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Health in Conflict: Syria's Refugees

By Lauren Glenn Manfuso

As refugees flee across the borders of war-torn Syria, they leave behind a rapidly crumbling health system with too few physicians, too little medicine and too many hospitals that have been abandoned or destroyed.

But in the camps and cities they’re running to, basic health care and essentials can be equally elusive. Simple necessities—like running water or heating fuel—are scarce as well. Meanwhile, as the conflict intensifies, the number of refugees flocking into the surrounding countries rises, too. Currently estimated by the U.N. to be around 
1 million, Syrian refugees are expected to triple by the year’s end.

Because of difficulties entering the country, addressing public health needs within Syrian borders has proved challenging if not impossible for foreign aid workers. Still, the Bloomberg School’s Center for Refugee and Disaster Response (CRDR) researchers are determined to try. They’re launching injury surveillance at health facilities in Aleppo, in northwestern Syria, and working with NGOs providing humanitarian assistance in Syria to better understand the country’s greatest health needs. To answer that same question about Syria’s refugee community, Bloomberg School researchers and students are actively working in the camps and cities in the nearby countries. “The idea is to look at the current state of refugee populations in the region so that we can better inform donors and providers of humanitarian assistance about what is most needed,” says Shannon Doocy, PhD, an associate professor in International Health. Doocy is launching two studies—one in Syria and one in refugee host countries.

The Syria-based study is still in its infancy and is moving slowly, explains Tom Kirsch, MD, MPH, an associate professor in International Health and Emergency Medicine, and a co-investigator of Doocy’s studies. “The government is at active war with various groups,” he says, “and they don’t want outsiders within their boundaries.”

For now, that leaves researchers focused on refugees in the surrounding countries, where they are witnessing firsthand refugee conditions, whether in tent settlements—where the nights are cold and toilets are sometimes nonexistent—or, as Alicia Hernandez witnessed, camping out in unfinished buildings.

“One place that particularly stayed with me was a construction site,” recalls Hernandez, an MPH student and a registered nurse, who recently returned from Lebanon. “It was extremely remote, a large concrete structure set back about a mile from the road. One lone family with children was staying there. Even in the daytime it felt like being in an ice cube. They had to walk at least 30 minutes to a water source and only had one large, flat mat for the five of them to sleep on.”

The actual camps, she continues, often lacked proper sanitation facilities. “Most camps used one central tap as the water source for camps of up to 150 people,” Hernandez says. “Almost no one was treating the water before consuming it for lack of money, resources or knowledge how. No one had proper latrines.”

Hernandez surveyed the displaced Syrian citizens about their health and medical needs. She is using the information gathered to devise a training manual for community health educators. A majority of those she encountered were children and women—many of them pregnant—who desperately needed basic necessities like blankets.

MPH student Jonathan Strong has a different focus: elderly refugees and their greater burden of chronic diseases such as diabetes or heart failure. Strong surveyed elderly Syrian refugees in Lebanon. Many lack access to affordable, basic health care, making their chronic diseases difficult to manage. “The high cost of health care there poses a huge public health challenge,” Strong says. “Many of the Syrian refugees I spoke to in Lebanon are forgoing necessary medical care due to cost.”

Both Strong and Hernandez visited the region for work supported by Caritas Lebanon Migrant Center.

While their projects are nearing completion—Hernandez’s training manual has been drafted and Strong is analyzing the completed studies and compiling the results—Doocy’s work is just beginning.

Once her studies are complete, she hopes the information she gathered can guide aid groups assisting refugees and those remaining in Syria.