Monthly Archives: January 2017

BLOG: By Janet Janbek: Vaccine Preventable Infectious Diseases in the Syrian Context

The Zaatari refugee camp near the Jordanian-Syrian border. Available: http://www.dailymail.co.uk/news/article-342983

The combination of having lived in Jordan for over 20 years and being a passionate public health student, it seemed obvious to me which topic I would cover with research when talking about health care in disaster situations. When the Syrian war first broke out, we could see and feel the consequences first hand in Jordan with a huge influx of Syrian refugees into the country- most directly sensed economically due to a simple equation of having huge numbers of people in a small country with limited recourses. When zooming in on the different dimensions of this crisis, one particular issue catches the eye- the infectious diseases situation, and more specifically the vaccine preventable ones. These include polio, Tuberculosis (TB), cutaneous leishmeiniasis (CL) and measles. The table below shows numbers for the cases of these diseases in Syria and the neighboring countries.

Infectious disease Country and Statistics
Measles Syria: UNICEF reported 594 cases by end of

2014, other sources claim 7000 to 10000 cases

Lebanon: 13% increase.* Jordan: From 24 cases to over 200 in one year.*

TB Syria: 6% new cases and 31% re-treatment cases

Lebanon: 27% increase in cases * Jordan: 22% increase in cases due to Syrian refugees (of the total 40% increase).

CL Syria: More than 41,000 cases in 2013 **

Turkey: 1843 cases in refugee camps in 2014 *

Lebanon: 97% of all cases involve Syrian refugees in 2013

Polio Syria: 7,600 cases.

No new cases from 2015 until April 2016

*Increase in cases is documented to be attributed to the Syrian refugees.

** Syria has been endemic with CL for decades.

Table by Janet Janbek, adapted from (1) and (5).

It is important to note that these statistics are not inclusive of all cases due to a large number of refugees living outside of the camps in poor conditions and have no access to medical care, inability of hosting countries to screen refugees when huge numbers come in within a short period of time and difficulty in detecting cases inside Syria due to the hardships and risks connected with reaching the dangerous areas.

Many factors have contributed to this crisis, these include destruction of health care systems in Syria, interruption infection control and immunization programs, shortage of drugs, sanctions imposed on Syria, huge numbers of Syrians seeking refuge in neighboring countries and Europe who live in camps or outside in unsanitary and crowded conditions, lack of access to water, starvation and unsafe food. Response has been in the form of huge immunization programs in the whole region by international institutions as well as individual neighboring countries. Despite that, the fact that diseases have not yet been eradicated makes this an important topic for response analysis to identify the gap between the responses and needs. Firstly, the mentioned contributing factors remain present with the ongoing war and constant relocation of Syrian refugees challenges surveillance systems and vaccination programs. Secondly, there is no uniformity in screening procedures among hosting countries where health policies differ and are majorly challenged by having to treat individuals with no medical records. Thirdly, international aid has been modest and underfunding is a big challenge especially for hosting countries with limited recourses. In Jordan for example, the cuts on the governmental health provisions have led to big numbers of refugees being denied access to health care services. Lastly, funding sent to Syria continues to be rejected by the government.

 

Efforts need to be made and recourses allocated by donor countries to support the national agencies and health care systems in hosting countries. It is crucial to point out the importance of keeping documentations of different offered interventions to avoid repetitions and unnecessary usage of resources. This needs to be achieved by the constant collaboration of involved international health organization in plotting interventions and emergency plans for response as well as unifying guidelines for treatments and interventions offered to the hosting countries. Donor countries and international aid agencies need to continue efforts to negotiate with and put pressure on the Syrian government and their allies and ask for access to distant locations that are difficult to reach. Furthermore, European countries and others need to help host more refugees and lift the burden off the current hosting countries which can allow to better carry out surveillance, screening and vaccinations programs. Financial support from international organizations is highly needed to carry out set out programs.

Sources:

  1. Ozaras R, Leblebicioglu H, Sunbul M, Tabak F, Balkan I, Yemisen M et al. The Syrian conflict and infectious diseases. Expert Review of Anti-infective Therapy [Internet]. 2016 [cited 13 December 2016];14(6):547-555. Available from: http://dx.doi.org/10.1080/14787210.2016.11774572.
  2. Sharara SKanj S. War and Infectious Diseases: Challenges of the Syrian Civil War. PLoS Pathogens [Internet]. 2014 [cited 1 December 2016];10(11):e1004438. Available from: http://dx.doi.org/10.1371/journal.ppat.1004438
  3. Syria crisis: humanitarian situation, needs and response [Internet]. International Committee of the Red Cross. 2016 [cited 13 December 2016]. Available from: https://www.icrc.org/en/document/syria-crisis-humanitarian-situation-needs-andresponse
  4. Murthy SChristian M. Infectious Diseases Following Disasters. Disaster Medicine and Public Health Preparedness [Internet]. 2010 [cited 2 December 2016];4(03):232-238.Available from: http://dx.doi.org/10.1001/dmp.2010.hcn10005
  5. Ismail S, Abbara A, Collin S, Orcutt M, Coutts A, Maziak W et al. Communicable disease surveillance and control in the context of conflict and mass displacement in Syria. International Journal of Infectious Diseases [Internet]. 2016 [cited 6 December 2016];47:15-22. Available from: http://dx.doi.org/10.1016/j.ijid.2016.05.011