The prolonged conflict in Syria has severely disrupted the healthcare system, with rheumatology services among the most affected. This study aims to evaluate the burden of rheumatic diseases in northwest Syria, a region facing immense healthcare challenges due to the ongoing war and the collapse of infrastructure. A retrospective analysis was conducted on all patients diagnosed with rheumatologic conditions who attended internal medicine outpatient clinics in northwest Syria between September 2019 and February 2022. Demographic data and clinical diagnoses were collected from patient records, ensuring no duplication. In addition, the study assessed the availability of essential diagnostic investigations and medications for rheumatic diseases in the region. A total of 488 patients were included in the study, with a mean age of 37.4 years; 63% were female. Connective tissue diseases were the most frequently diagnosed category (25.6%), followed by osteoarthritis (12.1%) and rheumatoid arthritis (8.2%). The conflict has led to a dire shortage of trained rheumatologists, with only three specialists serving an estimated population of 5.5 million people in the region. Diagnostic services have been significantly compromised, with limited access to immunological and imaging tests essential for proper diagnosis and monitoring. Furthermore, the availability of Disease-Modifying Anti-Rheumatic Drugs (DMARDs) and biologics is extremely limited, and the high cost of medications poses an additional barrier to treatment adherence. This study highlights the substantial unmet needs of patients with rheumatic diseases in conflict settings. There is an urgent necessity to strengthen healthcare services, expand training programs for healthcare providers, and improve access to essential diagnostics and treatments. Addressing these gaps is critical to reducing disease burden and improving quality of life for affected individuals in northwest Syria.

Dr. Wasim Zakaria is a specialist in Internal Medicine with a strong interest in Rheumatology. He currently serves as the Chair of the Scientific Council of Internal Medicine at the Syrian Board of Medical Specialties (SBOMS). Dr. Zakaria holds a diploma in Medical Education and is currently pursuing his PhD at Idlib University, Syria. He has extensive experience in academic leadership and clinical training supervision, contributing significantly to the development of medical education and healthcare services in conflict-affected areas of northwest Syria. He has published several research articles in the fields of rheumatology, health challenges in fragile settings, and curriculum development. Dr. Zakaria has also been actively involved in organizing national and international medical conferences and contributing to the design of national training programs and guidelines aimed at improving healthcare quality. In addition to his academic and clinical roles, Dr. Zakaria is known for his passion for teaching and training and is recognized as a key reference in advancing medical education and research in resource-limited environments.