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Polio in Syria, The Tip of the Iceberg

I was in Syria on a medical mission to Aleppo when I heard the news confirming the resurgence of polio in Syria, which has reappeared for the first time in 14 years.

Written by Dr. M. Zaher Sahloul Published on Read time Approx. 5 minutes

According to the World Health Organization, 22 cases of flaccid paralysis have been reported in the rural areas of Deir al-Zour, a northeastern governate in Syria that straddles the Euphrates River and borders the Kurdish region in Syria, Iraq and Turkey. The resurrection of polio is the latest sign of the collapse of the public healthcare system and the tip of the iceberg of what is happening in this tragic humanitarian crisis.

Polio is a preventable, incurable and highly infectious viral disease that especially affects children under five years old. It is transmitted by contaminated food and water and poor hygiene, and causes lifelong disability and death. It threatens the whole region unless an aggressive vaccination campaign reaching hundreds of thousands of Syrian children trapped by the fighting is launched. The World Health Organization had an optimistic plan to eradicate polio from the whole world, the same way it eradicated smallpox. Polio was on its way to becoming a footnote in medical history, with only 223 reported cases in four countries last year, down from 350,000 in 1988, but with the 22 reported cases in Syria, the number of cases this year has reached 301, the first upward trend since 2008.

The resurgence of polio is devastating news. Before the crisis, Syria used to have one of the highest vaccination rates in the region. It had a reasonable public healthcare system in spite of low public spending. Health benchmarks on child mortality, life expectancy and maternal health have been increasing steadily in the past few decades due to decentralized public health infrastructure, implementation of preventive measures, especially vaccination campaigns, proper nutrition and its world-class medical personnel. Unfortunately, the public healthcare system has been slowly disintegrating over the past 32 months, like the infrastructure and communal life.

The city of Deir al-Zour, like the Aleppo, Homs, Daraa and Damascus suburbs, is a microcosm of what has happened in Syria. Called the jewel of the Euphrates, it is the heart of the al-Jazeera fertile region, with its historic landmarks such as the suspension bridge built in 1927, but destroyed by aerial bombing during the current conflict. Like the rest of Syria, the inhabitants of Deir al-Zour are diverse and they include Arabs, tribal Bedouins, Armenians, Assyrians and Kurds. Unfortunately the fabrics of urban and communal life have been gradually unraveling, and centuries of communal ties have been broken due to war, polarization and displacement. Most of the city’s inhabitants, estimated to be 500,000 before the conflict, have been displaced internally or became refugees in Turkey, Iraq and Jordan. Most of the rural areas are controlled by the opposition, while most of the city is controlled by the Syrian regime. The majority of the city hospitals have been damaged or completely destroyed, and most of its doctors have been forced to flee due to violence, detention, bombing and collapsed economy. After three years of fighting, drought and unprecedented inflation, patients are no longer capable of paying for doctors’ visits and non-emergency procedures or purchasing their medications. Like the rest of Syria, most patients with chronic diseases, like diabetes, heart disease, asthma, hypertension and kidney disease, have stopped buying their medications. Chronic diseases have been the silent killer in the current crisis in Syria, taking the lives of an estimated 200,000 patients, much more than the 120,000 people killed by bombs, ballistic missiles and guns or the estimated 1,400 people killed by nerve gas.

My organization, the Syrian American Medical Society (SAMS), has been training Syrian doctors, or what is left of them, how to deal with the unfolding medical disaster by establishing underground field hospitals in different regions in Syria, including Deir al-Zour, to provide basic free healthcare and life-saving surgeries to the local population currently deprived from healthcare. We have been providing hands-on education on trauma, critical care, burn care, psychological trauma and chemical weapons attacks. SAMS has been also providing medical supplies and equipment and sending medications to treat resurgent diseases, like leishmaniasis, typhoid and measles. Lately we have been focusing on the treatment of chronic diseases after the collapse of the local pharmaceutical industry. Many of our members have been leaving their comfortable and safe private and academic practices in Chicago, Detroit, Los Angeles and Washington to volunteer in dangerous medical missions in Aleppo, Idlib, Latakia and Deir al-Zour to boost the heroic work of our Syrian colleagues. Now we have to add polio to our ever-expanding list of what to address in Syria.

While our doctors in the U.S. have been addressing computer glitches in our Affordable Healthcare Act, the Syrian doctors have been fighting a losing battle over the past 32 months, often risking their lives in order to save the lives of innocent Syrian children and civilians. In a recent report by the United Nations Commission of Inquiry, Syrian government forces are systematically attacking hospitals and medical staff members and denying treatment to the sick and wounded from areas controlled or affiliated with the opposition. Public hospitals have been used as torture centers by military intelligence agencies.More than 160 Syrian medical personnel have been killed since the beginning of the crisis, including 22 Syrian Red Crescent volunteers, and more than 800 were detained and tortured by the Syrian authorities.

Last week, members of the Syrian Ministry of Health, the World Health Organization, UNICEF and several local organizations began a project to vaccinate 2.4 million children against polio, measles, mumps and rubella. It is doubtful that such a campaign will succeed within the current circumstances. The main hurdles for the deterioration of the vaccination rate are fighting, displacement of population and the government blockade of areas under siege. NGOs have been complaining that the Syrian authorities are blocking them from accessing these areas and providing much needed food and medicine to the trapped civilians. For example, in the suburb of Almoadameyya in western Ghouta, the ICRC and the Syrian Red Crescent are unable to deliver food, clean water, baby formula and medications due to the suffocating military blockade for the past year and a half. It is doubtful that the Syrian government will suddenly change its policy and allow the vaccination of children without strong international pressure.

The U.S. and the United Nations Security Council should tackle the disintegration of the public healthcare system in Syria with its ramifications on regional and global health with the same urgency it tackled the use of chemical weapons by the Syrian regime. The spread of polio and other incurable and infectious diseases is just as dangerous as the spread of chemical weapons, extremism and instability fueled by the Syrian crisis. A child who is dying from polio or indiscriminate aerial bombing should not be viewed any differently from a child who is gassed to death. Death is death, regardless of the cause.

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