The effects of a 13-year war on the reality of ophthalmology services and education in Syria

Purpose: To evaluate the impact of the Syrian conflict on ophthalmology services, residency training, and clinical infrastructure, and to identify areas requiring urgent reform in the post-conflict healthcare reconstruction period. Design: A mixed-methods study combining a comprehensive scoping review with two national cross-sectional surveys of ophthalmology residents and public ophthalmology hospitals across Syria. Methods: A scoping review of English-language ophthalmology-related literature concerning Syria (1979–2025) was conducted using five major databases and grey literature. Two structured surveys were administered: one targeting ophthalmology residents to assess training quality and educational structure, and another targeting public hospitals to evaluate equipment, service delivery, and patient volume. Descriptive statistics and thematic analysis were used to analyze survey data. Results: The scoping review included 49 studies categorized into five themes: war-related ocular trauma, disease prevalence, refugee eye health, ophthalmology education, and public awareness. The residency survey (n = 135) revealed that 63.5 % of respondents lacked structured curricula, 67.2 % reported no surgical case tracking, and 91.9 % reported absence of formal evaluation rubrics. The facility-based survey received responses from 4 of 13 hospitals, revealing critical equipment shortages, high patient loads, and unequal access to subspecialty and surgical services. The survey revealed significant shortages of functional ophthalmic equipment, including slit lamps, fundus cameras, perimeters, OCT machines, keratometers, tonometers, and YAG lasers. Many hospitals reported outdated or non-functional devices, with essential diagnostic and surgical tools either unavailable or in critical need of repair. Conclusion: Ophthalmology services and education in Syria have been severely affected by conflict-related damage, infrastructure collapse, and displacement. This study underscores the urgent need for national reconstruction efforts focused on standardizing residency curricula, upgrading hospital infrastructure, and ensuring equitable access to advanced ophthalmic care. International partnerships, targeted investments, and sustainable reform strategies will be critical in rebuilding Syria's ophthalmic healthcare and education system.