Deir Ezzor province has been largely free of infectious disease outbreaks for the duration of Syria’s conflict. Now, doctors here say that polio has returned 14 years after the country’s last recorded case – and that the implosion of the province’s medical infrastructure could make the situation worse.

We spoke to a group of doctors in Deir Ezzor about the outbreak.

Syria Deeply: What kind of cases do you typically encounter and treat?

Dr. Raafat al-Assaad, Mohassan Field Hospital: In the beginning, the work of the field medical staff mostly revolved around war injuries. We treated all the wounded who came through, be they FSA fighters or regime soldiers. The medical organizations working here also provided needed medical equipment and drugs mainly tailored to treat war wounds.

However, we recently discovered many cases involving a number of infectious diseases, such as polio, tuberculosis, whooping cough and other respiratory diseases. This required us to work twice as hard to contain and treat these cases while trying to obtain the proper medication and vaccinations [for future use].

At the same time, the medical cadre in the area has tried to reopen many medical centers located in opposition-held areas by providing the basic equipment to be able to receive patients possibly carrying these diseases in Deir Ezzor.

Syria Deeply: What is the standard procedure for treating a patient carrying an infectious disease if he or she is in an opposition-held area or a hot zone?

al-Assaad: Currently, our work is limited to the hot zones where the Free Syrian Army and the regime forces are fighting. We perform field operations to treat a patient’s war wounds. We also try to provide first aid if there are field hospitals available that are close to the conflict area.

Syria Deeply: What was the first infectious disease you discovered here and how?

Dr. Imad al-Mustafa, director, Let’s End Polio in Syria: The first infectious disease was polio. A child from the city of Sabikhan was diagnosed after he exhibited all the symptoms. A sample was sent to a lab in Istanbul and the result came back positive, confirming that the patient had polio.

We immediately formed several medical teams to examine patients exhibiting similar symptoms. Many came back positive; in the Deir Ezzor governorate alone there are over 70 polio cases. A circular was issued and shared with the medical facilities in other governorates. We got word that they too had polio cases, which is why we had to do something to stop the disease from spreading.

Syria Deeply: How do you handle these cases? How can you stop polio from spreading?

al-Mustafa: We contacted the polio patients directly, and we offered them treatment. Many are still undergoing treatment. To contain the outbreak, the World Health Organization (WHO) along with the National Syrian Coalition (NSC) support unit and other international medical corps provided the needed vaccinations, which are two years overdue, since the work of the Health Ministry came to a halt after some areas fell out of the regime’s control, and because of the absence of health institutions capable of executing the task properly.

After the deal was struck to provide us with the vaccinations, we compiled a list of how many children needed to be vaccinated. We then submitted the list to WHO, who then handed the vaccinations over to our campaign. The handover was under the supervision of several international health organizations, such as Physicians Across Continents (PAC).

The vaccination campaign targeted 239,570 children. Over two rounds, all children were given the vaccine. The first round covered 205,058 children, while the rest were given their shots a week later.

The campaign “Let’s end polio in Syria” was carried out by 700 teams made of two volunteers: one to administer the vaccine and the other to record the process. Each area was supervised by a PAC health expert who played the biggest role in training, supervising and evaluating the volunteer teams.

Syria Deeply: What are the other infectious diseases that have surfaced in Deir Ezzor?

Dr. Ibrahim al-Mazeed, director, Al-Ashara Revolutionary Medical Center: Tuberculosis (TB), measles, smallpox, urticarial and skin conditions, and respiratory diseases, such as asthma. But polio remains the most widespread in the area.

A few patients exhibited TB symptoms. We transferred some of these cases to specialized chest clinics. After X-rays and lab tests were carried out in al-Qasha’, it became clear we were dealing with TB cases.

Today, there are 25 TB cases in the province distributed between the city of Deir Ezzor, al-Ashara, al-Mayadeen, Sabikhan, al-Basira, Buqrus and al-Tiyaneh.

Syria Deeply: What measures are you taking to control the disease?

al-Mazeed: After we confirm a case, we send the test results to international health organizations, including WHO.

We also went public on TV and print media as well as on the internet to create awareness and inform people of how dangerous these diseases are, especially in the areas that don’t have access to health care given the current circumstances and because the Health Ministry can no longer operate in opposition-held areas.

We had been promised aid, but until now, we haven’t had sufficient or proper [medical aid delivered] because of the ongoing fighting close to border crossings, and that has made it difficult to transport the needed medication.

Syria Deeply: What contributed to the outbreak of these diseases?

al-Mazeed: The lack of vaccinations and the fact that the Health Ministry has stopped them from being brought into opposition-controlled areas have enabled the outbreak of these diseases, especially among newborns and children under three years old. Additionally, [air and water] pollution have played a big role. They are the direct result of people randomly extracting and burning petrol as well as from the lack of clean [drinking] water.

The biggest challenge that we face is the lack of required medication to treat these cases. Because of the high incidence of internally displaced persons, we don’t have the needed vaccines to prevent an outbreak.

(Edited by Karen Leigh.)