资源分配是一个持久的医疗问题。从第二次世界大战中的青霉素分类，到生物侵害攻击后有关器官可用性或医疗对策的当代讨论，案件比比皆是，案件比比皆是，其中稀缺的资源需要沿着道德，原则性的线条分配给人群。
There’s a gap in this story, however. Most cases of allocation that scholars and policymakers address are either:
- The allocation of scarce resources to the military during wartime; or
- The allocation of scarce resources to civilians during peacetime, or (in the case of terrorist attacks in developed nations) outside of a warzone.
What we hear very little about, however, are the difficulties allocating resources to civilians during wartime, within a theater of armed conflict.
This is the problem my colleague, Mohamed Sekkarie, and I set out to address, using the case of dialysis resources in the Syrian conflict.
一般原则，具体变化
Allocation principles follow relatively standard rationales. We can prioritize the welfare of a population; guarantee a fair and impartial process through a lottery; help the worst off or chose patients most likely to survive; or favor essential personnel to support the community in a crisis.
在灾难情况下，我们经常想到最后一个，也是第一个：社会实用性，例如首先对待医疗人员；和实用程序，以挽救最多的生命。我们还可以优先考虑年轻人和儿童，而不是老年人，以挽救最多的终身生活，以挽救生命最多的生命。
War is a disaster: a protracted, longstanding, humanitarian disaster. Supplies once plentiful quickly dwindle; replacements may be delayed, captured, or destroyed. Allocation in wartime is thus the worst of all worlds: scarce resources, in that we don’t have enough to go around, but also insecure resources we have no guarantee or expectation of replenishing.
Even when resources are on hand, getting access to care is dangerous for those living day to day in fear of war. All travel carries risk, even if it is only the risk of driving to and from an appointment. But civilians in a warzone must contend with bombings in the street, firefights, or deliberate attacks on healthcare facilities. These represent a degree of risk potentially high enough that they may outweigh the expected benefit of frequent clinical care.
Syria
We chose Syria, a country decimated by war for seven years, because the long-term effects of the conflict on the civilian population of Syria are frequently neglected. We know the war has claimedapproximately 400,000 lives，但是联合国观察家和非政府组织努力通过食物和医疗短缺造成的忽视战争对战争的损失。我们知道，然而, that critical medical resources are in short supply, and that doctors and clinics alike have been targeted during the war.
透析
It may be less obvious why we would choose dialysis as a case study. An underappreciated effect of the Syrian conflict has been the collapse of support for individuals receiving long-term clinical care, including patients with end stage renal disease (ESRD). Treatment for ESRD is costly, complex, and can quickly kill a patient if interrupted. It is an understudied problem in the context of armed conflict. Dialysis centers in areas such as Aleppo, Homs, and Idlib have beendestroyed, looted, or occupiedby armed groups, motivating our concern for allocating dialysis supplies.
The allocation of dialysis units is also an important part of the history of bioethics. In 1960s Seattle, the first dialysis units were overseen by the so-called “God Squad,” charged with making decisions about who would receive care. In the US, dialysis is common enough that we rarely hear about it as an allocation problem, but it remains an urgent and scarce therapy in other parts of the world.
通过关注ESRD和透析，我们希望强调向叙利亚人民提供护理以及解决冲突的紧迫性。半个世纪以来，这种医疗资源一直是数百万美国人的医疗保健的重要组成部分。它在叙利亚的稀缺性说明了当地的可怕情况。
当然，解决这些短缺的方法不是配给：这是和平。
Unlike hearts or lungs, which would arguably remain scarce even if we had greater participation in organ donation programs, nothing but politics makes dialysis a scarce medical resource in Syria. This means that as long as our governments continue to politicize the conflict, exacerbate it, or further it, they remain complicit in the suffering of the Syrian people.
Medical professionals should lobby their governments to provide more aid, maintain humanitarian corridors, and ultimately end the conflict in Syria. Our principles are for caregivers to use in the meantime, while this larger task remains unsolved.
注释