The Syrian health tragedy Dr Adam Coutts Dr Fouad M. Fouad
Brown University November 8 th 2013
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Inside Syria Nearing the third year of the conflict. Greatest
humanitarian disaster of the past two decades - largest-ever
humanitarian appeal 5.2 billion dollars. 2 million plus Syrians are
now living as refugees in the neighbouring countries Lebanon,
Jordan, Iraq and Turkey. Over 115,00 killed and 600,000 seriously
injured. 25% (6.25 million) of the population have become
Internally Displaced (IDPs). 4,000 cross into neighbouring
countries per day. Over 9.3 million people are at elevated risk and
in urgent need of food and medical assistance.
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Health situation has been neglected Silent and bigger killers
Communicable disease outbreaks Injuries and disabilities Chronic
diseases Mental and psychosocial disorders Starvation and famine
Diseases don't care whether you're for Assad or against Assad, or
uninterested in politics. It strikes everyone as an equal
opportunity. Anne Richard, Assistant Secretary of State for
Refugees (June 2013).
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Destruction of health infrastructure and supplies system
collapse 60% of medical facilities not functioning or destroyed.
Direct targeting of health workers by both sides 180 killed. 70% of
medical workforce left Syria. Overburdened with patients - 30,000
ER/trauma cases per month nationally. Lack of trained staff and
equipment.
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Siege, starvation and lack of sanitation 2.5 million people in
areas under siege / inaccessible to UN. Eastern Ghouta Suburb of
Damascus 15,000 facing acute food shortages. Water, sanitation and
hygiene infrastructure destroyed. Rubbish and waste remains on
streets for months in opposition areas.
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Source: UOSSM 2013
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A regional problem - a system overwhelmed Refugees have
increased the population of Lebanon by 15% (1.3 to 1.5 million).
Cost $7.5bn in lost revenue. Hundreds of millions of dollars
required to stabilise public services. Public health system and
hospitals have reached capacity refugees being turned away from
public hospitals. Refugees returning to Syria for treatment in
government areas due to high costs in Lebanon.
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Refugees June 2012 Syrian Refugees 25,400
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Registered Syrian Refugees 175,000 Refugees December 2012
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TODAY 805,701 Registered Syrian Refugees
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December 2013 1 Million Registered Syrian Refugees
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Photos by Rabia Shibli Saida South Lebanon
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Health situation in Lebanon Communicable diseases are rising -
Lebanese Ministry of Health (MoH) reporting measles outbreaks
increased from 9 in 2012, to 1,456 in 2013. Threat of epidemic
outbreaks in Informal Tented Settlements (ITS) due to poor
sanitation and over crowding. Discrepancies or under-reporting in
health statistics. MoH recently recorded 420 cases of Leishmaniasis
whereas a local NGO that operates throughout Lebanon found over
40,000 cases of skin diseases. Health Information System of MoH and
UNHCR very basic. Failing to provide accurate and timely
picture.
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The response less than robust. Syria Humanitarian Response Plan
(SHARP) and Regional Response Fund (RRP). Underfunded: donors slow
to secure funds. 63% SHARP, 57% RRP currently funded. Lack of
knowledge on response capacity and quality of services already
available WHO IS DOING WHAT, WHERE AND WHAT RESOURCES DO THEY HAVE?
Leads to duplication of projects inside and outside Syria.
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Threats and challenges Massive demographic changes threaten to
bring about collapse of public services. Neglect of chronic
diseases no surveillance or treatment for cancer, CVD, Type II
Diabetes, HIV among refugees will create long term burdens on all
social systems. 80% of excess deaths due to health / diseases in
conflicts Darfur 300,000 excess deaths Lancet 2010. Large numbers
die post conflict in stabilisation phase communicable diseases and
diarrhea.
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Less than robust response - Do Security Council members think
the situation is not that bad? SYRIA
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Possible policy responses Long-term thinking - bridge
humanitarian and development policies - need schools, health care
facilities, infrastructure in host communities. Universal Health
Care, labour market reform and infastructure. Make donor money
conditional on domestic reforms taking place Lebanon / Jordan.
INGOs demonstrate cost-effective interventions set up field trials
of existing interventions. Compulsory health screening and
treatment of refugees when registering. Actually collect data and
carry out proper surveys!
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Dr Adam Coutts London School of Hygiene and Tropical Medicine
Fouad M.Fouad MD, Faculty of Health Sciences American University of
Beirut
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ANNEX DATA AND MAPS
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Current conflict situation Source: U.S. Department of State,
Humanitarian Information Unit
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Source: UNDSS, UMASS (October 2013) Conflict areas
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Documenting the effects Lack of reliable and robust data from
inside Syria esp in areas of greatest need opposition areas.
Reliance on informal networks of contacts built up over time field
hospitals, clinics and fellow academics / medics. Government
sources (Ministry of Health) and UN (WHO- EMRO) only cover
government areas. Two large assessments carried out in opposition
areas by NGOs: OCHA reports in April that 6.8 million people are in
need Joint Rapid Assessment of Northern Syria (J-RANS II -APRIL) -
10.5 million people in urgent need OCHA to release a national
assessment on November 21 st 2013.
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At least 469 health workers are currently imprisoned. 180
health workers killed by Government and opposition. 60% of
hospitals / clinics destroyed or low capacity. 70% of the trained
medical staff doctors and nurses have left the country. Of 6000
physicians in Aleppo in 2011 30 remain. Nationally estimated now
4,041 people per doctor, compared to 661 persons per doctor in
2010. The health workforce
Slide 26
Public opinion turning against refugees Fear of sectarian
conflict and civil war (52%) Syrians are taking our job (82%)
Syrians refugees are supported financially to an unfair degree
(50%) Syrians should not be close neighbors (61% are not
comfortable with the presence of Syrians living as close neighbors)
The UN should establish refugee camps for Syrians (70%) The border
with Syria should be more policed (98%) FAFO 2013 Norwegian
NGO
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Italy, France, South Africa and Russia low donors
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The response less than robust Mix of International (MSF),
Syrian expat (UOSSM), Islamic Organisations (Qatari Red Crescent)
and private individuals Gulf. Divisions between International NGOs
and local NGO apparent lack of trust especially of UN by Saudis and
Islamic organisations. Inter agency sector working groups (Health,
education, WASH) in Lebanon have become talking shops with little
achieved. INGOs / NGOs having a toxic effect and increasing
community tensions due to bad planning and lack of local knowledge
and networks e.g., paying way above local market rates for services
and essential goods water and food stuffs.