃的冲突环境对人道主义卫生组织和工作人员构成了具有挑战性的操作环境。一些冲突的一个新特征是对卫生工作者、设施和患者的直接暴力。自 2011 年战争爆发以来，叙利亚遭受了针对卫生设施和工作人员的极端蓄意暴力袭击。本文报告了一项定性研究的结果，该研究调查了叙利亚人道主义卫生工作者面临极端道德挑战和应对道德困境的生活经历。对叙利亚西北部和南部的 58 名一线卫生工作者进行了深入访谈。参与者描述了在极端条件下提供服务时遇到的一些道德和运营挑战，以及用于应对这些挑战的策略。考虑了个人和组织挑战的复杂交集，并将调查结果与关键的道德和人道主义原则联系起来。提供了实用建议和行动步骤来指导人道主义卫生组织。