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Abstract: SA-PO625

Building a Framework for Enhancing Dialysis Services in Conflict-Affected Regions: A Multi-Level Action Plan

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis


  • Alasfar, Sami, Mayo Clinic Arizona, Scottsdale, Arizona, United States
  • Alashawi, Hani Subhi, Health Cluster, Gaziantep, Turkey
  • Kaysi, Saleh, UVC Brugmann, Brussels, Belgium
  • Burnham, Gilbert M., Johns Hopkins University Center for Teaching and Learning, Baltimore, Maryland, United States

The provision of dialysis to patients with ESKD in areas affected by conflict poses various challenges. Reports have shown a high incidence of hepatitis B&C among patients on hemodialysis (HD) & poor HD operations in Northwest (NW) Syria, an area enduring armed conflict. A framework is necessary to address the hindrances to HD in such environments.


The Health Cluster Hub in Turkey is collaborating with Johns Hopkins University to spearhead a quality improvement initiative for HD in NW Syria. Objectives are to address difficulties of HD in this region and enhance care delivered by NGOs administering HD. The project comprises 3 phases: baseline asssement, setting up basic standards & action plan, and putting a support supervision system, alongside creating a framework to attain these targets.


The 1st phase involved a survey of HD centers and 2 workshops utilizing the fishbone technique & theory of change models to map the necessary changes. Through this phase, an action plan (Fig 1) was developed and involved various stakeholders with different objectives. The 2nd phase focused on building quality curricula, which were subsequently taught through courses, creating a record system, & establishing minimal standards for HD centers. Furthermore, a framework was created to address dialysis services in NW Syria and other conflict settings (Fig 2).


As it is the responsibility of the nephrology community and humanitarian agencies to ensure quality care for patients with ESKD, we propose a comprehensive framework to enhance HD care in unstable areas. This framework involves engaging all stakeholders in care delivery, establishing minimum standards, and mitigating risks to patients.


  • Government Support – Non-U.S.