The Cost Of War

A boy receives polio vaccine drops -- REUTERS/Gleb Garanich

Health needs in conflict zones must be addressed

BY Dr. Ala Alwan

Prior to the current conflict in Syria, immunization rates in the country were among the highest in the Eastern Mediterranean Region. More than 90 percent of Syrian children were vaccinated against diseases like measles and polio and there was no incident of a child being paralyzed by polio since the 1990s.

Last year, however, Syria saw the resurgence in the outbreak of measles and pertussis. In 2013, the country experienced a polio outbreak that paralyzed 35 children and spread to Iraq. Its containment required vaccinating more than 25 million children, many who were living in conflict zones over eight countries.

The main cause of the diseases’ resurgence can be attributed to war. Since the fighting in Syria began almost five years ago, half of the health workers have left the country to safer grounds; medicine and medical supplies are scarce and many health facilities have fallen into disrepair. As a result, many children have not been immunized.

Of the 22 countries in the World Health Organization’s Eastern Mediterranean Region, about half are in acute or protracted states of emergency. People are at increased risk of disease in areas that are inaccessible due to violence and insecurity.

Compounding the problem, 20 million people in the afflicted region have fled the conflict areas in search of safety. Many of them have crossed borders to live in neighboring countries. As a result, Jordan’s refugee population has doubled in recent years whereas Lebanon’s has tripled to the point where almost 30 percent of its population today comprises refugees. These increases in numbers have put immense pressure on the national systems as demands on services for health, education, water and sanitation have increased exponentially.

The low immunization rates among those living in and fleeing from conflict zones, endangers the lives of people across the entire region. The recent outbreak of polio in Syria led to its resurgence in Iraq, which had been free of the disease for 14 years.

In 2013, Jordan experienced an outbreak of measles which attributed to Syrian refugees at a time when the Hashemite kingdom was about to announce the disease’s eradication.

Stabilizing the health risks in crisis areas requires sustainable support. Emergencies don’t need to result in the collapse of health systems. In fact, when built well, health systems can be resilient and should be able to remain functional, even at times of critical urgencies.

Where health systems are allowed to collapse, viruses and disease outbreaks will become inevitable. They do not recognize borders. When funding for emergencies is delayed, or pledges not honored, the health of any region’s people will suffer.

Today, Iraq faces a serious humanitarian crisis: In five major governorates, at least 14 major hospitals and over 160 primary health-care facilities have been nonfunctional since July, leaving millions without access to life-saving treatment. Despite repeated calls for assistance, international and national organizations providing direct support to the health system had only received about $16 million of the $60 million needed for the initial humanitarian response plan.

In August, the funding shortfall almost led to the closure of 84 percent of health programmes and services. A short-term rescue from the U.S. government, European Union and the U.N. prevented for the time being, what would have left millions of people without access to urgently needed health-care services, including trauma care, nutrition supplementation, primary health care, outbreak detection and management, immunization services and reproductive health-care services.

However, in light of the current cholera outbreak in Iraq and additional displacement, support for health programmes is more essential than ever to ensure the delivery of services to the most vulnerable communities.

Despite increasing demand for health services, the region’s health programmes have only received funds that cover about 34 percent of its needs this year. This impedes the ability of humanitarian organizations to respond to health needs and threatens existing public health functions and health services.

In Yemen, more than 15 million people need access to health services and almost five million of them are in areas that are inaccessible for health service providers. It is the same for people living in areas that are beyond reach in Syria and Iraq. People living in remote places are the most likely to go unvaccinated; disease outbreaks in such areas are harder to detect early, more likely to go unnoticed for longer periods of time and spread farther.

It is important for world leaders to recognize that the situation is unprecedented and requires urgent attention.

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