News / Middle East

    Syrian Conflict a Public Health Disaster

    Injured Syrian women arrive at a field hospital after an air strike hit their homes in the town of Azaz on the outskirts of Aleppo, Syria, August 15, 2012.Injured Syrian women arrive at a field hospital after an air strike hit their homes in the town of Azaz on the outskirts of Aleppo, Syria, August 15, 2012.
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    Injured Syrian women arrive at a field hospital after an air strike hit their homes in the town of Azaz on the outskirts of Aleppo, Syria, August 15, 2012.
    Injured Syrian women arrive at a field hospital after an air strike hit their homes in the town of Azaz on the outskirts of Aleppo, Syria, August 15, 2012.
    Cecily Hilleary
    The United Nations estimates the civil war raging in Syria has left more than 2.5 million people in dire need of food, water, drugs and medical supplies. 
     
    After 18 months of fighting, thousands are dead and thousands more wounded.  If past wars are any indication, the health and well-being of Syrians will likely be affected long after the last guns are fired.

    Before the uprising started, Syria boasted nearly 500 hospitals and 70 licensed pharmaceutical manufacturers that supplied 90 percent of the nation’s drugs. All that has changed. 

    Tarik Jasarevic is a spokesman for the World Health Organization (WHO), which recently sent a team of observers into the embattled city of Homs.   He says many hospitals and health centers in Homs have been badly damaged by shelling. Only six of 12 public hospitals remain open, and eight out of 32 private hospitals are still in operation-- at greatly reduced capacity.

    “The 350-bed National Hospital has been completely destroyed,” Jasarevic said. “Lack of access to health care facilities, both by patients who need care and health workers who provide care, is one of the main obstacles being faced.”

    Staff shortages make matters worse. “At least half of all the medical doctors in Homs have left the city,” Jasarevic said.  “Many of the health facilities are staffed with volunteers who don’t have any medical or health training.”

    My wife has many sicknesses like increasing glucose, cholesterol, heart problems and high blood pressure. My kids have problems sleeping. They are always waiting for someone to break through the front door…
    Most of Syria's once-prosperous pharmaceutical industry was located in Aleppo, Homs and rural provinces near Damascus.  However, economic sanctions, violence, rising fuel costs and a shortage of raw materials have forced most of them to shut down. 
    “As a result, there is a critical shortage of life-saving medicines, vaccines, insulin, antibiotics, cancer drugs—even basics like oxygen, nitrogen gas or anesthesia drugs,” Jasarevic said.
     
    The disruption of Syria’s health care system means surgeries are being postponed and many patients with chronic health problems are not being treated.  Expectant mothers are not getting sufficient pre-natal care, and children are often skipping life-saving vaccinations. 
     
    Human Costs
     
    By late September, the Local Coordinating Committees had documented more than 25,000 dead from the fighting in Syria. The Syrian Observatory for Human Rights reported a higher figure -- 27,000 dead, with more than 6,880 of them members of Syria’s armed forces and security agencies. 
     
    Dr. Anas Al-Kassem is an Ontario-based surgeon and founder of the non-profit Canadian Relief for Syria (CRS). The group is made up of physicians who travel to the Turkish border with Syria every month to set up field hospitals and work to get much-needed medical supplies to the area.
     
    Al-Kassem says that while the death toll from the fighting is catastrophic, more attention should be paid to the many Syrians who survive with debilitating injuries -- and what impact this will have on the country’s future. 
     
    “Imagine, every day there’s almost 1,000 wounded -- added on top of the 1,000 wounded the day before,” Al-Kassem said.  “If you have 100,000 disabled, that means a half-a-million dependents will have lost the persons supporting them. 
     
    “I think that’s going to be the major issue, these disabilities, and the psychological effect is going to be unbelievable,” he said. 
     
    Moreover, Al-Kassem says the injuries he sees are getting more severe by the day.  Six months ago, he said, most of the injuries were gunshot wounds, something relatively familiar to doctors and comparatively easy to treat.
     
    Now that the regime his firing on civilians from the air, Al-Kassem says he is seeing more dramatic injuries than he has ever seen before -- even during his trauma fellowship in a Canadian medical school.  
     
    “Sometimes we don’t know where to start, what to do, how to ‘survive’ these patients,” Al-Kassem said. “So it is getting very, very impossible.  It’s a war zone there.”
     
    Hidden Wounds
     
    Civilians may not be taking a direct role in the fighting, but they experience war trauma in a number of indirect ways:  Their homes may be bombed.  They may be shot at.  They may lose family members or be displaced.  They may suffer shortages of food and water.  They may be arrested, beaten or raped.
     
    Dr. Elie Karam is founder and director of the Beirut Institute for Development, Research, Advocacy and Applied Care and an expert on the impact of war on civilian mental health.  His studies of the population of Lebanon after its 16-year civil war demonstrate that war increases the risk of mental problems – including depression, post-traumatic stress disorder (PTSD) and/or problems with impulse control.   Syria, he predicts, will face the same challenges.
     
    “You’re going to see a lot of depression,” he said.  “You are you going to see lots of anxiety disorders, including PTSD, and you are going to have an increase in impulse control disorders.” 
     
    Refugees vulnerable
     
    The United Nations says more than 250,000 Syrians have fled their homes for refugee camps in Turkey, Jordan and elsewhere—most of them women and children.  Studies suggest that refugees suffer from higher rates of PTSD and depression, particularly if they are disabled.
     
    Children are perhaps the most vulnerable victims of war.  Dr. Barry S. Levy of the Tufts University School of Medicine in Massachusetts has studied the issue of children in war zones and is co-author of War and Public Health.
     
    “Violence begets more violence,” he said in an interview with VOA. “When a child sees his family killed, suffers, witnesses atrocities or is uprooted – some of them seek revenge and that may go on for years or even generations.”
     
    Reproductive health risks
     
    War stress also contributes to complications in reproductive and sexual health.  A 2007 study on male infertility in Lebanon, for example, found that war may limit access to good obstetric care and assisted delivery, and this has been shown to lead to an increase in birth defects. 
     
    According to the United Nations Population Fund, the bulk of Syrian refugees are women and children.  Women are more likely to be raped, as studies show that the power of rape as a tool of war goes up in countries where the greatest stigma is attached to a woman’s honor during peacetime.   But according to the Women’s Media Project, which has been tracking reported cases of rape in Syria, sexual violence is also being perpetrated against men and children.
     
    Post Conflict Health Challenges
     
    The Syrian International Coalition for Health (SICH) is a consortium of organizations and health care providers who have banded together to address Syria’s health care emergency. 
     
    In an article in the forthcoming issue of the Avicenna Journal of Medicine, SICH member Mazen Kherallah and co-authors warn that Syria’s health care should not be allowed to collapse altogether, as has occurred in other regional conflicts.  Kherallah says SICH will meet in Geneva next month to discuss how to protect lives and reduce disease, malnutrition and disabilities in Syria -- and to empower Syria’s health care system so that it can meet war-related health care challenges in the future.

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    Comment Sorting
    Comments
         
    by: Ethan from: USA
    September 29, 2012 3:28 PM
    The world condition today makes one ashamed to be human.

    by: Jack
    September 28, 2012 8:04 PM
    Let the Arab League pick up the tab.

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