Attacks on Medical Education by International Federation of Medical Students' Associations

Attacks on Medical Education

Islamic University of Gaza. Photo: Mahmoud Al-hams Agence France-Presse (AFP) www.ifmsa.org

IFMSA Imprint Executive Board Carlos Acosta (Brazil), Hana Lučev (Croatia), Frida Vizcaíno (Mexico), Batool Alwahdani (Jordan), Amela Hamidović (Serbia), Satria Nur Sya’ban (Indonesia) Contributors Marian Sedlak (Slovakia), Aikaterini Dima (Greece), Abdulaziz Tibar (Libya), Haytham Sughayer (Palestine), Natalia Babenko (Ukraine), Alaa Abusufian E. Dafallah, Hafsa Abdurahim Moalm Hassan (Sudan), Dana Shubat (Syria), Francisco Enrique Machado Toro (Venezuela), Abdullah M. Bahaisami (Yemen), Faisal Abdulatef Ali (Yemen), Ahmed S. Maknoon (Yemen), Basheer M. Almashgari (Yemen) Layout Design Fahmi Kurniawan (Indonesia) Cover Mahmoud Al-hams - Agence France-Presse (AFP)

The International Federation of Medical Students’ Associations (IFMSA) is a non-profit, non-governmental organization representing associations of medical students worldwide. IFMSA was founded in 1951 and currently maintains 137 National Member Organizations from 127 countries across six continents, representing a network of more than 1.3 million medical students. IFMSA envisions a world in which medical students unite for global health and are equipped with the knowledge, skills and values to take on health leadership roles locally and globally, so to shape a sustainable and healthy future. IFMSA is recognized as a nongovernmental organization within the United Nations’ system and the World Health Organization; and works in collaboration with the World Medical Association.

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Contents www.ifmsa.org

Introduction Page 4 Disclaimer Page 5 Methodology and Time Frame Page 6 Country profiles 1. Libya Page 8 2.Palestine Page 11 3. Ukraine Page 14 4. Sudan Page 16 5. Syria Page 18 6. Venezuela Page 21 7. Yemen Page 25 Conclusion Page 29 References Page 31

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Attacks on Medical Education ART. 18. â&#x20AC;&#x201D; Civilian hospitals organized to give care to the wounded and sick, the infirm and maternity cases, may in no circumstances be the object of attack, but shall at all times be respected and protected by the Parties to the conflict. - IV. Geneva Convention relative to the protection of civilian persons in time of war. 12 August 1949

An attack on any civilian is an attack against humanitarian principles, against the very core values we collectively strive to preserve as medical professionals, as citizens of our countries, as human beings. Last decade witnessed an increasing occurrence of armed and violent conflicts, different in their nature and scope. However, conflicts of today are very different from violent clashes of the past. The proportion of civilian victims has increased from 5 percent at the start of the century to more than 90 percent in the conflicts of the 1990s. This shift has been caused by numerous factors, including an approach to war conflicts, technological advance, change in fighting strategies, a spread of non-state armed groups, and retraction from international norms and agreements covering the way how wars are fought. The impact of wars and violence on health care is far-reaching. Whenever a patient, a nurse, a doctor, a medical student, or any other component of a health care system is attacked, be it threats or actual violence, it has not only direct consequences for the affected and their health but also on the health of the served populations, causing ripples across the delivery of healthcare. Basic human rights are broken, the faith in justice fades away. Rhetorics concerning the issue of attacks on health care services usually focus the majority of

their attention on health workers, facilities, and health systems as structures ensuring access to health care for populations. This makes perfect sense since the vast majority of attacks on health care target these objects. Health workers are the cornerstone of the provision of health care - without human resources for health, there is no health care at all. Yet, health workforce must be built, raised, and educated. Without the education for health care, we skip the first and the foremost condition for strong and resilient health systems. After all, medical education is an integral component of every health system. The process of raising future health professionals is a pivotal condition of the sustainable health workforce. Hence, any interference with medical education naturally impacts the ability of a health system to effectively deliver health care to its communities. The aim of this report is to explore an impact of violence on medical education, with its specific components, such as education facilities, teaching hospitals, libraries, professors, medical students and all other directly related components. This document also had an additional goal - through work on this report we desired to empower medical students to take a lead in research and advocacy related to attacks on health care. These passionate individuals and their organisations took the first step to become champions in the protection of health

International Federation of Medical Studentsâ&#x20AC;&#x2122; Associations (IFMSA)

services in their communities. The collection of information and data connected to this project often meant for students to leave their duties behind, to sacrifice their time and energy for the project, to spend hours by researching often very inaccessible or unclear reports. They were driven by their passion and underlying commitment to shed a light on the invisible suffering of medical education in conflict zones. The Attacks on medical education is a pilot project of IFMSA and its national member organisations in this area. We invite you to read this report, to reflect on its findings, and to engage with IFMSA and its member organisations to work together to explore and research attacks on health care together with the future of health workforce. An impact of violence of any kind on health structures will have far-reaching consequences for health systems, and as doctors of the future, we will face and meet these challenges. Hence, our dedication and motivation to work with all the stakeholders to end the attacks on health care, in all their forms. Only through multilateral and interprofessional collaborations, we transform rhetorics into reality, we transform recommendations to policies, we transform this era into a safer and peaceful future for us all. Marian Sedlak IFMSA Liaison Officer for Human Rights and Peace Issues

Disclaimer The International Federation of Medical Studentsâ&#x20AC;&#x2122; Associations (IFMSA) envisions a world in which medical students unite for global health and are equipped with the knowledge, skills, and values to take on health leadership roles locally and globally. Founded in 1951, it is one of the worldâ&#x20AC;&#x2122;s oldest and largest student-run organizations. It represents, connects and engages every day with an inspiring and engaging network of 1.3 million medical students from 137 national member organizations in 127 countries around the globe. To empower medical students and their national & local organisations, the country parts of this report were researched and written independently by our national member organisations, which are properly credited and mentioned in respective country parts. The IFMSA has been created by its members, and it relies on its members to work and report on events in line with values of medical professionals - truthfulness, objectiveness, and authenticity. As IFMSA, we understand that especially in war conflicts as well as in a violent environment, it is innately challenging for all parties involved to separate and dissociate personal experience, especially when their families have been directly affected by horrible crimes. However, this report required our student members to do so. Hence, the country reports are to be recognized as the work of the particular national member organisation and not of the IFMSA. As enshrined in IFMSA Constitution, the Federation pursues its aims without political, religious, social, racial, national, sexual or any other discrimination; the Federation promotes humanitarian ideals among medical students and so seeks to contribute to the creation of responsible future physicians; and the Federation respects the autonomy of its members. This report aims to present findings of our member organisations in line with IFMSA Constitution, and no other incentives should be perceived in this paper.

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Methodology and Time Frame When selecting countries suitable for this report, we have mapped and contacted IFMSA member organisations in countries covered by 2016 Safeguarding Health in Conflict Coalition report, and we added few countries with an ongoing violent conflict with a possibility of attacks on medical education. IFMSA does not have member organisations in several of the countries covered by the 2016 report, therefore we were not able to include these chapters in our paper. Countries were provided with the standard information note and data collection guideline, which served as a template to unify the frame of this research. Due to significant differences in work of our member organisations, situations in countries, nature of conflicts, and access to data and information, we have explained specific methodologies of research in every country chapter. Apart from Venezuela, all the countries included in ‘’Attacks on medical education’’ report have been also covered in 2017 Safeguarding Health in Conflict annual report. IFMSA report expands the understanding of attack on healthcare by adding a unique aspect of medical education, opening a brand new area of possible consequences of attacks on healthcare services on health systems and their sustainability.

The data was collected by IFMSA member organisations from December 2017 to March 2018. The country profiles covered by this report have diverse time frames, reflecting different lengths of conflicts and specific situations in particular countries. For every country, the time period covered in the section is specified by the date of the number of schools before the conflict, and the date when the up-to-date number of medical schools was recorded.

International Federation of Medical Students’ Associations (IFMSA)

COUNTRY REPORTS

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1. Libya 1. Libya

This section was written by members of the Libyan Medical Students & Young Doctorsby This section was written Association (LMSA-Libya), with members of the Libyan full credits the end &ofYoung this MedicalatStudents section. Doctors Association (LMSALibya), with full credits at the

The insurgency Libya started in end of thisin section. 2011 as a part of the Arab Spring protests. This turmoil directly The insurgency in Libya started 2011 as a part Arab led toin the period whichof istheoften Springas protests. This turmoil described the ‘’First Libyan Civil directly led to the period which War’’, including an international is often describedThis as the ''First military intervention. conflict Libyan Civil War'', including an ultimately led to the eviction and international military deathintervention. of Muammar This Gaddafi, the conflict former Libyan leader. left ultimately led to The thewar eviction Libyaand in a very and deathcomplicated of Muammar deficient situation, a breeding Gaddafi, the former Libyan leader. war left Libyaand in a ground for The various armed complicated deficient rebelvery groups. Soon and after, the situation, instability anda breeding violence ground spreadfor various armed and rebel across the country, leading up groups. Soon after, the to further deterioration which instability and violence spread resulted into the second escalation across the country, leading up of armed conflictdeterioration in 2014. which to further

▉ - Fully operating: Zawia, Benghazi, Tripoli and Misrata Universities ⬤ - Partially operating: Sirte University ▲- Non-operating school: None

into the second interruption in medical education postponed a graduation Theseresulted violent conflicts affected escalation of armed conflict in 2014.of thousands of future medical doctors, which resulted into a the whole country, including the significant delay of supply of fresh doctor graduates for Libyan higherThese healthviolent education system. In the conflicts affected whole country, including the higher health education system. In public health system. addition to already documented addition to already documented attacks on health care services, the medical education system in the attacks on health care from services, the ofAlmost country suffered outbreaks hostilities as well. Severalrepeated medical in schools, including the same situation 2014, when the universities renewed in medical education system in theshut escalation Misrata and Benghazi, were down in theofperiod of February - December 2011. The violence forced medical universities in closure Tripoli, was mostly induced nearby fights army and operations. interruption in medical education postponed country suffered frombyoutbreaks of and Zawia MisrataThis to cease their operations for the period of a graduation of thousands of future medical doctors, which resulted into a significant delay of supply of hostilities as well. Several medical July to November 2014. freshincluding doctor graduates for Libyan schools, universities in public health system. Country profile: Misrata and Benghazi, were shut Almost the same situation repeated in 2014, when the renewed escalation of violence forced medical downuniversities in the period of February Methodology: internal information and interviews of in Tripoli, Zawia and Misrata to cease Data, their operations for the period of July to November - December 2011. The closure 2014. Libyan Medical Students & Young Doctors Association (LMSAwas mostly induced by nearby Libya) and its members. fightsCountry and armyprofile: operations. This

Methodology: Data, internal information and (IFMSA) interviews of Libyan Medical Students & Young Doctors International Federation of Medical Students’ Associations

Number of medical schools before the conflict started (January 2011): 5 medical schools - Zawia, Benghazi, Tripoli, Sirte and Misrata Universities Number of operating medical schools now (February 2018): 5 medical schools - Zawia, Benghazi, Tripoli, and Misrata Universities working fully, Sirte University partially operating. Number of enrolled students before the conflict and in present time: No official data available. According to approximate estimations of LMSALibya, there can be around 18850 medical students enrolled in all medical schools in Libya. The comparison of students numbers before and after conflict did not drastically change, but this number had oscillated in between of violent periods (students taking breaks or unable to access their education for various reasons).

Case studies: Province of great Tripoli: When the Libyan revolution started in February 2011, the university paused its operations due to the unstable situation in the country and general insecurity about its future. It shortly resumed its activities (March 2011), however, the majority of residing students did not return for their education, mostly due to their will to express solidarity with friends and family members who were arrested, injured or killed during protests and violence. Another interruption of education started off in August 2011, this time because of the ongoing military operation to liberate the city of Tripoli, and resumed in December 2011. Due to these disturbances in continuity of medical education, the administration of the University obliged students to re-do the whole academic year.

Province of Zawiya: The situation in the province of Zawiya was mostly similar to Tripoli university (distance between University of Tripoli and University of Zawiya is approximately 50km). The interference of violence with medical education mostly copied the pattern described in the province of great Tripoli. Province of Misrata: As for all other medical faculties, February of 2011 was a critical date for the University of Misrata as well. Protests in Misrata were exceptionally violent, and many of them were suppressed by brutal force. The city was under the siege of Gaddafiâ&#x20AC;&#x2122;s forces for six months, which had a substantial impact on the continuity of medical education. The University paused its operation from February 2011 till December 2011. In reaction to urgent need of health workers and medical support, many medical students volunteered in field hospitals and improvised healthcare facilities. Province of Sirte: Situation of Sirte was slightly different from other provinces. Since Sirte was the stronghold of Gaddafiâ&#x20AC;&#x2122;s regime, February 2011 events did not influence education as much as in other cities. With a small one-week pause in February 2011, the university operated fully till August 2011. In September, the armed conflict entered Sirte and the university operations were ceased till the end of 2011, restored in early 2012. In the spring of 2015, the so-called Islamic State of Iraq and the Levant (ISIL) took control of Sirte and forced universities to shut down their operations. In reaction, a majority of health students who were able to leave the city did so, and they joined other universities to complete their education and degrees. This led to an unproportional increase www.ifmsa.org

was interrupted in June 2014, with onset of conflict between local militias an period of violence affected the whole city, including the university, till August majority of students joined other universities to supplement their theoretical a

Conclusion:

To summarise, attacks on medical education in Libya were mostly represe and prolonged barriers to access medical education. In addition to accessibi conflicts left indelible scars on infrastructure and facilities, crucial for raisi workforce. An unstable environment, combined with direct physical and violence and conflicts, have left deep impressions in medical students' mind to cope with closures of certain schools posed an unproportional increas medical education facilities, which naturally influenced several of their capac mode of their operations. Setbacks in medical education will definitely have a sector in Libya, however, these potential consequences must be explore prevent any harm towards the population of this country.

of students in other universities around Libya. In 2016, the library of Sirte’s university was burned down and significant portion of its furniture was destroyed as well. In December 2016, the city was liberated by Libyan army and the medical university started to restitute its activities.

Contributors:

Province of Benghazi:

Contact details:

Abdulaziz Tibar - National Officer on Human Rights and Peace at LMSA Libya

Marian Sedlak - IFMSA Liaison Officer for Contributors: Abdulaziz Tibar - National Officer on Human 2017/2018 Rights and Peace at LMSA Liby Human Rights and Peace Issues Marian Sedlak - IFMSA Liaison Officer for Human Rights and Peace Issues

Similar to other cities, education was paused from February till November 2011. A relatively calm period was interrupted in June 2014, with onset of conflict between local militias and Marshal Hafter forces. This period of violence affected the whole city, including the university, till August 2015. During this period, the majority of students joined other universities to supplement their theoretical and practical lectures.

Contact details:

Libyan Medical Students & Young Doctors Association (LMSA-Libya)

Libyan Medical Students & Young Doctors Associ Contact person: Abdulaziz Tibar - National Officer on LMSA Libya; norp.lmsa@gmail.com

Contact person: Abdulaziz Tibar - National Officer on Human Rights and Peace at LMSA Libya; norp.lmsa@ gmail.com

Conclusion: Attacks on medical education in Libya were mostly represented by numerous, repeated and prolonged barriers to access medical education. In addition to accessibility and continuity issues, war conflicts left indelible scars on infrastructure and facilities, crucial for raising a future of Libya’s health workforce. An unstable environment, combined with direct physical and emotional consequences of violence and conflicts, have left deep impressions in medical students’ minds. Mechanisms which aimed to cope with closures of certain schools posed an unproportional increase of demands on the rest of medical education facilities, which naturally influenced several of their capacities connected to a standard mode of their operations. Setbacks in medical education will definitely have an impact on the public health sector in Libya, however, these potential consequences must be explored and researched further, to prevent any harm towards the population of this country.

2. Palestine

International Federation of Medical Students’ Associations (IFMSA)

2. Palestine This section was written by members of the International Federation of Medical Students’ Associations - Palestine (IFMSAPalestine), with full credits at the end of this section. Palestine has a relatively short history of education in the medical field. The first medical school was opened in 1994, and since then, three additional schools have started their operations. In reflection to current geopolitical situation and the character of demographics, the needs of the health system present a very The IslamicIslamic University in Gaza started its operations in 2006. On 29 December 2008, the university University of Gaza after bombardments. Photo: Mahmoud Al- was complex and unique task bombed for in hams six air strikes as part of the „„Operation Cast Lead‟‟ offensive in December 2008 and January - Agence France-Presse (AFP) The attack destroyed the university‟s laboratories as well as damaging the central library and medical education in Palestine. 2009. The computer facilities (1). Some sources state that approximately 74 laboratories were destroyed in this very nature of healthcare services attacks (3). Country profile: in Palestine is quite fragmented The United Nations Fact-Finding Mission on the Gaza Conflict examined this attack, and it stated in its between governmental, private report that ''it also saw the destruction caused at the Islamic the University and instarted other university buildings Number of medical schools before conflict (2012): that were destroyed or damaged. These were civilian, educational buildings and the Mission did not find and those run by NGOs (e.g. Al-Quds University in Abu Dis, East Jerusalem, West Bank; Alany information about their use as a military facility or their contribution to a military effort that might have Doctors Without Borders; made themNajah a legitimate target in the of the West Israeli armed (4). TheUniversity University hasinbeen University in eyes Nablus, Bank;forces'' Al-Azhar bombed again in 2014, causing further destruction of already fragile facilities (5). Palestine Red Crescent Society), Gaza city, Gaza Strip; Islamic University in Gaza city, Gaza international bodies (e.g. Access the to medical Strip education: Palestinian medical students constantly face difficulties to access their clinical training. The most critical UN and its agencies), and issue is related to the process of obtaining permits to train at Jerusalem hospitals (for students Number of operating medical schools now (2018): Sameof Al-Quds as religious institutions1. Often University), which have numerous departments and specialities not available anywhere in the rest of the region. Theabove permits are of two types - standard and restricted permit. Standard permit allows students to unpredictable, the political and access hospitals in Jerusalem at all times, and is automatically renewed every 6 months. Restricted safety situation in the country also permit, in contrast, allows to access hospitals in Jerusalem only during specific hours during a Number ofstudents enrolled students before the conflict and in present day, and also needs to be renewed more often than a standard permit. Of course, a student can be fully presents a significant challenge time: Approximately 4000, numbers do not oscillate due to the denied any type of a permit as well. The procedures for students to obtain these permits are very for sustainable and strategic complicatedprolonged, and bureaucratic core stable nature. Instage addition, are reports deliberate delays in butin their mostly ofthere insecurity inofthe country. processes, often forcing students to wait for their decisions about permits for hours, even days (6). approach towards medical Case studies: education. The contribution below aims to summarise the Attacks on medical education: most important issues connected Violence against higher education institutes, including medical to safety of medical education faculties, is present in the whole history of the region’s conflict, in the country, access to medical naturally rising during times of sudden escalation of violence. education, and daily situations UNESCO examined an impact of conflict during its escalation medical students have to cope between 7th of July and 26th of August 2014. In its findings, with. www.ifmsa.org

it states that ‘’there was a failure to protect education from attack during the 50-day crisis’’. Higher education institutes, including medical schools, ‘’were directly targeted during the hostilities, sustaining significant injury and loss of life among staff and student populations, as well as damage to vital infrastructure, including buildings and equipment. Such attacks have had a devastating impact on access to higher education and have implications for long-term development’’2. The Islamic University in Gaza started its operations in 2006. On 29 December 2008, the university was bombed in six air strikes as part of the ‘‘Operation Cast Lead’’ offensive in December 2008 and January 2009. The attack destroyed the university’s laboratories as well as damaging the central library and computer facilities. Some sources state that approximately 74 laboratories were destroyed in this attacks3. The United Nations Fact-Finding Mission on the Gaza Conflict examined this attack, and it stated in its report that ‘’it also saw the destruction caused at the Islamic University and in other university buildings that were destroyed or damaged. These were civilian, educational buildings and the Mission did not find any information about their use as a military facility or their contribution to a military effort that might have made them a legitimate target in the eyes of the Israeli armed forces’’4. The University has been bombed again in 2014, causing further destruction of already fragile facilities5. Access to medical education: Palestinian medical students constantly face difficulties to access their clinical training. The most critical issue is related to the process of obtaining permits to train at Jerusalem hospitals (for students of Al-Quds University), which have numerous departments and specialities not available anywhere in the rest of the region. The permits are of two types - standard and restricted

permit. Standard permit allows students to access hospitals in Jerusalem at all times, and is automatically renewed every 6 months. Restricted permit, in contrast, allows students to access hospitals in Jerusalem only during specific hours during a day, and also needs to be renewed more often than a standard permit. Of course, a student can be fully denied any type of a permit as well. The procedures for students to obtain these permits are very complicated and bureaucratic in their core nature. In addition, there are reports of deliberate delays in processes, often forcing students to wait for their decisions about permits for hours, even days. Students who were not able to obtain permits or access these rotations felt that they were at a learning disadvantage6. Variety in training opportunities and learning styles is also important to equip medical students with abilities to adapt to different local and practical contexts of hospital and healthcare management. Issues with access to medical education are also related to checkpoints procedures. These problems also include arbitrary permit rejections, long wait times, delays and mistreatment of medical students at checkpoints. The time needed to pass the checkpoint is very often unpredictable. The majority of medical students from Al-Quds University felt that their education and quality of life had been strongly negatively affected by their experience trying to access these hospital training sites (6).

Conclusion: The situation of attacks on medical education in Palestine reflects the image of its prolonged conflict and insecurity. The medical faculty of the Islamic University in Gaza was bombed several times in the span of 6 years, with every attack further damaging already fragile university buildings. This prolonged and repeated

International Federation of Medical Students’ Associations (IFMSA)

destruction made medical education for students in Gaza irrealizable. Access to medical education was not compromised only in terms of physical destruction of facilities. Palestinian students face struggles obtaining permits to access training hospitals. Failure to obtain these permits (or the most suitable type of permit) leaves students with diminished options for their medical training, which is crucial especially for specialties which are not available in any other location in Palestine. Even when they obtain permits, students can expect another set of obstacles related to checkpoints procedures, including arbitrary permit rejections, long wait times, delays and mistreatment of medical students at checkpoints. Although the history of medical education in Palestine is quite short, it had and still has to overcome several challenges related to intermittent armed conflict and its consequences. Unquestionably, attacks on medical education add new scars on the face of Palestineâ&#x20AC;&#x2122;s medical education. Contributors: Haytham Sughayer - President of IFMSAPalestine Contact details:

Contact details: The International Federation of Medical Students' Associations Palestine (IFMSA-Palestine) Contact person: Haytham Sughayer, President of IFMSA-Palestine, ifmsapalestine@ifmsa.org // haythamsu@gmail.com

The International Federation of Medical Studentsâ&#x20AC;&#x2122; Associations - Palestine (IFMSAPalestine) Contact person: Haytham Sughayer, President of IFMSA-Palestine, ifmsa-palestine@ifmsa.org // haythamsu@gmail.com

3. Ukraine This section was written by members of

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3. Ukraine

This section was written by

his section was written by members of members ofMedical the Ukrainian e Ukrainian Students Medical Students Association ssociation (UMSA), with full credits at with full credits at the e end(UMSA), of this section.

end of this section.

he hostilities in the east of Ukraine started The hostilities in the east of April 2014 when an armed conflict started in Donetsk April 2014 tweenUkraine the self-declared and an armed conflict hanskwhen People's Republics andbetween Ukraine self-declared arted. theEvents were Donetsk preceded and by Luhansk People’s uromaidan protests, the fall ofRepublics Ukrainian esident and the annexation of Crimea and Ukraine started. Eventsby e Russian Federation.byThe Ukrainian were preceded Euromaidan litary protests, reported the intensive fall ofmovement Ukrainianof oops and equipment from Russia into of the president and the annexation paratist-controlled parts of eastern Crimea by the Russian Federation. kraine. However, the Russian leadership The Ukrainian military reported s consistently rejected both accusations intensive movement of troops participation in hostilities and the supply andtoequipment from Russia into weapons the insurgents.

the separatist-controlled parts of eastern Ukraine. However, the Russian leadership has consistently rejected both accusations of participation in hostilities and the supply of weapons to the insurgents.

The political situation affected all institutions of the region, including higher education. Two medical Universities were closed for one semester until they were moved to other cities located out of the conflict area and were both reopened at the beginning of 2015. Another Medical University in Simferopol, Crimea remained on an annexed territory. Although no material damage to people or facilities was reported, the interruption in education resulted

▉ - Old locations of Donetsk and Luhansk Medical universities ⬤ - New locations of Donetsk and Luhansk Medical universities ▲- Simferopol Medical Academy

in significant academic difficulties for both students and teachers.

Country profile: Methodology: Data, internal information and interviews of Ukrainian Medical Students Association (UMSA) members, Student Scientific Societies members, official Universities websites and social media. Number of medical schools before the conflict started (April 2013): 23 medical schools Number of operating medical schools now (March 2018): 22 medical schools according to the official data Number of enrolled students before the conflict and in present time: No precise data available. The number of students enrolled in Luhansk and Donetsk Medical Universities decreased from about 8000 to 5000 during the conflict. About 6000 students were enrolled in Simferopol Medical University in 2013, now this number stands at 3600.

International Federation of Medical Students’ Associations (IFMSA)

Case studies: Donetsk: After military operations began in April 2014 the semester concluded on time but the next one was delayed. There was a gap in the education process for half a year. From December 2014 on, the University temporarily moved to 4 cities (Kramatorsk, Slaviansk, Mariupol, Liman). The number of students and teachers was extremely low in the beginning. In 2016 there were 1000 students and 294 teachers. Now this number stands at about 3000 students. There is still a University on an occupied territory, however, their diploma has no value in Ukraine. The Donetsk University plans to move back as soon as the war ends.

there. The Simferopol University was not moved to any other city. However, the government plans to re-open it in Kherson city.

Conclusion:

Summarizing, medical education and medical students in Ukraine found themselves in the middle of a political conflict, resulting in the loss of a semester for two medical schools and great decreases in the numbers of international and local schools in all 3 faculties that were affected. This exerted a subsequent effect in the public health sector and the countryâ&#x20AC;&#x2122;s economy. Evidently, the future of medical schools is closely related to political conditions, although the safety of students and teachers should never be effect in the public health sector and the countryâ&#x20AC;&#x;s economy. the mentione inimpact doubt. on the medical education of the country despite the taken measures.

of local and international students affects both the public health sector a Evidently, tThe future medical schools is closely related to political condi students and teachers should never be in doubt.

Lugansk:

Contributors:

The University was also closed for 1 semester after the beginning of military operations in May 2014. Before 2014, the number of students was about 8000, in 2018 the number is less than 2000. Most of the students entered other universities of Ukraine. From January 2015, Lugansk University started working in the city of Rubizhne, which is located in an unoccupied territory near Lugansk. Diplomas are fully accepted in Ukraine. There is still an University on an occupied area controlled by the local government, but Ukraine does not accept the diploma.

Natalia Babenko - Local Officer on Human Contributors: Nataliaand Babenko - Local Officer on Human Rights and Peace, Odessa Rights Peace, Odessa

Contact details: Ukrainian Medical Students Asso Anastasiya Petrenko, President of U president@ukrmsa.com

Contact details: Ukrainian Medical Students Association (UMSA) Anastasiya Petrenko, President of UMSA, president@ ukrmsa.com

Simferopol: After the occupation of Crimea, the University was renamed by Russian government into a Medical Academy. It now operates and the diploma is only recognized in Russia. About 400 international students left the University that time, many of them entering other universities of Ukraine. Currently, about 3600 students study

4. Sudan This section was written by members of the Medical Students International Network-Sudan (MedSIN-Sudan), with full credits at the end of this section. Sudan

has

been

experiencing

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4. Sudan section was written by 4.This Sudan members of the Medical Students International Network-Sudan This section was with written by (MedSIN-Sudan), full credits members of the Medical Students at the end of this section.

International Network-Sudan Sudan has been experiencing (MedSIN-Sudan), with full credits at thepolitical end of this section. and armed instability orconflicts in education-related Exact data on how these incidents involved medical students are not in the regionsprotests. of Darfur, available. With been 65and medical schools Sudan has experiencing South Kordofan Blue Nile Statelocated geographically in 17 states of Sudan, it is important to address how such and barriers to access and continue medical education are affecting medical students political and armed conflicts for a instability few attacks decades now. More than communities around. inand the regions of Darfur, South

1,000 university students were

Kordofan and a arrested, 15Blue killedNile andState morefor than Country few decadesprofile: now. More than 1,000 450 injured, including medical Number of medical schools before and health sciences students, in the conflict started (from date the period 2009-2012, mostly âŹ¤ - Schools with recorded incidents 2010): approximately 37 medical in demonstrations on campus schools or in education-related Number of operating protests. medical Number of enrolled students before the conflict and in present Exact data on how these incidents time: (no official statistics available) schools now (on date Feb 2018): 65 medical schools involved medical students are Number of enrolled students before the conflict and in present time: (no official statistics available)

Summary of incidents and their details: not available. With 65 medical schools located geographically Summary of incidents and their in details: Universities/Medical Schools with incidents and reports of 17 states of Sudan,Schools it is important Universities/Medical with incidents and reports of attacks arearound from all Sudan states around and in attacks are from all states and inSudan particular, particular, Darfur, Nyalaattacks & Al-Fasher universities, South North universities, Kordofan universities, to address how such and Darfur, Nyala & and Al-Fasher South andKhartoum North university, Al-Ahlia Kasala & Al-Gadareef universities. These attacks took place in university barriers to accessuniversity, and continue Kordofan universities, Khartoum university, Al-Ahlia university, campuses, and no disaggregated evidence was taken to quantify the involvement of medical students in medical education are affecting Kasala & Al-Gadareef universities. These attacks took place these events. Therefore, in our findings we refer to a diverse group of students from various specialities, medical students and communities in university campuses, and no disaggregated evidence was with undisputed, yet not measurable participation of medical students. around. taken to quantify the involvement of medical students in these events. Therefore, in our findings we refer to a diverse From October 2010 to May 2012, several clashes occurred between students supporting rival group political Country profile: of students from various specialities, with undisputed, yet not movements that left at least 20 students injured, one of them critically, at Nyala University. Later in 2012, Number of medical schools measurable participation medical students. student protests in University of Khartoum over the killing of of Darfuri students turned violent after before the conflict started (from involvement of armed forces and the incident resulted in 140 students arrested, 180 injured and From October 2010 to May 2012, several clashes occurred date 2010): ofapproximately discontinuation education for 437 months, which directly affected its medical faculty. A similar incident 2 between students supporting rival political movements that left medical years laterschools in 2014 also caused a temporary closing of the faculty for 3 months. 2015 also witnessed a at least 20 students injured, one of them critically, at Nyala tragic attack after a student was shot dead by armed forces amidst riots in University of Khartoum, one of Number of operating medical University. Laterand in arrested. 2012, student protestswere in organised University by of a the casualties amongst other dozens who were injured The protests schools now (on date Feb 2018): theunequal killing of Darfuri students rights, turned but violent local Darfur students association, aimingKhartoum to shed a over light on access to students' these 65 medical schools after involvement of armed forces and the incident resulted protests soon turned violent after interventions of security forces. The incidents resulted in discontinuation 7 in 140 students arrested, 180 injured and discontinuation of of education for 4 months . education for 4 months, which directly affected its medical

Attacks also targeted professors, researchers and campus speakers perceived to be undertaking controversial research or making anti-government remarks. According to the African Centre for Justice International Federation of Medical Studentsâ&#x20AC;&#x2122; Associations (IFMSA) 16 and Peace Studies, on 24th November 2011, the National Intelligence and Security Services (NISS)

faculty. A similar incident 2 years later in 2014 also caused a temporary closing of the faculty for 3 months. 2015 also witnessed a tragic attack after a student was shot dead by armed forces amidst riots in University of Khartoum, one of the casualties amongst other dozens who were injured and arrested. The protests were organised by a local Darfur students association, aiming to shed a light on unequal access to students’ rights, but these protests soon turned violent after interventions of security forces. The incidents resulted in discontinuation of education for 4 months7. Attacks also targeted professors, researchers and campus speakers perceived to be undertaking controversial research or making anti-government remarks. According to the African Centre for Justice and Peace Studies, on 24th November 2011, the National Intelligence and Security Services (NISS) raided the offices and arrested members of an AIDS education and prevention group located at Al Gezira University. The only reason was that the group had carried out a survey on the prevalence of HIV and AIDS. The members of the group were released on the same day, but all reports, findings and data related to their research were confiscated and the DirectorGeneral of the Ministry of Health suspended the research8. Another report mentions five students of the University of Khartoum, who were arrested and detained by NISS without a reason on 13th of April 2016 at Khartoum Dental Hospital. They only accompanied an injured friend to the hospital. The students were released later in June 20169.

Conclusion:

education in Sudan. However, we can observe that attacks on medical education, its leadership, facilities, and medical students themselves, have immense implications. A temporary, but repeated discontinuation of education has delayed and affected academics and training in many medical schools in Sudan. In affected schools, students now graduate after 7 years or more, instead of a normal period of 6 years. In the past, similar delays have been reported in Liberia10 and Iraq11 with significant long-term consequences onConclusion: healthcare delivery. The effects on the In summary, the lack of monitoring and reporting frameworks, data collection m sustainability ofit the country’s health on this topic makes problematic to uncover the real workforce scale of attacks on me However, we can observe that attacks on medical education, its leadersh cannot be predicted. The psychological setback students themselves, have immense implications. A temporary, but repeated d has delayed and affected academicsstudents and training as in many medical schools experienced by medical a result of in S sStudents now graduate after 7 years or more, instead of a normal period of 6 unstable learning environment and frequent delays have been reported in Liberia (4) and Iraq (5) with significant lon healthcarehas delivery. The effects on the sustainability of the country's hea attacks a detrimental effect on students’ predicted. The psychological setback experienced by medical students as a motivation performance. environment and and frequent attacks has a detrimental Ultimately, effect on students' mo Ultimately, inhibiting the access of medical students to education induces a c inhibiting the access of medical students to much needed health services in conflict-affected populations. Unstable and v country, naturally influencing the area of of current and that future affect medical profess education induces a chain events influencing and recruitment of medical students by various armed and id much needed health services in conflict-affected opposing the moral and ethical values of doctors-to-be (6). populations. Unstable and volatile environment inResources: the1. country, naturally influencing the area of Sudan [Internet]. Protectingeducation.org. 2018 (accessed on 16 Ma http://www.protectingeducation.org/country-profile/sudan current and future medical professionals, opens a 2. ACJPS, Sudan Human Rights Monitor October-November 2011 (ACJP space influencing and recruitment of medical 3. for Safeguarding Health in Conflict Coalition. Impunity must end: attacks o conflict in 2016. (accessed on February 10, studentshttps://www.safeguardinghealth.org/sites/shcc/files/SHCC2017final.pdf by various armed and ideological 4. Challoner, R., & Forget, the N. (2011). civil war on med groups, directlyK. opposing moralEffect andof ethical International Journal12 of Emergency Medicine, 4(1), values of doctors-to-be . https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3051893/ 5.

Barnett-Vanes, A., Hassounah, S., Shawki, M., Ismail, O. A., Fung, C., of conflict on medical education: a cross-sectional institutions in Iraq. BMJ open, 6(2), e0104 http://bmjopen.bmj.com/content/6/2/e010460 Alaa Abusufian E. Dafallah - SCOME Regional Assistant 6. Gadher, D.; Corke, J. (2017, February 5). British medics studying in for AfricaAvailable at: https://www.thetimes.co.uk/edition/news/british-medicsHafsa Abdurahim Moalm Hassan - National Officer on join-isis-80vcjvkcj (2016). Impact Contributors:

Human Rights and Peace Contributors: Aikaterini Dima - IFMSA Liaison Officer for Medical Alaa Abusufian E. Dafallah - SCOME Regional Assistant for Africa Education IssuesMoalm Hassan - National Officer on Human Rights and Peace Hafsa Abdurahim

Aikaterini Dima - IFMSA Liaison Officer for Medical Educa

Contact details:

Medical Students’ International Medical Students' International Network-Sudan (Me Network-Sudan (MedSIN-Sudan) Contact details: ElTahir Abdelrahman, President of sudan@ifmsa.org

In summary, the lack of monitoring and reporting frameworks, data collection mechanisms, and research on this topic makes it problematic to uncover the real scale of attacks on medical

Contact details:

Contact details: ElTahir Abdelrahman, President of MedSIN-Sudan, medsin-sudan@ ifmsa.org www.ifmsa.org

5. Syria

This section was written by This section members members ofwas the written SyrianbyMedical Medical Students' of the SyrianAssociation Students’ (SMSAAssociation (SMSA-Syria), with full Syria), with full credits at the end credits at the end of this section. of this section. Syria profound changes Syria went wentthrough through profound since 2011 - a 2011 civil conflict turned changes since - a civilthat conflict into armed clashes and caused the that turned into armed clashes and worst humanitarian crisis of the 21st caused leaving the worst century, morehumanitarian than 450,000 crisis ofbehind, the 21st martyrs andcentury, causing leaving a colossal more than 450,000 destruction in the martyrs country‟s infrastructure, including schools, behind, and causing a colossal hospitals, universities, and houses. destruction in the country’s

infrastructure, including schools, hospitals, universities, and houses.

Country profile:

Methodology: Official governmental resources, verified media pages, Country profile: human resources (including medical students and teachers) contacted Methodology: Officialin universities. governmental resources, verified

media pages, human resources

▉ - Fully operating: Aleppo, Tishreen, Al-Andalus, Hama, Al-Baath, Kalamoon, Syrian Private and Damascus Universities ⬤ - Partially operating: none ▲- Non-operating school: Al-Furat

Number of medical schools before (including medical students and the conflict started (2011): 9 teachers) contacted in universities. Number of operating medical schools now (2018): 8 areas. Al-Baath, Aleppo and Al-Kalamoon came geographical Number students before the conflict and in present time: Before: 18000, After: 16200 Numberof enrolled of medical schools

back to function after one semester while Al-Furat was 75% before the conflict started destroyed and citizens have fled from the city; it has been Before the conflict, Syria had 9 operating medical schools. After the first year, Al-Furat university, Al(2011): 9 university, Al-Baath universitydysfunctioning since then. Kalamoon and Aleppo university paused their operations due to the circumstances in their geographical areas. Al-Baath, Aleppo and Al-Kalamoon came back to function after

Number of operating medical schools now (2018): 8

Number of enrolled students before the conflict and in present time: Before: 18000, After: 16200 Before the conflict, Syria had 9 operating medical schools. After the first year, Al-Furat university, Al-Kalamoon university, Al-Baath university and Aleppo university paused their operations due to the circumstances in their

Some Private universities which have been opened in Syria after 2000, had to stop education at their original buildings (mostly situated in suburbs of Damascus or Daraa-highway) and rented schools or buildings in the city center of Damascus. Medical students attended their classes in alternative buildings in the city center, while they were not able to reach the original buildings of the university in Kafr-Ali area. Although public universities still function, in case of missiles, mortals, bombings or any other attack, students automatically pause their education for one day at a time. In 2013, a major explosion took place in Aleppo university which caused the death of 226 people including 83 students, at the first day of mid-term exams. The reaction was that all the Syrian

International Federation of Medical Students’ Associations (IFMSA)

universities paused their education process for three days due to what happened in Aleppo university. Students from the destroyed university of Al-Furat had a possibility to continue (transfer) their studies to either Damascus, Aleppo or Tishreen university. Therefore, ministry of higher education increased the number of accepted students in medical schools from 700 per year (before conflict) to 1000 students per year. With incoming students from Aleppo, Al-Furat and AlBaath universities, numbers of students in faculty of medicine of Damascus university raised to approximately 1300-1500 students per year.

Science school, on March 28th 2013 - a destructive missile was thrown randomly and shrapnels reached the studentsâ&#x20AC;&#x2122; cafeteria where students spend their breaks. The death toll reports vary from 12 to 17 people, with many injured. The perpetrator of this attack remained unknown as no party claimed the responsibility for the attack 13,14. Most of the photos shared back then werein not relateduniversity: to destruction of Lecturing theatre Damascus facilities, but6th to 2015, injuries and suffering of students. On February several mortars (number not defined Damascus university which caused destruction in lecturing The place of cafeteria was fixed later and it ha they were empty at the time, but damage to furniture and w functions normally in present days. partially

fixed

later.

Perpetrators

remain

Lecturing theatre in Damascus university:

Case studies: Major destruction in Al-Furat university: Al-Furat university colleges are based in Deir Ezzour and Raqqa. Those two cities have been shelters for civilians in 2011, eventually, they became targets in the next years of war conflict. Attacks were random, leading to profound destruction in some parts of university facilities, and less in other parts. The whole city of Deir Ezzour was destroyed, every building and bridge was damaged, burnt or torn down. The responsibility lies on the shoulders of all fighting groups, but the major destruction was done by foreign forces and ISIS. Studentsâ&#x20AC;&#x2122; Cafeteria attack in Damascus university:

Lecturing hall at Damascus University after the February 6th 2015 attacks. Source: Yawmiat Kazifat Hawin team

On February 6th 2015, several mortars (number not defined) were thrown at the biology building in Damascus university which caused destruction in lecturing halls. No injuries of students were noted, as they were empty at the time, but damage to furniture and walls has been severe. Classrooms were partially fixed later. Perpetrators remain unknown as no party adopte d the attack.

Faculty of Science, Damascus university, after the March 28th 2013 attack. Source: Yawmiat Kazifat Hawin team

ecturing theatre in Damascus university:

www.ifmsa.org

enrollments in the receiving faculties and creating a burden for the unprepared infrastructure. Direct attacks on lecturing theater and student gathering areas such as cafeterias and halls led to deaths, injuries, destruction of infrastructure and a large number of students not returning to their studies. Overall, the losses created by the war greatly impacted education as well, and the human cost of attacks on medical education in Syria is yet to be discovered.

3. Karouny, M. (2013, January 15). Explosions kill 83 at Syrian u Available at: https://www.reuters.com/article/us-syria-crisis/explo exams-begin-idUSBRE90E0V820130115

Lecturing hall at Damascus University after the Contributors: February 6thstudents’ 2015 gathering attacks. Source: Yawmiat Aleppo university, hall: Contributors: January 15th 2013, theteam most brutal attack with a destructive missile on Aleppo University is noted. It was Kazifat Hawin Dana Shubat - President of SMSA

Dana Shubat - President of SMSA an exam day, and all students were in one place waiting for their exams to start. This caused a huge loss; Aleppo gathering 83 victims anduniversity, hundreds ofstudents’ injured students and hall: bystanders. All the universities Contact details: in the country were forced to pause their operation, and exams were postponed. This incident represents a breaking point in January 2013, the attack withtheir a education after this attack, and many fled the Syrian crisis15th for students as most many brutal students paused destructive missile Aleppo University is very noted. after the loss of friends andon family members. It was a tragic day for Syrian people and it was followed by minor attacks on other universities the weekwere after.in Perpetrator remains unknown as no party It was an exam day, and all instudents claimed the attack (3).

Contact det

Syrian Medi

Contact pers smsa-syria@

one place waiting for their exams to start. This caused a huge loss; 83 victims and hundreds Formatted: Font Conclusion: color: Blue of injured students and bystanders. All the The 2011 Syrian outbreak and the subsequent civil war left a significant mark on medical education. One universities the forced Syrian Medical Students’ Association (SMSAmedical school hasin still notcountry resumedwere operation and to thepause remaining 8 were forced to temporarily cease their operations. Some private to postponed. resume operations different locations for safety reasons. their operation, andfaculties examshad were This inSyria) Largeincident numbersrepresents of studentsahad to transfer universities, causing a significant increase in the number of breaking point in the Syrian enrollments in the receiving faculties and creating a burden forContact the unprepared Direct President of person:infrastructure. Dana Shubat, crisis for students as many students paused their attacks on lecturing theater and student gathering areas such SMSA, as cafeterias and halls led to deaths, smsa-syria@ifmsa.org education after this attack,and anda large manynumber fled after injuries, destruction of infrastructure of students not returning to their studies. Overall, the loss of by friends and family members. It was the losses created the war greatly impacted education as well. a very tragic day for Syrian people and it was followed by minor attacks on other universities in the week after. Perpetrator remains unknown as Resources: 15 no party claimed theMarch attack 1. Dehghanpisheh, B.(2013, 28)..Mortar attack on University of Damascus kills at least 12. The

Washington Post. Available at: https://www.washingtonpost.com/world/middle_east/mortar-attack-onConclusion: university-of-damascus-kills-at-least-12/2013/03/28/b713b018-97c3-11e2-97cd3d8c1afe4f0f_story.html?utm_term=.7178c39d66d8 The 2011 Syrian outbreak and the subsequent 2. Holmes, O. (2013, March 28). Mortar strike kills 15 in Damascus University: state media. Reuters. civilat:war left a significant mark on medical Available https://www.reuters.com/article/us-syria-crisis-students/mortar-strike-kills-15-in-damascuseducation. One medical school has still not university-state-media-idUSBRE92R0E020130328

resumed operation and the remaining 8 were forced to temporarily cease their operations. Some private faculties had to resume operations in different locations for safety reasons. Large numbers of students had to transfer universities, causing a significant increase in the number of

International Federation of Medical Students’ Associations (IFMSA)

6. Venezuela

This section was written by members of the Federación Venezolana de Sociedades Científicas de Estudiantes de Medicina (FEVESOCEM), with full credits at the end of this section.

▉ - Fully operating ⬤ - Partially operating

▲- Non-operating

Venezuela went through one of the worst health sciences, who provided first aid service civil conflicts of the last decades in 2017. This during these protests. The marches began a Venezuela went through one of the worst civil conflicts of the last decades in 2017. This situation started situation started in Aprilaround and culminated around series of rulings by thebySupreme Court Justice in April and culminated August of that year. The conflict was marred barricades, tearofgas August thatclashes year. between The conflict was marred (Tribunal de were Justicia) that caused a canisters,ofand demonstrations and security state Supremo forces; these the scenes that marked the day-to-day of Venezuela by barricades, tear gas canisters,in this andperiod. clashes status quo change in the decision making abilities between demonstrations and security state of the National Assembly. The marches began on April 4, 2017, with some episodes more violent than others, and left 123 dead forces; these were the scenes that marked the During these conflicts, all of the Venezuelan until July 30, including two students of health sciences, who provided first aid service during these day-to-day of Venezuela in this period. universities were stopped due to their problems and the challenges that made it impossible to The marches began on April 4, 2017, with some continue classes: principally access to them, episodes more violent than others, and left 123 including all the schools of medicine in the dead until July 30, including two students of www.ifmsa.org

protests. The marches began a series of rulings by the Supreme Court of Justice (Tribunal Supremo de Justicia) that caused a status quo change in the decision making abilities of the National Assembly. During these(15 conflicts, all of the Many Venezuelan universities were stopped due to their problems and thestudents before the conflict country in total). attacks occurred Number of enrolled challenges that made it impossible to continue classes: principally access to them, including all the against during classes, against and medical in present schools of medical medicine in schools, the country (15 in total). Many attacks occurred against schools,time: during No official data available. classes, against students, even against the principal headquarter of the Red Cross country office (1). students, even against the principal headquarter Based on the internal data of FEVESOCEM 16 of the Red Cross country office . Venezuela - approximately 9500 before the conflict, approximately 6500 after the conflict

Case studies: Threats / intimidation of medical personnel of the Central Hospital of San Cristóbal during protests: During the month of April and May several threats were reported against the personnel of the Central Hospital of San Cristóbal, Táchira state, because the National Guards forbade Picture: Doctors with arms treating the wounded during social protests, crossed during the march of doctors on May 22nd,some 2017 in doctors who attended these intimidating Caracas, Venezuela. Picture: Doctors with arms crossed during wounded youth, despite the multiple protests Source: Jamez42 the march of doctors on May 22nd, 2017 in (https://commons.wikimedia.org/wiki/File:Medic_Protesters_Venezuela_2017.jpg#filelinks), that took place in the hospital, this intimidation https://creativecommons.org/licenses/by-sa/4.0/legalcode Caracas, Venezuela. did not stop. Source: Jamez42 (https://commons. wikimedia.org/wiki/File:Medic_Protesters_ Venezuela_2017.jpg#filelinks), https:// creativecommons.org/licenses/by-sa/4.0/ legalcode

Tear gas pumps near the Del Valle maternal and child hospital on 04/20/2017:

3. Search reports

Oscar Noya is a doctor and professor at the Central University of Venezuela (UCV). He works continuously for the population that lives in the upper Orinoco. Through the Twitter social network it was possible to know that in the afternoon of Thursday, April 20, Dr. Oscar Noya was arrested, when participated in the protest. Moya was helping people affected by tear gas in Santa Monica, Caracas.

The use of tear gas bombs by the Bolivarian National Police and the Bolivarian National Guard in Longaray and the Intercomunal Avenue of El Valle affected the patients of El Country profile: Valle Children’s Maternity Hospital. Gases Country profile: Short methodology: seeped into hospital facilities affecting workers, Short methodology: mothers and newborns17. 1. Contacting medical their 1.- Contacting medical students for theirstudents testimonies of for the attacks, interviews with students testimonies of the attacks, interviews with Detention of the professor of medical school students of the Universidad Central de Venezuela, MD Óscar Noya, on 04/20/2017: 2. Investigations on the internet 4. Register information Number of medical schools before the conflict started (April 2017): 15 Number of operating medical schools now (February 2018): 14

International Federation of Medical Students’ Associations (IFMSA)

In various sources it was stated that the journalist Magda Gibelli - who was with Noya at the time of his arrest - indicated that they were one block away from the Cristo Rey school, when suddenly some GNB officials came and stopped him without saying a word. They insulted him and kicked him continuously. He only told them that he had no weapons, that he was a doctor and father of three children. Noya provided a series of recommendations to people who had to get into the Guaire River to escape the effect of tear gas bombs by GNB officials18. Detention of medical team: 2 residents of traumatology of the Hospital “Dr. Patrocinio Peñuela Ruiz” on 05/16/2017: On May 16 2017, two traumatology residents of the Dr. Patrocinio Peñuela Ruiz were arrested for having served students who were protesting and were injured by pellets at the hands of the National Guard, the doctors did not obey the rules of the National Guard and therefore were taken handcuffed outside the Hospital. Shooting and burning of auditorium of medicine of the Universidad de Los Andes and two vehicles at the hands of police and collectives on 05/18/2017: A peaceful protest by university workers and students turned violent on Wednesday when collectives and police officers attacked demonstrators and bystanders on avenues in Mérida, leaving several wounded. The action began around 10 o’clock in the morning, after an Intergremial Assembly of workers of the Universidad de los Andes (ULA) was held in an auditorium of the Faculty of Medicine of the same house of studies. There, the Association of Teachers (Apula), the Association of Employees (Aeula), the Union of Professionals and Technicians (Siprula) and the Union of Workers of the ULA (Soula), together

with the Trade Union of Graphic Arts of the State of Mérida (Sagem) ) and the Federation of University Centers (FCU) agreed on a calendar of protests to demand the defense of Venezuelan higher education, among these, the closure of several avenues this Wednesday, a 24-hour strike on Thursday and a bang on Friday19. Murder of Paul Moreno, member of first aids and medicine student on 05/18/2017: The Deputy of the National Assembly, Juan Pablo Guanipa, confirmed this Thursday May 18 the death of a young man in Maracaibo named Paúl René Moreno, 24 years old. “We report with deep sorrow the death of Paúl Moreno (24) another Venezuelan young man assassinated by the dictatorship of Nicolás Maduro in Maracaibo,” the deputy told Parliament on his Twitter account @ JuanPGuanipa. He explained that Moreno “was a medical student, he helped those affected in the demonstrations, and he was vilely run over with a white Hilux van escorted by motorized vehicles. Today they killed a Green Cross in Maracaibo.” Paúl Moreno was a volunteer and was studying a year of medicine,” deputy José Manuel Olivares also declared. The University of Zulia said that the incident occurred in the line of armed forces. Moreno was transferred to Adolfo Pons Hospital, presented with a skull, multiple rib fractures and a femur fractures. Witnesses commented that Moreno was sitting on the sidewalk, when he was rammed by the truck. Commissions of the CICPC and GNP are in place collecting information of criminal interest20. Shots, siege inside the facilities of the school of health sciences “Dr. Francisco Battistini Casalta” of the Universidad de Oriente, loss of university autonomy on 05/24/2017: www.ifmsa.org

Within the facilities of the school of health sciences “Dr. Francisco Battistini Casalta” of the Universidad de Oriente, in Ciudad Bolívar in the Bolívar state, were fired at, by the hands of the National Guard and collectives, with was total loss of university autonomy resulting from this fact; in addition, injuries by buckshot were noted. Shots, siege inside the facilities of the deanship of medicine of the Universidad de Oriente, murder of one nursing student on 05/24/2017: The deputy to the National Assembly, José Manuel Olivares, reported on Wednesday May 24 the death of nursing student Augusto Pugas, after receiving a bullet in the head during the protests in the state of Bolivar. “Augusto Puga, another young man who was murdered by the dictatorship, has just passed away. Enough to kill the future. We accompany his family in this pain” said the parliamentarian on his Twitter account @joseolivaresm. According to deputy Tony Geara, the student was in the deanship’s facilities of the UDO Bolívar when he was hit by the projectile21.

officials. A broad banner was extended at the main entrance of the building, where on 05/06/2017 it was attacked by toxic gases, which affected those who remained in custody and the staff of the institution. From its account on the Twitter social network, the international medical organization explained that “the emblem of the Red Cross indicates protection to the injured, the personnel that assist them and the place where they are assisted. Respect the emblem.” Since that Friday night and early Saturday morning, the La Candelaria sector was the scene of strong clashes between military officials and anti-government shock groups that took one of the popular sectors23. Contributors:

Contributors: Francisco Enrique Machado Toro - President of Francisco Enrique Machado Toro - President of FEVESOCE FEVESOCEM

Contact details: Federación Venezol Estudiantes de Med Contact person: Franc FEVESOCEM, francisc presidencia@fevesoce

Tear gas pumps inside the “Dr. Héctor Nouel Joubert” Hospital on 05/31/2017: The Bolivarian National Police launched tear gas bombs against Dr. Héctor Nouel Joubert Hospital, located in Ciudad Bolívar in Bolívar state, which affected hospitalized patients and they had to be evicted22. Attack against the Red Cross building in Caracas on 06/10/2017: The headquarters of the Red Cross organization, located in the La Candelaria sector in Caracas, hoisted its international flag on the front of the building, as a symbol of protection for patients, staff and the building where it operates, after it was the target of a bomb tear gas thrown during clashes between protesters and National Guard

Contact details: Federación Venezolana de Sociedades Científicas de Estudiantes de Medicina (FEVESOCEM)

7. Yemen

Contact person: Francisco Enrique Machado Toro, President of FEVESOCEM, franciscomachadotoro@gmail.com // This section was presidencia@fevesocem.org

International Federation of Medical Students’ Associations (IFMSA)

written by members of the National Association of Medical Students Yemen (NAMS- Yemen), with full credits at the end of this section.

Contact person: Francisco Enrique Machado Toro, President of FEVESOCEM, franciscomachadotoro@gmail.com // presidencia@fevesocem.org

7. Yemen 7. Yemen

This section was written by members of the National Association of Medical Students section was Yemen (NAMS-This Yemen), with full written by members of credits at the end of this section. the National of Medical Number of Association medical schools Students Yemen before the (NAMSconflictYemen), started with (2013): 7 full credits at the end of this section.

Number of operating medical schools now (2018): Number6 of medical schools before the Number of enrolled students conflict started (2013): before the conflict and in 7 present time: (no official statistics Number of operating available) medical schools now 6 “Since 2014, (2018): ongoing conflict Number of enrolled students before the conflict and in present time: (no official statistics available) between government and According to WHO, more than 1,900 out of 3,507 health nongovernmental forces has facilities 16 governorates are either non-functional “Since 2014, ongoing conflict betweeningovernment and nongovernmental forces has produced aor severe produced a severe humanitarian partially functioning. An estimated 30,000 dedicated local humanitarian crisis. The clashes have destroyed public infrastructure and services, like hospitals and crisis. The clashes haveblocked destroyed health play the largestpeople role infrom ending outbreak schools, access to basic workers supplies who and forced 3 million their this homes. 22.2 million public infrastructure services, have not been paid— their nearly 10 months Peopleand — 75 percent of the country‟s population are insalaries desperatefor need of humanitarian aid,and including like hospitalsfood,and schools, water and medicine“ (1). operational costs in more than 3,500 health facilities are not blocked access to basic supplies paid. Between 19 March and 15 July, reported deaths and half of all health facilities non-functional - An estimated 10.4 reached million people lack and access to and forced 3“Nearly million people injuriesare from health facilities in Yemen 8,389 basic 22.2 healthcare, including56,130 8.8 million living in severely and medical from their homes. million respectively. Given under-served that only 45areas. per Medicine cent of health People — 75 percent of the facilities are functioning, the actual figures are likely to be country’s population — are in higher”25. desperate need of humanitarian At the beginning of the second decade of the 21st century, aid, including food, water and medical education in Yemen was undergoing a process medicine“24. of standardizing curriculum in seven medical schools that “Nearly half of all health facilities are present throughout the country to ensure quality and to are non-functional - An estimated promote a new generation of doctors that are equipped with 10.4 million people lack access knowledge and skills to serve their community. However, to basic healthcare, including these efforts have ceased due to the internal conflict that 8.8 million living in severely has affected the educational process in many ways. During under-served areas. Medicine the days of the conflict, most of the medical schools stopped and medical supplies/materials operating because of insecurity and damage to their buildings are in chronically short supply. or damage to infrastructures.

www.ifmsa.org

Case studies: Hadhramout: Hadhramout University College of Medicine (HUCOM) is a medical school situated in Hadhramout province south of Yemen. It is considered one of the governmental local medical schools that adopt innovative medical curricular modules such as problem-based learning (PBL). Due to the security instability and damage to infrastructure, it stopped operating for six months at the beginning of the conflict in April 2015 when al-Qaida took over Al Mukalla city. This situation led most of the foreign professors and students to flee the country. In the same year, the total number of students was 846 according to the university records which was considered less than previous years. However, in the following two years (2016\2017), when al-Qaida slowly moved out of the area, which led to security stability, and thanks to this relative stability, medical students were attracted to resume their studies in HUCOM. As the result, students’ number attending HUCOM increased with a total number of students (893, and the next term 907) respectively. On the other hand, most of the foreign doctors have not come back. Aden: Aden University College of Medicine, the medical school situated in Aden, the temporary capital of Yemen, stopped operating for seven months at the beginning of the conflict on 26 of March 2015, when Houthis attacked the city. The total number of students in the year 2015/2016 was 1236, and in the year 2017/2018 is 1552 according to the university records. The total number of students who cannot continue their studies due to security instability is approximately 40, for unknown reasons. We know that there is some damage to the infrastructure of the college in various buildings, and damage to medical laboratories, teaching and training materials,

however, the main obstacle to perform a more detailed study is a very poor security situation and violent armed conflict. Al Hudaydah: Faculty of medicine and health sciences in Al Hudaydah University stopped operating after students‟ number attending HUCOM increased with a total number of students (893, and the next term 907) respectively. On the other hand, most of the foreign doctors have not come back. being targeted at the end of 2015. Students Aden: could not continue their studies. One of the Aden University College of Medicine, the medical school situated in Aden, the temporary capital of Yemen, stopped operating for seven months beginning of the conflict on 26 of March 2015, when reasons, besides anat theongoing armed conflict, Houthis attacked the city. The total number of students in the year 2015/2016 was 1236, and in the year 2017/2018 1552 according to the university records. total number of students buildings who cannot continue wasis that a large part ofThethe college their studies due to security instability is approximately 40, for unknown reasons. We know that there is some damage to the infrastructure of thestudents college in various buildings, and damage to medical was destroyed. The were transferred to laboratories, teaching and training materials, however, the main obstacle to perform a more detailed study is a very colleges, poor security situation and violent armedthe conflict. other including Faculty of Medicine at Sana’a University. There was a drop in Al Hudaydah: Faculty of medicine and health sciences in Al Hudaydah University stopped operating after being targeted theend ofnumber crisis,besides and a at the 2015. Students of could students not continue their after studies. Onethe of the reasons, an ongoing armed conflict, was that a large part of the college buildings was destroyed. The students were significant decrease inof Medicine the number ofThere foreign transferred to other colleges, including the Faculty at Sana'a University. was a drop in the number of students after the crisis, and a significant decrease in the number of foreign students from students from other countries. other countries.

C H S h k

Destruction of Al Hudaydah University. 2015. Source: https://www.youtube.com/watch?v=kir_ RsTJvhM&feature=youtu.be academic year 2015-2016 in Jordan, in the city of Ibb, and the city of Taiz. Then, after the liberation of the Taiz:

The University of Taiz, College of Medicine, closed after Houthi militias started the war on the city of Taiz.

These battles lasted for approximately seven months, during which the college fell under their control. By this time, the Faculty of Medicine opened three programs to prepare students for the completion of the

Taiz: The University of Taiz, College of Medicine, closed after Houthi militias started the war on the city of Taiz. These battles lasted for approximately seven months, during which the college fell under their control. By this time, the Faculty of Medicine opened three programs to prepare students for the completion of the academic year 20152016 in Jordan, in the city of Ibb, and the city of Taiz. Then, after the liberation of the University of Taiz, it returned to function in its own camps. It also opened a program in Al-Hoban district in the province of Taiz along with the academic

International Federation of Medical Students’ Associations (IFMSA)

education in the university building. So far, the educational process continues in the university building, alongside an educational program outside the city in Alhoban for those who could not enter the city. Additionally, the program also resumed its course in the Faculty of Medicine in the city of Ibb. Some of the main reasons which led to the closure of the College of Medicine in Taiz were: 1. Lack of security due to the control of Houthi militias over the university; 2. Destruction of many laboratories and buildings especially in the Faculty of Medicine; 3. Displacement of many teachers as well as the cutting the university budget by the Houthi militias in Sana’a. The challenges and difficulties of resuming the educational process: 1. Damage to many laboratories; 2. Displacement of teachers as well as the inability to pay their salaries on a regular basis; 3. Low university budget; 4. Security challenges Programs were opened in Alhoban for those who could not enter the city because of the siege imposed by the Houthi militias. Sana’a: Sana’a University College of Medicine stopped operating at the beginning of the conflict for two months from March 2015 until May 2015, because of a security instability and some damage to infrastructure. However, it regained its function shortly afterwards. In regard to the teaching staff, some professors and doctors

escaped the country and the others stopped teaching because the college stopped providing them with salaries. Nevertheless, some of them continued teaching in college camps as volunteers. The college continued its operations regardless of the airstrikes, the security instability, and the damage to the infrastructure with the lack of fuel and electricity, which was powered by solar energy. The college of medicine in Sana’a received students from different provinces such as Taiz, Dhamar, and Al-Hudida. Hence, overcrowding of the classes arose as a significant problem. Some batches had reached a number of 355 students in one class. Students from the Al-Hudida had their medical school hit by an airstrike and was out of function, leading them to open a branch of their college in Sana’a University. The overcrowding of classes, the lack of salaries for teachers who worked and work in more than one university to compensate for their livings, the damaged infrastructure, and the airstrikes near the teaching hospitals have all affected the quality of medical education in Sana’a University College of Medicine. Challenges: Due to security issues, problems with electricity and communication, we were unable to get access to some colleges, thus we do not have a complete picture of Yemen’s medical schools. It was very difficult to verify reports of attacks.

Conclusion: Similarly to Syria, the humanitarian crisis in Yemen has resulted in significant impairments to medical education. The closing of a medical school due to the destruction of infrastructure and the temporary pause in operations of 4 other medical schools for several months resulted in ongoing problems. Large number of students were transferred, for which receiving institutions www.ifmsa.org

had been unprepared. Faculty staff stopped receiving payments or they were significantly lowered, thus forcing them to compensate by teaching in multiple occasions to provide for themselves and their families; however, many continued to teach on a voluntary basis. Direct attacks on the infrastructure were also noted including hospitals and university buildings. Contributors: Abdullah M. Bahaisami - President of NAMSYemen Faisal Abdulatef Ali - NAMS-Yemen Vice President Internal Ahmed S. Maknoon - National Officer on Medical Education Abdullah M. Bahaisami - President of NAMS-Yemen

Basheer M. Almashgari - SCOPH assistant Faisal Abdulatef Ali - NAMS-Yemen Vice President Internal

Ahmed S. Maknoon - National Officer on Medical Education Basheer M. Almashgari - SCOPH assistant

Contact details:

Contact details: National Association of Medical Students - Yemen (NAMSYemen) Contact person: Abdullah M. Bahaisami, President of NAMSYemen, nams-yemen@ifmsa.org

National Association of Medical Students Yemen (NAMS- Yemen) Contact person: Abdullah M. Bahaisami, President of NAMS-Yemen, nams-yemen@ifmsa. org

Conclusion:

As evidenced by the present report, a multitude of incidents resulting in disturbances to medical education were recorded, varying in nature and extent. These disturbances concern the initiation, continuation and conclusion of medical studies and range from direct attacks to teaching locations such as Al-Furat and Damascus Universities in Syria, or the attacks against faculties in Venezuela, to indirect attacks inhibiting studentsâ&#x20AC;&#x; access to medical education, such as the obstruction to obtaining permits noted in Palestine, effectively excluding Palestinian students, or the cease of operations across multiple faculties in Libya. The attacks have largely taken the form of barriers to access, rather than targeted strikes. Obstructions to access medical education differ in their causes, nature and length. In the vast majority of countries presented in this report,Associations the sole presence International Federation of Medical Studentsâ&#x20AC;&#x2122; (IFMSA)of violent conflict and disturbances posed

Conclusion As evidenced by the present report, a multitude of incidents resulting in disturbances to medical education were recorded, varying in nature and extent. These disturbances concern the initiation, continuation and conclusion of medical studies and range from direct attacks to teaching locations such as Al-Furat and Damascus Universities in Syria, or the attacks against faculties in Venezuela, to indirect attacks inhibiting studentsâ&#x20AC;&#x2122; access to medical education, such as the obstruction to obtaining permits noted in Palestine, effectively excluding Palestinian students, or the cease of operations across multiple faculties in Libya. The attacks have largely taken the form of barriers to access, rather than targeted strikes. Obstructions to access medical education differ in their causes, nature and length. In the vast majority of countries presented in this report, the sole presence of violent conflict and disturbances posed a significant challenge for medical students to enter their schools. Direct violence, insecure environment, damaged infrastructure, fear of risking their lives and safety, or sympathy with their families and friends - these are several reasons contributing to restrained access to medical education. However, the number of direct assaults towards medical education facilities can be undervalued. Several member organisations mentioned the lack of monitoring frameworks and absence of disaggregated data as a potential reason of such attacks going unnoticed. Without disaggregated data, it is almost impossible to quantify the rate of attacks on health care with medical education components as direct or indirect targets. In many cases, a violent conflict or prolonged civil disturbances, leading up to disturbances in

electricity supply, internet connection or access to information, turned research into a problematic, and sometimes even impossible task. In most cases, nationwide political conflicts have been responsible for collateral damage inflicted upon educational institutes. In some cases, however, educational institutes have been the primary target, with an aim to deter the learning process and the operation of health systems. This has been the case on multiple occasions in Venezuela, where attacks have been reported against medical teams, medical students, healthcare facilities and individual health practitioners. Another type of interference with medical education are individual or repeated interruptions in its continuity. Of approximately 128 medical schools from 7 countries followed in this report, 22 had to pause their operations for shorter or longer period of time. However, if we exclude universities from Sudan (65 schools) and Ukraine (23 schools), where we focused on a small portion of facilities which were directly affected by particular disturbances, data presented highlights 40 medical schools from 5 countries, with 22 forced shutdowns, accounting for 55% of medical schools from Libya, Palestine, Syria, Venezuela, and Yemen. In Libya and Yemen, all reported medical schools in these countries ceased their operations during some period of the conflict. In Syria, almost half of medical schools paused their operations in the first year of the conflict, resuming their operations months (or years) later. Similar discontinuations occured in all the countries in our report, but predominantly in Yemen, Ukraine and Sudan. Out of 22 medical schools that were forced www.ifmsa.org

to pause education (according to our data), 19 resumed once conflicts were resolved or confined. This proves that a drive for education is stronger than violence and war, but on the other hand, it also shows that despite strong efforts, some schools still remain closed. A large portion of students were given the opportunity to resume their studies in other faculties, resulting in disproportionate numbers of enrolled students that faculties were not originally prepared for. Such increase of students posed a significant challenge not only for the infrastructure and material equipment of these ‘’compensating’’ universities, but also for the capacity of human resources for medical education, including teachers and administrative personnel. Above all, a large portion of medical students either chose or was forced to indefinitely pause their education. Attacks on medical education harbor great danger to the sustainability of health systems and healthcare delivery and on occasion have significantly affected it by destruction of infrastructure and by decline of human resources, future and present. Moreover, the effect of conflict on medical students and academic staff remains in question and must also be studied to explore its subsequent factoring effect in health services. The International Federation of Medical Students’ Associations remains committed to this task, and will continue to explore and report on attacks on medical education. Medical students are on the forefront of protection of health services, and through our work on local, national and global level we aim to contribute to the momentum to safeguard the future of healthcare for all. Aikaterini Dima and Marian Sedlak IFMSA Liaison Officer for Medical Education Issues & Liaison Officer for Human Rights and Peace Issues

International Federation of Medical Students’ Associations (IFMSA)

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Barnett-Vanes, A., Hassounah, S., Shawki, M., Ismail, O. A., Fung, C., Kedia, T., ... & Majeed, A. (2016). Impact of conflict on medical education: a cross-sectional survey of students and institutions in Iraq. BMJ open, 6(2), e010460. Available at: http://bmjopen.bmj.com/content/6/2/e010460 11

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Dehghanpisheh, B.(2013, March 28). Mortar attack on University of Damascus kills at least 12. The Washington Post. Available at: https://www.washingtonpost.com/world/middle_east/ 13

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mortar-attack-on-university-of-damascus-kills-at-least-12/2013/03/28/b713b018-97c3-11e2-97cd3d8c1afe4f0f_story.html?utm_term=.7178c39d66d8 Holmes, O. (2013, March 28). Mortar strike kills 15 in Damascus University: state media. Reuters. Available at: https://www.reuters.com/article/us-syria-crisis-students/mortar-strike-kills-15in-damascus-university-state-media-idUSBRE92R0E020130328 14

Karouny, M. (2013, January 15). Explosions kill 83 at Syrian university as exams begin. Reuters. Available at: https://www.reuters.com/article/us-syria-crisis/explosions-kill-83-at-syrian-universityas-exams-begin-idUSBRE90E0V820130115 15

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UN OCHA. 2018. Yemen - crisis overview. Available at: http://www.unocha.org/yemen/aboutocha-yemen 25

International Federation of Medical Students’ Associations (IFMSA)

Algeria (Le Souk)

Egypt (IFMSA-Egypt)

Kuwait (KuMSA)

Saint Lucia (IFMSA-Saint Lucia)

Argentina (IFMSA-Argentina)

Latvia (LaMSA)

Senegal (FNESS)

Armenia (AMSP)

El Salvador (IFMSA-El Salvador)

Lebanon (LeMSIC)

Serbia (IFMSA-Serbia)

Aruba (IFMSA-Aruba)

Estonia (EstMSA)

Lesotho (LEMSA)

Sierra Leone (SLEMSA)

Australia (AMSA)

Ethiopia (EMSA)

Libya (LMSA)

Singapore (AMSA-Singapore)

Austria (AMSA)

Fiji (FJMSA)

Lithuania (LiMSA)

Slovakia (SloMSA)

Azerbaijan (AzerMDS)

Finland (FiMSIC)

Luxembourg (ALEM)

Slovenia (SloMSIC)

Bangladesh (BMSS)

France (ANEMF)

Malawi (UMMSA)

South Africa (SAMSA)

Belgium (BeMSA)

Gambia (UniGaMSA)

Malaysia (SMMAMS)

Spain (IFMSA-Spain)

Bolivia (IFMSA-Bolivia)

Georgia (GMSA)

Mali (APS)

Sudan (MedSIN)

Bosnia & Herzegovina (BoHeMSA)

Germany (bvmd)

Malta (MMSA)

Sweden (IFMSA-Sweden) Switzerland (swimsa)

Greece (HelMSIC)

Mexico (AMMEF-Mexico)

Bosnia & Herzegovina – Republic of Srpska (SaMSIC)

Mongolia (MMLA)

Syrian Arab Republic (SMSA)

Montenegro (MoMSIC)

Taiwan - China (FMS)

Morocco (IFMSA-Morocco)

Tajikistan (TJMSA)

Nepal (NMSS)

Thailand (IFMSA-Thailand)

The Netherlands (IFMSA NL)

The Former Yugoslav Republic of Macedonia (MMSA)

Brazil (DENEM)

Ghana (FGMSA) Grenada (IFMSA-Grenada)

Brazil (IFMSA-Brazil)

Guatemala (IFMSA-Guatemala)

Bulgaria (AMSB)

Guinea (AEM)

Burkina Faso (AEM)

Guyana (GuMSA)

Burundi (ABEM)

Haiti (AHEM)

Cameroon (CAMSA)

Honduras (IFMSA-Honduras)

Canada (CFMS)

Hungary (HuMSIRC)

Canada – Québec (IFMSA-Québec)

Iceland (IMSA) India (MSAI)

Pakistan (IFMSA-Pakistan)

Catalonia - Spain (AECS)

Indonesia (CIMSA-ISMKI)

Palestine (IFMSA-Palestine)

Chile (IFMSA-Chile)

Iran (IMSA)

Panama (IFMSA-Panama)

China (IFMSA-China)

Iraq (IFMSA-Iraq)

Paraguay (IFMSA-Paraguay)

China – Hong Kong (AMSAHK)

Iraq – Kurdistan (IFMSA-Kurdistan)

Peru (IFMSA-Peru)

Colombia (ASCEMCOL)

Ireland (AMSI)

Philippines(AMSA-Philippines)

Costa Rica (ACEM)

Israel (FIMS)

Poland (IFMSA-Poland)

Croatia (CroMSIC)

Italy (SISM)

Portugal (ANEM)

Cyprus (CyMSA)

Jamaica (JAMSA)

Qatar (QMSA)

Czech Republic (IFMSA-CZ)

Japan (IFMSA-Japan)

Republic of Moldova (ASRM)

United States of America (AMSA-USA)

Democratic Republic of the Congo (MSA-DRC)

Jordan (IFMSA-Jo)

Romania (FASMR)

Uruguay (IFMSA-URU)

Kazakhstan (KazMSA)

Russian Federation (HCCM)

Uzbekistan (Phenomenon)

Denmark (IMCC)

Kenya (MSAKE)

Venezuela (FEVESOCEM)

Dominican Republic (ODEM)

Korea (KMSA)

Russian Federation – Republic of Tatarstan (TaMSA)

Ecuador (AEMPPI)

Kosovo - Serbia (KOMS)

Rwanda (MEDSAR)

Zambia (ZaMSA)

Nicaragua (IFMSA-Nicaragua) Nigeria (NiMSA) Norway (NMSA) Oman (MedSCo)

Peru (APEMH)

Tanzania (TaMSA) Togo (AEMP) Trinidad and Tobago (TTMSA) Tunisia (Associa-Med) Turkey (TurkMSIC) Turkey – Northern Cyprus (MSANC) Uganda (FUMSA) Ukraine (UMSA) United Arab Emirates (EMSS) United Kingdom of Great Britain and Northern Ireland (SfGH)

Yemen (NAMS)

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