Workplace violence in a conflict zone: a study from Syria’s healthcare frontline

Workplace violence (WPV) is a significant occupational hazard for healthcare workers. This study aimed to examine the prevalence, nature, and associated factors of WPV among resident doctors and nurses in Syrian public university hospitals to inform institutional policies and protective strategies. A cross-sectional study was conducted in public, Ministry of Higher Education-affiliated teaching hospitals in Damascus, Aleppo, and Lattakia, Syria. A total of 832 healthcare workers (68.1% physicians/residents, 31.9% nurses) completed a self-administered electronic questionnaire, distributed using a multi-stage, non-probability sampling strategy. The main outcome measures were the prevalence of psychological, physical, and sexual harassment in the last year, and factors associated with experiencing violence. Data were analyzed using logistic regression. The overall prevalence of exposure to at least one form of WPV was 64.78%. Psychological violence was most common (55.3%), followed by physical violence (19.8%) and sexual harassment (9.5%). Most workers (87.3%) had received no training on handling WPV, and although 56.1% of workplaces had reporting procedures, only 25% of participants had used them. Significant risk factors for WPV included being a physician/resident (AOR = 2.72), working night shifts (AOR = 1.82), and having direct patient contact (AOR = 2.63). A very strong association was found with the level of concern about violence; those who were “extremely concerned” had 22.7 times the odds of reporting WPV exposure. Workplace violence is a crisis-level occupational hazard for healthcare workers in Syria, exacerbated by a lack of preventive training and a culture of underreporting. These findings represent an urgent call for health policymakers and hospital administrators to implement robust, multifaceted interventions, including fostering a culture of safety, to protect the workforce as an essential prerequisite for a functioning healthcare system.