A scoping review of epidemics of substance misuse and suicide in Syria: casualties of protracted conflict and political instability.

Background: Over a decade of conflict in Syria had resulted in significant displacement and an increase in humanitarian needs. Emerging evidence points to a growing burden of substance misuse and deliberate self-harm- issues that remain underreported due to stigma, fear of criminalization, and a fragmented health system. This scoping review provides an overview of the prevalence, risk factors and health services available for these conditions inside Syria, supplemented by findings from an expert workshop with Syrian mental health stakeholders.

Methods: A scoping review of academic and grey literature was conducted across PubMed, PsycINFO, Embase, and Google Scholar using terms related to substance misuse, suicide, self-harm, and Syria. Studies published on or after the onset of the Syrian conflict in 2011 and available in English or Arabic were included. These findings were contextualized with insights from an expert workshop conducted in Arabic, which included 25 Syrian mental health stakeholders, including psychologists, psychiatrists, public health, and policy professionals to identify priorities for research, programming and policy.

Results: Our review identified a total of 29 sources (15 peer-reviewed and 14 from the grey literature) on substance misuse and self-harm inside Syria. Overall, data on the prevalence of these conditions in Syria is limited, with significant gaps in quality, consistency, and geographic coverage. Workshop participants identified critical barriers to understanding the scale and scope of these conditions including stigma, lack of trained personnel, and insufficient integration of services. Recommendations included expanding telemental health services, adopting WHO mhGAP tools to increase capacity of staff in primary care settings, investing in long-term MHPSS programming, and scaling up family-skills training to prevent substance misuse and self-harm.

Conclusions: Though current evidence gaps and shortfalls in funding around substance misuse and deliberate self-harm in Syria remain, this study highlights the urgent need to address substance misuse and self-harm in Syria through multi-level, culturally adapted interventions, as well as through comprehensive mental health system reform and policy. Prioritizing MHPSS within Syria's health reconstruction agenda, particularly for internally displaced and high-risk populations, is essential for long-term peacebuilding and recovery.