Thinking Aloud: “Health Needs of Populations Displaced by Conflict and Political Upheaval,” Part II

June 29, 2015 by Darius 

[Last week, I attended the Middle East Institute’s conference “Cut Off from Care: The Health Crisis of Populations Displaced by Conflict.”  The most informative panel was “Health Needs of Populations Displaced by Conflict and Political Upheaval.”  Yesterday I shared the comments of Andrew Harper, head of the UN High Commissioner for Refugees’ office in Amman, Jordan, and Leonard Rubinstein of Johns Hopkins University.]

Zaher Sahloul of the Syrian-American Medical Society spoke of conditions on the ground in Syria.  The Syrian-American Medical Society is itself an amazing organization.  It is composed of Syrian-American doctors (according to Sahloul, fully 1% of doctors in the US are of Syrian descent) who have gone back to Syria to treat the victims of war.  Before the conflict started, SAMS had one permanent employee and an annual budget of $70,000, mostly focusing on small charity events in Syria.  Currently, SAMS works in five countries and has an annual budget of $24 million.

According to Sahloul, before the war, the Syrian medical system was a leading light in the region, on par with or better than the health systems of other middle income countries.  Polio, for example, was eradicated in Syria in 1999.

However, Sahloul said a greater percentage of Syria’s people have been impacted by the current conflict than the people in any other country in any other conflict in the last century.  The health effects have been disastrous.  Polio, eradicated in 1999, reappeared in Syria in 2013.  In the last four years, the life expectancy in Syria has fallen by 20 years, from 76 to 56.

Sahloul said there are 640,000 people in Syria under complete siege, cut off from food, water, and medical care except via smuggling.  Many of these besieged people are in Syrian cities.  Aleppo, for example, Syria’s largest city before the war, is now only accessible via the Turkish border.  There is no longer a single functioning CT scanner in all of Aleppo.  Field hospitals are often deliberately targeted by the regime, so they are hidden and operated in secret.  Recently, many field hospitals have been constructed literally underground to avoid barrel bomb attacks.

According to Sahloul, currently, almost all Syrian refugees are Sunni Arab.  It is entirely possible, though, that later in the conflict, there will be a wave of minority refugees (e.g., Alawites, Kurds, Druze, Christians).  It isn’t at all clear how mainly Sunni host countries and NGOs will react.  For the moment, though, Sahloul considered Turkey to be the model country for its response to the refugee health crisis.

Sahloul also spoke of the ethical issues of operating in Syria.  Doctors and other health personnel are deliberately targeted.  How can an organization like SAMS ask them to remain in Syria to treat desperate people but put their own lives at risk in the process?

Tragically, according to Sahloul, the biggest cause of death for Syrians has not been the regime or any of the rebel groups.  The biggest cause of death has been preventable noncommunicable diseases made fatal by the destruction of the health system.  Patients on dialysis or undergoing chemotherapy before the war have been unable to continue their treatments and died as a result.  Normally trivial medical problems like appendicitis have become fatal because patients are unable to undergo any surgery at all, no matter how routine.  These people are not included in the death toll of the Syrian war.  Yet their lives have been lost just the same.

You can probably understand why this was perhaps the most heartbreaking panel I’ve ever attended.

 

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