A recent article by Dr Ala Alwan, WHO Regional Director for the Eastern Mediterranean, highlighted an often-underrated cost of war: disease. The article appeared in Newsweek magazine and was a hit on social media.
Dr Alwan takes Syria as a case study in how a country can shift dramatically from stability to turmoil in just a few short years – and the impact this has on public health there and in neighbouring countries.
Immunisation rates in Syria were among the highest in the Eastern Mediterranean Region until conflict broke out. More than 90% of Syrian children were vaccinated against measles and polio and there had been no case of a child being paralysed by polio since the 1990s.
Sadly, the country experienced a polio outbreak in 2013 which paralysed 35 children and spread to Iraq. This was followed by epidemics of measles and pertussis in 2014.
To contain the polio outbreak – which jeopardised a global push to eradicate the disease – international organisations launched a programme to vaccinate more than 25 million children spread over eight countries.
It was an effective and essential intervention; a testament to the power of international cooperation. Yet it cost money and time that might otherwise have been invested in other public health or development initiatives.
“The main cause of the diseases’ resurgence can be attributed to war,” says Dr Alway. “Since the fighting in Syria began almost 5 years ago, half of the health workers have left the country to safer grounds; medicine and medical supplies are scarce and many health facilities have fallen into disrepair. As a result, many children have not been immunised.”
He points out that Syria’s neighbours have absorbed huge numbers of refugees, most of whom are crammed into densely-populated camps. In Lebanon, 30% of the total population comprises refugees.
As we know, infectious diseases do not recognise borders; the prey on stressed health and social systems. And where immunisation rates drop in tandem with deteriorating sanitation and nutrition, the conditions favour outbreaks of disease.
Whatever the politics of the current Syrian conflict – and the many other conflicts taking place today – it is essential that preventative health services are preserved and supported. Otherwise, the most vulnerable will suffer most – making them the victims of events far beyond their control.