LONDON (Thomson Reuters Foundation) – The north of Syria is in the grip of a measles epidemic and cases of acute diarrhoea are on the increase across conflict-hit areas, as health experts warn that rising temperatures, poor sanitation and insecurity are worsening the risk of disease outbreaks.
Medical aid group Medecins Sans Frontieres (MSF) said this week there are up to 7,000 known cases of measles in northern provinces, including Aleppo, Ar-Raqqah and Idlib, despite efforts to vaccinate more than 75,000 children in the region.
When violence erupted in 2011, the country's routine vaccination programme – which had achieved coverage of 95 percent – was disrupted, leaving thousands of children unprotected, MSF said.
National immunisation coverage has dropped to around 45 percent this year, according to the World Health Organization (WHO). U.N. agencies and the health ministry are targeting around 2.5 million children, but only managed to reach 1.1 million with their latest vaccination campaign in April and May.
"Carrying out a vaccination campaign in a polarised conflict such as this one is proving extremely difficult, but vaccination campaigns and basic healthcare are as much needed as war surgery," Teresa Sancristóval, MSF’s emergency desk manager, said in a statement.
Deaths from measles remain low in the northern outbreak, but the disease increases children’s vulnerability to other infections, MSF said. The epidemic is "an indication that humanitarian needs are increasing and the country’s healthcare system is in a state of collapse", it added.
Statistics show that 37 percent of Syria's public hospitals are out of service, and another 20 percent have been damaged in the fighting. Among primary healthcare centres, 11 percent are no longer functioning, and just over half the country's ambulances are out of use.
In addition, the WHO warned earlier this month that public health risks from waterborne diseases – hepatitis, typhoid, cholera and dysentery – were rising due to overcrowded and unsanitary living conditions for most of the 4.25 million people displaced inside the country, as well as disruptions to water supplies and waste management.
Elizabeth Hoff, the WHO's representative in Syria, told Thomson Reuters Foundation on Thursday there is a steady increase in acute diarrhoea. In the first week of June, 828 cases were reported – almost 250 percent more than at the start of the year – with rural Damascus, Idlib, Homs, Aleppo and Deir al-Zor the worst affected. Between 100 and 150 cases of hepatitis A were also documented in the same week, as well as 12 cases of meningitis in Aleppo.
While the situation is not yet alarming, the WHO is worried about how it might evolve, and is pre-positioning medicines and kits to deal with any surge in infections. It has also put together a cholera outbreak plan, Hoff said.
ATTACKS, RESTRICTED ACCESS
The main problem facing health and medical aid efforts in Syria – which have now reached more than 2.4 million people – is the difficulty of accessing those in need.
"It's not that we don't have the goods inside Syria, but it is this constant negotiation to get them to people," Hoff said. For example, when an outbreak of watery diarrhoea occurred in an opposition-controlled area of Homs, she had to go there to arrange for medical kits to be brought in, which took longer than expected.
On the roads, there are numerous checkpoints to negotiate, and in government offices, there are constant conversations with the ministries of health and foreign affairs to enable aid groups to operate and medicines and equipment to be moved around safely. "We are not resting on this at all, we are putting on a lot of pressure," Hoff said.
Yet, despite persistent lobbying and calls for international humanitarian law to be respected, the high level of insecurity across much of the country makes it extremely difficult for aid workers and medical staff to do their jobs.
Hoff noted how a Syrian Arab Red Crescent vaccination team had recently gone into a hard-to-reach area around Homs with the necessary approval letters, but its car was shot at nonetheless, and two of its doctors were wounded.
A 21-year-old volunteer rescuer from Aleppo told Médecins du Monde (Doctors of the World) she had witnessed violence against healthcare facilities and medical personnel. She said government forces had used ambulances to attack field hospitals. Three nurses were arrested for carrying first-aid kits, and their partly burned bodies were returned to their families seven days later.
"It is our responsibility to remind the government forces just as much as the armed groups in Syria that not everything is permitted,” Thierry Brigaud, president of Médecins du Monde France, said in a statement. "No, you cannot bomb hospitals and neighbourhoods with impunity. You cannot finish off the wounded or execute the doctors and staff that seek to help them."
In some places, up to 70 percent of the health workforce has fled, leading to a lack of qualified medical expertise particularly for trauma, anaesthesia and specialised laboratory personnel, the WHO said. Medicines are also in short supply, as most Syrian factories making them have stopped production.
The WHO says it is impossible to know the extent to which deaths from ill-health have risen in Syria. But MSF said mortality rates are rising, especially among the most vulnerable, due to the lack of preventive measures such as vaccinations and restricted access to basic healthcare.
“Wars tend to bring about a drastic reduction in basic medical services precisely when they are most needed,” Sancristóval said.
MSF – which runs five hospitals in northern Syria in areas controlled by opposition groups – said it is prioritising children, pregnant women, the elderly and those suffering from chronic diseases in its response.
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