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WHO: Crisis in Syria sets stage for disease epidemics
The conflict in Syria has resulted in an increase in the prevalence of communicable diseases inside the country and among Syrian refugees who have fled the violence, according to WHO.
“All the risk factors that enhance the transmission of communicable diseases in emergencies are present in the current crisis in Syria and its neighboring countries,” Jaouad Mahjour, MD, director of the department for communicable diseases at WHO’s Regional Office for the Eastern Mediterranean, said in a press release. “We are anticipating a number of public health risks from waterborne diseases, specifically hepatitis, typhoid, cholera and dysentery. Given the scale of population movement both inside Syria and across borders, together with deteriorating environmental health conditions, outbreaks are inevitable.”
According to WHO, the conflict has severely disrupted health services; 35% of Syria’s public hospitals are no longer in service, and up to 70% of the health workforce has fled. Approximately 4.25 million internally displaced Syrians are living in overcrowded and unsanitary conditions, and the provision of safe drinking water has been disrupted, as well.
Syria’s early warning system for outbreaks reported that acute watery diarrhea increased by 172% from the first week of January to the second week of May. Hepatitis A increased by 219% during the same period.
The prevalence of vaccine-preventable diseases also has increased, according to WHO. Vaccination coverage of measles decreased from 95% in 2010 to approximately 45% in 2013, and the number of laboratory-confirmed cases increased from zero in 2010 and 2011 to 139 in the first quarter of 2013. More than two-thirds of those cases were unvaccinated. The conflict also has disrupted national programs to vaccinate children aged 5 years or younger, resulting in greater numbers of unvaccinated children.
Cases of measles, tuberculosis and cutaneous leishmaniasis have been reported among displaced Syrians, thousands of whom cross the border every day into neighboring countries such as Turkey, Iraq and Jordan.
During the next several months, WHO will partner with other health organizations to address the growing number of infectious disease cases in Syria. Their efforts include the provision of safe drinking water, sanitation and bed nets to the affected population, as well as pre-positioning medicine and medical supplies, strengthening Syria’s early warning systems to detect infectious diseases and training first-line responders.
- John Schoen
Perspective
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The ongoing armed conflict in Syria has created a very complex humanitarian emergency, accompanied by a perfect storm for infectious disease threats due to massive population displacements and collapse of the health care and public health systems in the country. The most vulnerable groups include infants, children aged younger than 5 years, pregnant women, the elderly, individuals with chronic diseases, and those injured in the fighting. The health system has been compromised by destruction of facilities, shortages of health care personnel, and lack of access to essential drugs and medical supplies. The public health infrastructure has been weakened by personnel shortages, limitations on mobility of staff, and compromised communication capacity. Internally displaced persons and their animals are in crowded temporary facilities in degraded environments, where disease surveillance and control programs are compromised, food security and access to safe water and adequate sanitation are grossly inadequate, and immunization and vector control programs are limited.
The risk of endemic enteric, respiratory, vaccine-preventable (eg, measles), and vector-borne diseases (as recent reports of cutaneous leishmaniasis from non-endemic parts of the country illustrate) is increased under these conditions. The injured are at increased risk for trauma-associated severe soft tissue and systemic infections. As the ongoing experience with cholera in Haiti following the introduction of Vibrio cholerae after the earthquake illustrates, Syria is at risk for the introduction and delayed recognition of epidemic diseases. The recent report of the detection of wild poliovirus type 1 in sewage samples in Israel is another example of a concern. Syria is also vulnerable to the introduction of MERS-CoV, the coronavirus currently associated with other countries in the region. Other issues of potential concern include cholera and avian influenza strains, compromised tuberculosis control efforts, and spillover of infectious diseases to adjacent countries resulting from cross-border migration. All of these issues pose enormous challenges for the Syrian population and for agencies and organizations with health care, public health, and humanitarian relief missions.