{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T20:24:17Z","timestamp":1783023857409,"version":"3.54.6"},"reference-count":26,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cholera continues to be a significant public health threat, particularly in underserved regions with overcrowding and poor sanitation. The 2022\u20132023 cholera outbreak in Syria, particularly in Aleppo, overwhelmed medical staff, who faced extreme stress, extended work hours, and department closures. This cross\u2010sectional study examines the association between this outbreak and the psychological distress, fatigue, and post\u2010traumatic stress disorder (PTSD) experienced by healthcare workers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross\u2010sectional study, conducted at Aleppo University Hospital between September 20 and October 20, 2022, adhered to STROBE guidelines. A total of 75 healthcare providers voluntarily participated by completing a structured questionnaire that assessed socio\u2010demographic data and utilized standardized instruments to measure psychological distress, fatigue, and PTSD symptoms. In addition, qualitative data were collected to explore the challenges faced by healthcare workers during the outbreak and to gather their suggestions for better management in the future.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The findings indicate that most healthcare providers experienced low to moderate psychological distress and fatigue during the cholera outbreak, with moderate psychological distress being the most prevalent (84%,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200963), followed by moderate fatigue in almost two\u2010thirds of the participants (62.7%,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200947). Conversely, PTSD symptoms were rare, with only 8% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20096) of participants indicating PTSD according to the PCL\u20105 questionnaire. Notably, the majority of medical staff perceived the cholera outbreak as less severe or more manageable compared to the COVID\u201019 pandemic. However, a smaller number acknowledged that learning from the previous pandemic conditions mitigated the impact of the cholera outbreak. In terms of challenges faced, inadequate hospital resources and medical staffing were frequently cited, alongside gaps in patient awareness regarding the seriousness of the disease. Suggested solutions emphasized the need for better resource allocation, focused medical staff training, and enhanced hygiene awareness campaigns.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The cholera outbreak in Syria has exerted significant psychological and physical strain on medical staff, underscoring the urgent need for targeted interventions to support their mental health and well\u2010being. Addressing these challenges is vital for sustaining an effective healthcare response during current and future public health crises.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.71958","type":"journal-article","created":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T03:50:23Z","timestamp":1775188223000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Psychological Distress, Fatigue, and Post\u2010Traumatic Stress Disorder Among Medical Staff Facing the Acute Watery Diarrhea Outbreak in Syria, Difficulties and Solutions: A Mixed\u2010Methods Study"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1254-6647","authenticated-orcid":false,"given":"Ahmad Yamen","family":"Arnaout","sequence":"first","affiliation":[{"name":"Internal Medicine, Aleppo University Hospital University of Aleppo Aleppo Syrian Arab Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdallah","family":"Aladna","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Aleppo Aleppo Syrian Arab Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan","family":"Alshaker","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Aleppo Aleppo Syrian Arab Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Besher","family":"Shabouk","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Aleppo Aleppo Syrian Arab Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Arnaout","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Aleppo Aleppo Syrian Arab Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Najjar","sequence":"additional","affiliation":[{"name":"Internal Medicine, Aleppo University Hospital University of Aleppo Aleppo Syrian Arab Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"issue":"3","key":"e_1_2_14_2_1","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1001\/jama.2022.23551","article-title":"WHO Report: Cholera Resurgent in 2022 After Years of Decline","volume":"329","author":"Larkin H.","year":"2023","journal-title":"Journal of the American Medical Association"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2023-082385"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2019.07.078"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0003832"},{"key":"e_1_2_14_6_1","unstructured":"Syria cholera response situation report for 04 October 2022 \u2010 Syrian Arab Republic. United Nations International Children's emergency funds [UNICEF]; 2022 https:\/\/www.unicef.org\/syria\/reports\/cholera-situation-report-4-october-2022."},{"key":"e_1_2_14_7_1","unstructured":"UNICEF Wa. Whole of Syria cholera outbreak situation. 2023. Report No.: 13 https:\/\/reliefweb.int\/report\/syrian-arab-republic\/whole-syria-cholera-outbreak-situation-report-no-13-issued-28-february-2023."},{"issue":"20","key":"e_1_2_14_8_1","first-page":"9058","article-title":"Burnout Syndrome Among Emergency Medicine Physicians: An Update on Its Prevalence and Risk Factors","volume":"23","author":"Boutou A.","year":"2019","journal-title":"European Review for Medical and Pharmacological Sciences"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/MEJ.0000000000000194"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12991-023-00470-1"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-024-05922-w"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39335.541782.AD"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.2307\/2136404"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/occmed\/kqu168"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apnu.2024.02.006"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.15288\/jsad.2018.79.649"},{"issue":"12","key":"e_1_2_14_17_1","first-page":"1117","article-title":"Descriptive Statistics in Health Sciences","volume":"99","author":"Ben Abdelaziz A.","year":"2021","journal-title":"La Tunisie Medicale"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/0004867420951255"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m1642"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czw055"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1109\/ACCESS.2020.3033069"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.1080\/21665044.2016.1228326"},{"key":"e_1_2_14_23_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41562-018-0376-6"},{"key":"e_1_2_14_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jiac.2024.08.025"},{"key":"e_1_2_14_25_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid1212.060584"},{"key":"e_1_2_14_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2006.01.001"},{"key":"e_1_2_14_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03403782"}],"container-title":["Health Science Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hsr2.71958","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hsr2.71958","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hsr2.71958","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T19:52:09Z","timestamp":1783021929000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hsr2.71958"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":26,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1002\/hsr2.71958"],"URL":"https:\/\/doi.org\/10.1002\/hsr2.71958","archive":["Portico"],"relation":{},"ISSN":["2398-8835","2398-8835"],"issn-type":[{"value":"2398-8835","type":"print"},{"value":"2398-8835","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2024-11-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71958"}}