{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T08:47:24Z","timestamp":1791967644944,"version":"4.3.4"},"reference-count":17,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["mededpublish.org"],"crossmark-restriction":false},"short-container-title":["MedEdPublish"],"abstract":"<ns5:p>Wars and armed conflicts are widely recognised as a threat to health systems, yet the destruction of medical education is still too often treated as a secondary educational disruption. This opinion article argues that attacks on medical schools, teaching hospitals, clinical placements, accreditation systems and faculty pipelines should be understood as a distinct form of long-term public health harm. I propose the term \"meducide\" to describe the systematic destruction, dismantling or incapacitation of medical education during war, whether by direct attack or by structural conditions that render medical training impossible. The concept builds on existing scholarship on attacks on education, structural violence and health workforce fragility, while highlighting what is distinctive about medical education. It captures not only the destruction of medical schools and teaching hospitals but also the broader erosion of the conditions necessary to train future healthcare. Therefore, it sits at the intersection of higher education, health service delivery, professional regulation and the future health workforce. Naming Meducide does not replace careful empirical documentation or legal assessment of intent. Rather, it offers a precise conceptual language for recognising a recurring pattern: when medical education is destroyed, the effects extend beyond students and universities to patient care, population health, post-conflict recovery and health system sovereignty. The article calls for medical education to be documented separately in conflict monitoring, protected as critical civilian and health infrastructure, included in humanitarian and reconstruction planning, and supported through global recognition, cross borders faculty networks, conflict-adapted curricula and sustainable clinical training pathways.<\/ns5:p>","DOI":"10.12688\/mep.21604.1","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T11:44:05Z","timestamp":1781783045000},"page":"23","update-policy":"https:\/\/doi.org\/10.12688\/mep.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Meducide - Towards a new conceptual framework for the destruction of medical education in armed conflicts"],"prefix":"10.12688","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8767-4619","authenticated-orcid":false,"given":"Suhad","family":"Daher-Nashif","sequence":"first","affiliation":[{"name":"Keele England Keele University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e010460","DOI":"10.1136\/bmjopen-2015-010460","article-title":"Impact of conflict on medical education: a cross-sectional survey of students and institutions in Iraq.","volume":"6","author":"A Barnett-Vanes","year":"2016 Feb 1","journal-title":"BMJ Open."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s13031-024-00584-7","article-title":"War and education: the attacks on medical schools amidst ongoing armed conflict, Sudan 2023.","volume":"18","author":"E Mahgoub","year":"2024 Mar 29","journal-title":"Confl. Heal."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1186\/s12909-023-04768-2","article-title":"Medical education in times of war: a mixed-methods needs analysis at Ukrainian medical schools.","volume":"23","author":"A Mayer","year":"2023 Oct 26","journal-title":"BMC Med. Educ."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e0001340","DOI":"10.1371\/journal.pgph.0001340","article-title":"Medical education system (re) building in a fragile setting: Northwest Syria as a case study.","volume":"3","author":"Y Bdaiwi","year":"2023 Apr 11","journal-title":"PLOS Global Public Health."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/1865-1380-4-6","article-title":"Effect of civil war on medical education in Liberia.","volume":"4","author":"K Challoner","year":"2011 Feb 16","journal-title":"Int. J. Emerg. Med."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"793-804","DOI":"10.1111\/medu.14808","article-title":"Maintaining health professional education during war: A scoping review.","volume":"56","author":"V Dobiesz","year":"2022 Aug","journal-title":"Med. Educ."},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.r219","article-title":"Medical education in Gaza must be protected.","volume":"388","author":"D Shellah","year":"2025 Feb 6","journal-title":"BMJ."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"477-482","DOI":"10.2147\/AMEP.S510309","article-title":"Medical education in Afghanistan: challenges and policy implications.","volume":"16","author":"M Stanikzai","year":"2025 Dec 31","journal-title":"Adv. Med. Educ. Pract."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"8-9","DOI":"10.24052\/BMR\/V13NU02\/ART-28","article-title":"Educide: the genocide of education a case study on the impact of invasion and conflict on education.","volume":"13","author":"R Alousi","year":"2022 Aug 9","journal-title":"The Business and Management Review."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"83-101","DOI":"10.1108\/QEA-10-2024-0120","article-title":"Educide amid conflict: the struggle of the Palestinian education system.","volume":"2","author":"D Iriqat","year":"2025 Dec 15","journal-title":"Quality Education for All."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e009316","DOI":"10.1136\/bmjgh-2022-009316","article-title":"The global health workforce stock and distribution in 2020 and 2030: a threat to equity and \u2018universal\u2019health coverage?.","volume":"7","author":"M Boniol","year":"2022 Jun 27","journal-title":"BMJ Glob. Health."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2129-2154","DOI":"10.1016\/S0140-6736(22)00532-3","article-title":"Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019.","volume":"399","author":"A Haakenstad","year":"2022 Jun 4","journal-title":"Lancet."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"5","DOI":"10.25259\/SNI_538_2019","article-title":"Medical schools in times of war: integrating conflict medicine in medical education.","volume":"11","author":"J Fares","year":"2020 Jan 11","journal-title":"Surg. Neurol. Int."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"109-121","DOI":"10.1093\/heapol\/czac090","article-title":"Health-care worker retention in post-conflict settings: a systematic literature review.","volume":"38","author":"T Lin","year":"2023 Jan 1","journal-title":"Health Policy Plan."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1186\/s12909-025-07027-8","article-title":"Adaptive strategies of a medical school during Sudan\u2019s armed conflict.","volume":"25","author":"M Taha","year":"2025 Apr 29","journal-title":"BMC Med. Educ."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e0001610","DOI":"10.1371\/journal.pgph.0001610","article-title":"Transforming medical education in Liberia through an international community of inquiry.","volume":"3","author":"K Talbert-Slagle","year":"2023 Mar 8","journal-title":"PLOS Global Public Health."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"190-197","DOI":"10.29024\/aogh.21","article-title":"Introducing an E-learning solution for medical education in Liberia.","volume":"84","author":"S Walsh","year":"2018 Apr 30","journal-title":"Ann. Glob. Health."}],"container-title":["MedEdPublish"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/mededpublish.org\/articles\/16-23\/v1\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/mededpublish.org\/articles\/16-23\/v1\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/mededpublish.org\/articles\/16-23\/v1\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T07:59:22Z","timestamp":1791964762000},"score":1,"resource":{"primary":{"URL":"https:\/\/mededpublish.org\/articles\/16-23\/v1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,18]]},"references-count":17,"URL":"https:\/\/doi.org\/10.12688\/mep.21604.1","relation":{"has-review":[{"id-type":"doi","id":"10.21956\/mep.23149.r46305","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/mep.23149.r46089","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/mep.23149.r46089","asserted-by":"object"},{"id-type":"doi","id":"10.21956\/mep.23149.r46305","asserted-by":"object"}]},"ISSN":["2312-7996"],"issn-type":[{"value":"2312-7996","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,18]]},"assertion":[{"value":"Indexed","URL":"https:\/\/mededpublish.org\/articles\/16-23\/v1#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/mep.23149.r46089, Ayad M Al-Moslih, University of Central Lancashire, Preston, England, 29 Jun 2026, version 1, indexed","URL":"https:\/\/mededpublish.org\/articles\/16-23\/v1#referee-response-46089","order":0,"name":"referee-response-46089","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Suhad Daher-Nashif<\/b>; \n<i>Posted: 09 Aug 2026<\/i>; Dear Dr Al-Moslih, Thank you for your generous and constructive review. I greatly appreciate your positive assessment of the conceptual validity and potential value of \u201cmeducide\u201d, as well as your four suggestions for extending its practical and analytical application. First, I\u2019d like to highlight that Meducide is intended to complement, rather than replace, established frameworks concerning attacks on health care. An attack on a teaching hospital may simultaneously disrupt patient care and destroy clinical supervision, placements, assessment, research and future workforce capacity. Dual classification may therefore be appropriate. Second, the intergenerational workforce mechanism arises from the cumulative relationship between faculty loss, displacement and poor retention; diminished teaching and supervisory capacity; reduced or disrupted graduate and specialist training; and a progressively smaller pool of future educators. I acknowledge that the published article could have articulated more clearly how the cited sources support different components of this proposed cycle. Third, I agree that the WHO Surveillance System for Attacks on Health Care and the Global Coalition to Protect Education from Attack are relevant bodies for developing this categorisation. A dual-tagged approach could record both the health-service and educational functions affected by an incident. Fourth, the effects extend beyond workforce numbers to the disruption of locally established career-progression pathways, including internship, specialist training, examinations, licensing, continuing professional development, research, mentorship and promotion. These interruptions may ultimately reduce the number of future specialists, educators, researchers and institutional leaders. I also appreciate the reviewer\u2019s reference to Markenson et al. and agree that disaster planning, preparedness and response competencies are an important component of strengthening health-professions education in conflict-affected and conflict-vulnerable settings. Although the published text remains unchanged, I regard these reflections as valuable clarifications and as priorities for the future development and empirical application of the meducide framework.","URL":"https:\/\/mededpublish.org\/articles\/16-23\/v1#referee-comment-3772","order":1,"name":"referee-comment-3772","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/mep.23149.r46305, Rahul Barmanray, The Royal Melbourne Hospital, Melbourne, 04 Aug 2026, version 1, indexed","URL":"https:\/\/mededpublish.org\/articles\/16-23\/v1#referee-response-46305","order":2,"name":"referee-response-46305","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Suhad Daher-Nashif<\/b>; \n<i>Posted: 09 Aug 2026<\/i>; Dear Dr Barmanray, Thank you for your thoughtful review and for recognising the paper\u2019s potential value as a conversation starter. I appreciate your two important concerns regarding the specificity of the concept and the possible ambiguity of its name. I agree that \u201cmeducide\u201d should not be applied to every conflict-related interruption of medical education. Its use should require documented evidence that conflict-related acts or conditions have caused a substantial, sustained or systematic dismantling of medical training capacity. Application of the term should identify the educational functions affected, the mechanisms of harm, their scale and duration, their consequences for future workforce formation, and the evidence supporting any claim of intentional or systematic targeting. I agree that solated damage or temporary disruption should not automatically be labelled meducide. Similarly, an attack on a hospital should fall within the framework only when its educational functions (for example, clinical teaching, supervision, assessment or specialist training) have also been substantially affected. Claims about documented effects should also be separated from claims about intent, which require additional evidence. I\u2019d like to highlight here, that the killing of medical personnel may contribute to meducide when it destroys teaching and supervisory capacity. ~However, it is not synonymous with meducide. The defining concern is the destruction of the medical education system and its ability to produce future generations of health professionals. Thank you again. Your comments provide valuable guidance for developing more explicit application criteria and for communicating the concept with greater semantic clarity in future works.","URL":"https:\/\/mededpublish.org\/articles\/16-23\/v1#referee-comment-3773","order":3,"name":"referee-comment-3773","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}