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Responding to the Syrian health crisis: the need for data and research

2015; Elsevier BV; Volume: 3; Issue: 3 Linguagem: Inglês

10.1016/s2213-2600(15)00041-7

2213-2619

Adam Coutts, Fouad M. Fouad, Aula Abbara, Abla Mehio Sibai, Zaher Sahloul, Karl Blanchet,

Migration, Health and Trauma

As described in the News report about the ongoing crisis in Syria1Burki TK Syria: the ongoing crisis.Lancet Respir Med. 2015; 3: 103Summary Full Text Full Text PDF Scopus (2) Google Scholar in The Lancet Respiratory Medicine, the health situation of internally displaced people and refugees in Syria is severe and continues to deteriorate. The author called attention to many of the challenges faced by international organisations in addressing the health situation of internally displaced people and refugees in the country. However, we believe that urgent policy and research attention needs to be given to the generation of timely and high-quality evidence on the effectiveness of the humanitarian health response, the capacity of health systems within Syria, and the issue of non-communicable diseases among internally displaced people and refugees. Media outlets and decision makers have tended to focus on disorders such as leishmaniasis and poliomyelitis, rather than on non-communicable diseases. We agree with WHO and other humanitarian agencies when they act to stem the incidence of poliomyelitis in Syria. However, many less visible and untreated non-communicable disorders, such as cardiovascular disease, cancer, diabetes, and mental health issues are also highly prevalent in Syria and have caused the deaths and disability of thousands of internally displaced people and refugees from Syria. As with Iraq since 2003, the situation in Syria shows how conflict in middle-income countries affects the burden of non-communicable diseases.2Hagopian A Flaxman AD Takaro TK et al.Mortality in Iraq associated with the 2003–2011 war and occupation: findings from a national cluster sample survey by the university collaborative Iraq Mortality Study.PLoS Med. 2013; 10: e1001533Crossref PubMed Scopus (94) Google Scholar As a result, the humanitarian response in this new health context is shifting from the delivery of services related to communicable diseases to intervention for non-communicable diseases. Countries affected by the Syrian crisis such as Lebanon and Jordan are now requesting assistance from the WHO Eastern Mediterranean Regional Office to assist them in the design and implementation of humanitarian non-communicable disease interventions; however, up-to-date and reliable information on which to base an effective response is scarce in the context of the continuing conflict.3Blanchet K Sistenich V Ramesh A et al.An evidence review of research on health interventions in humanitarian crises. London School of Hygiene & Tropical Medicine, 2013http://r4d.dfid.gov.uk/Output/194740/Google Scholar The whole Arab region is having a non-communicable disease crisis, accentuated in the past 3 years by the conflict in Syria.4Rahim HFA Sibai A Khader Y et al.Non-communicable diseases in the Arab world.Lancet. 2014; 383: 356-367Summary Full Text Full Text PDF PubMed Scopus (210) Google Scholar Before the crisis, Syria had the highest proportion of cigarette smokers in the Arab region, with 62% of men smoking5Khattab A Javaidb A Iraqi G et al.Smoking habits in the Middle East and North Africa: results of the BREATHE study.Respir Med. 2012; 106: S16-S24Summary Full Text Full Text PDF PubMed Scopus (110) Google Scholar and a prevalence of chronic obstructive pulmonary disease of up to 6·1%.6Tageldin MA Nafti S Khan JA et al.for the BREATHE Study GroupDistribution of COPD-related symptoms in the Middle East and North Africa: results of the BREATHE study.Respir Med. 2012; 106: S25-S32Summary Full Text Full Text PDF PubMed Scopus (79) Google Scholar Research7Maziak W Rastam S Mzayek F Ward KD Eissenberg T Keil U Cardiovascular health among adults in Syria: a model from developing countries.Ann Epidemiol. 2007; 17: 713-720Summary Full Text Full Text PDF PubMed Scopus (52) Google Scholar also suggests that coronary heart disease accounted for more than half of all-cause mortality in Syria before 2011.8Taleb ZB Bahelah R Fouad FM Coutts A Wilcox M Maziak W Syria: health in a country undergoing tragic transition.Int J Public Health. 2014; 60: 63-72Google Scholar However, nowadays, data for the non-communicable and chronic diseases among internally displaced people and refugees in Syria are scarce—such data will be crucial for the planning of future humanitarian responses and for ensuring that health service needs are met. Within Syria, the situation is expected to worsen as the health system has become fragmented. Three main health systems operate at present in Syria: one managed by the Syrian Government; a second that exists as a hybrid model managed by local autonomous medical councils and international and Syrian non-governmental organisations, operating in areas controlled by different factions of rebel groups; and a third run by the self-proclaimed Islamic State. These health systems differ vastly in terms of service delivery capacity, number of trained staff, and access to essential medicines. Over the past year health facilities and the outbreak surveillance and response system seem to have stabilised, but are inundated with internally displaced people. In opposition-held areas, the situation is grave, with severely restricted access to basic drugs, anaesthetics, staff, and equipment because of security issues and the Syrian Government's control over cross-border aid assistance.9Assessment Capacities ProjectREACH InitiativeUN Office for the Coordination of Humanitarian AffairsSyria: multi-sectoral needs assessment (MSNA).http://www.humanitarianresponse.info/sites/www.humanitarianresponse.info/files/assessments/141028_Syria_MSNA_Report_FINAL_0.pdfDate: October, 2014Google Scholar An outbreak surveillance and response system has been established by the Assistance Coordination Unit, a humanitarian section of the National Coalition of the Syrian opposition, in opposition areas, focusing on infectious diseases. Within the Islamic State-controlled regions, no official health data have been produced. Interviews we have done over the past 3 months with medical personnel on the ground suggest that facilities are managing to cover a range of basic public health needs. Sanitation and hygiene conditions have improved since Islamic State took over last year and a hospital referral system has been established in the past 6 months between major urban centres in Syria and Iraq. The ability to collect evidence on the present health situation of populations in Syria to respond to and anticipate their health needs is now essential. The protracted nature of the conflict means that the humanitarian response has to increase its focus on addressing non-communicable diseases and assessing the effectiveness of response interventions and programmes for improving health. This focus is crucial at a time when aid budgets are being reduced and access to health care and drugs to treat chronic diseases for displaced people in Syria are becoming less affordable and increasingly scarce. Urgent donor investment is needed to support the work of the WHO Eastern Mediterranean Regional Office in their efforts to expand existing health information and surveillance systems, collect data, and provide research training for health-care professionals working in Syria. We declare no competing interests. Syria: the ongoing crisisAfter almost 4 years of civil war, the statistics tell their own story. At least 191 000 Syrians have been killed, 1 million have been injured, 9 million have been internally displaced, and 3 million have fled the country; 11 million need humanitarian aid, almost half of whom reside in regions in which it is either difficult or impossible for outside agencies to gain access. WHO estimates that 2015 will see 90% of Syrians living in poverty, with 60% unable to secure their own food supply. Vaccination rates, with the notable exception of polio, have fallen to roughly 50%, raising the spectre of future disease outbreaks. Full-Text PDF