Beyond rebuilding: scholasticide creates a medical training-time debt

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Dajani and colleagues argue that scholasticide threatens the sustainability of health systems by disrupting medical research, education, and future workforce pipelines.¹ We suggest that this disruption has an additional temporal dimension: a medical training-time debt—the cumulative loss of supervised training and professional progression that cannot be recovered simply by reopening institutions or rebuilding facilities.

Medical education is sequential. Undergraduate clinical exposure precedes graduation; graduation precedes postgraduate training; postgraduate training precedes specialist practice, supervision, and, for some, academic leadership. Interruption at one stage can therefore delay subsequent stages. When disruption affects successive cohorts, the consequence may be more than a temporary reduction in student numbers: it may create a prolonged deficit in clinicians, specialists, educators, and research supervisors.

Evidence from recent conflicts illustrates why reopening alone is an incomplete measure of recovery. In Sudan, 58.6% of 58 medical schools surveyed in conflict-affected areas were attacked in 2023; although 60.3% restored some educational activity through online learning or institutional collaboration, this did not necessarily restore clinical training capacity.² Two years later, a survey of respondents from 27 institutions found that 70.4% had relocated, clinical teaching remained suspended in some institutions, and an estimated 30% of academic staff had left their university posts.³ In Gaza, a recent review likewise described major disruption to medical schools and teaching hospitals, displacement of students and faculty, and persistent barriers to training and credentialing despite adaptations such as online learning.⁴ Data from Syria also suggest that conflict-related training conditions and institutional relocation can affect medical students’ academic performance, with improvement after hostilities decreased.⁵

These findings support a distinction between educational access and training recovery. A reopened medical school, resumed online curriculum, or returning student body may indicate continuity, but not restoration of the supervised clinical experience required for professional progression. We therefore propose that post-conflict recovery should track not only enrolment and institutional reopening, but also clinical placement capacity, faculty supervision, completion of required competencies, progression into postgraduate training, and retention of educators.

Recognising medical training-time debt also has practical implications. Cross-institutional clinical placements, reciprocal supervision arrangements, portable recognition of completed training, and protected pathways for displaced trainees may reduce avoidable delays. Such measures should preserve competency standards rather than compress training simply to compensate for lost time.

Scholasticide therefore creates not only infrastructural and workforce losses, but a temporal deficit that may propagate across generations of health professionals. Protecting continuity of medical training should be considered part of health-system protection itself.

References

1. Dajani R, Jabiri A, Aminlou M, Abukhalil M, Yasin SA. Scholasticide in war is devastating for medical research and training. BMJ. 2026;394:e100636. doi:10.1136/bmj-2026-100636.
2. Mahgoub EAA, Khairy A, Osman S, et al. War and education: the attacks on medical schools amidst ongoing armed conflict, Sudan 2023. Confl Health. 2024;18(1):23. doi:10.1186/s13031-024-00584-7.
3. Ahmed K, Abdalmonem M, Elamin ME, Konje JC. The impact of civil war on medical training in Sudan after 2 years- a questionnaire-based survey. BMC Med Educ. 2026;26(1):1255. doi:10.1186/s12909-026-09542-8.
4. Abu Alamrain A, Irfan B, Irfan K, et al. Medical education in Gaza: navigating disruption during the 2023-2025 Israeli military assault and beyond. Med Confl Surviv. 2026;42(2):278-306. doi:10.1080/13623699.2025.2605928.
5. Soqia J, Ataya J, Saadoun R, et al. Medical education in Syria at a time of crisis: Analysis of the results of the knowledge-based National Medical Examination. Med Educ. 2024;58(6):730-736. doi:10.1111/medu.15385.

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Scholasticide in war is devastating for medical research and training

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Beyond rebuilding: scholasticide creates a medical training-time debt

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Scholasticide in war is devastating for medical research and training

Check this box if you would like your letter to appear anonymously:: Last Name: WeiFirst name and middle initial: RenjieEmail:

renjie865@126.com

Address: The People's Hospital of Hechi, Hechi Guangxi, ChinaOccupation: Professor of Medicine and PhysicianOther Authors: Hanjun Ma Physician; Ju Liao Physician; Changwei Lu Professor of Medicine and Physician; Qi Wei PhysicianAffiliation: The People’s Hospital of HechiBMJ: Additional Article Info: Rapid response