28 January 2020
A broken healthcare system: the legacy of Syria's conflict
Published online 24 November 2014
Syrians and their neighbours are paying a hefty price for the collapse of Syria's healthcare system; with infectious diseases spreading and crossing borders, as a side effect to conflict.
As Syria’s three-year conflict continues, the country’s healthcare crisis means that the risk of infectious diseases becoming an epidemic is at its highest, according to a study published in PLOS Pathogens.
The study1 describes the crisis as “a public health emergency of global concern” – with vaccine-preventable diseases not only reappearing in Syria but being spread to other countries with the outpouring of refugees.
Polio has re-emerged in Syria because vaccination rates have fallen dramatically due to the ongoing conflict. In neighbouring Iraq, also wracked by war, a polio case was confirmed in northern Baghdad this March, the first in 14 years. In response to these outbreaks, the WHO, UNICEF, and ministries of health in seven countries launched the largest vaccination campaign in the region's history, aiming to reach more than 25 million children. Despite the campaign's success, hundreds of thousands of children remain unvaccinated, and the spread of polio throughout the region and beyond is still a realistic possibility, according to the WHO.
In Lebanon, which hosts some of the largest refugee camps for Syrians, the incidence of measles has surged among Lebanese nationals due to deficiencies in the immunization programme.
Leishmaniasis, which has been endemic in regions of Syria for decades, is now also found in refugee populations in Lebanon and Jordan. According to the PLOS Pathogens study, its sand fly vector may have been transported into Lebanon along with the refugees, raising concerns that the disease might spread to the general population.
Path to recovery
“Recovery on a national level will need a tremendous international and political push, both for getting funding and resources and for allocating them intelligently,” says Souha Kanj of the American University of Beirut, one of the authors of the study.
In the long term, the deterioration of the healthcare system presents a daunting prospect. “The longer a war takes, the more the institutions which you take for granted are destroyed or don't function properly anymore,” says Egbert Sondorp, senior lecturer in conflict and health at the London School of Hygiene and Tropical Medicine.
“Lack of trust is another issue. Winning back trust is very hard.” He compares it to the Balkan conflicts, where some hospitals favoured one ethnic group over another, leading people to lose faith in doctors and the medical system as a whole.
According to a study in The Lancet this year, many hospitals in Syria give priority to treating fighters, reducing access to healthcare for civilians. The military and anti-government forces have also threatened and targeted doctors, forcing them to choose between helping patients or saving their own lives. Healthcare professionals have fled Syria and Iraq, leaving a vacuum of competent personnel in both countries.
As a result of the militarisation of healthcare, many citizens have lost confidence in the proficiency and neutrality of health professionals.
“If you have a good peace agreement and there's a legitimate government and some external resources coming in, then you can definitely repair, but it usually takes much longer than people think,” says Sondorp. “Don't expect magic solutions. It takes time to restore systems and to restore trust. You need to put in a prolonged effort if you want to assist.”
- Sharara, S.L. & Kanj, S.S. War and Infectious Diseases: Challenges of the Syrian Civil War PLOS Pathogens (2014) doi: http://dx.doi.org/10.1371/journal.ppat.1004438