Donald Trump wants to cap the number of refugees entering the U.S. in 2017 at 50,000 and suspend resettlement from Syria indefinitely. As his attempt to do so is challenged in the courts, there has been a lot of talk about how such a ban impacts the U.S. — and less focus on how it would worsen what is best described as a health crisis in Syria and surrounding countries.
One out of every five displaced people in the world comes from Syria. As the Syrian conflict enters its seventh year, health care within and around the country has been unable to keep up with the medical needs of an increasingly vulnerable population. Since 2011, 70,000 Syrians have died non-violent deaths, as a result of infectious disease, food scarcity, falling vaccination rates, poor sanitation, and a lack of access to medicine. Another 1.9 million Syrians have been physically injured.
Half of displaced Syrians still live in Syria. Of those who escape, nearly all live as refugees in neighboring states. Both in and out of camps, people are unable to receive consistent treatment for chronic conditions. In Syria and neighboring countries, chronic illnesses like diabetes and heart disease kill just as many people as bullets and bombs, according to Doctors Without Borders.
A small portion live outside the country in overcrowded camps, where poor food, sanitation, and other conditions lead to health problems, said Zaher Sahloul, past president of the Syrian American Medical Society, who has treated people in the camps.
“You see a lot of abdominal pain, constipation, and heartburn related to the type of food provided in the camps,” he told The Outline. Because of crowding and difficulty managing sanitation, bacterial infections like dysentery and viral infections like the flu are mainstays as well, he said.
In Jordan, where Sahloul recently visited, camps are in the desert, with a lot of exposure to dust. “It’s cold at night, and hot during the day, and that increases the risk of respiratory diseases like asthma, especially among children,” he said.
In Syria and neighboring countries, chronic illnesses kill just as many people as bullets and bombs.
Many adults in refugee camps suffer and die from diseases that require regular follow-up. At Jordan’s Zaatari camp, the largest Syrian refugee camp, more than 20 percent of primary health care clinic visits were due to such diseases. Inability to provide preventative screenings also means that cancers are not being diagnosed or treated, according to Sahloul.
If you have diabetes in a refugee camp, you won’t be able maintain a healthy diet, and you will have limited access to insulin, Sahloul said. Not only can this be acutely dangerous, but in the long term, untreated diabetes leads to kidney disease, problems with nerves and blood flow, and blindness.
“Same goes for hypertension,” he said. “If a patient is not being given medication or checked regularly by a physician, they will have long-term complications like strokes, heart attack, and heart failure.”
Malnutrition is an issue as well. A 2014 survey at Zaatari found that nearly half of all children under 5 and women between the ages of 15 and 49 suffered from anemia, a marker for micronutrient deficiency. It’s common to see children with stunted growth in camps, Sahloul said.
Refugees within Syria itself do not have access to adequate care either. The health care system there has been systematically targeted and destroyed by the government and its allies. Outbreaks of diseases preventable by vaccine, such as polio and measles, have occurred, in some cases spreading outside the country.
Nearly all households in opposition-controlled areas in the north had unmet essential needs, Shannon Doocy, an associate professor at the Johns Hopkins Bloomberg School of Public Health, found in a broad survey last year. She discovered that half of all households were in poor condition, half had disruptions in water access, and more than 40 percent had inadequate access to hygiene.
Even in government-controlled areas, where it’s easier to provide humanitarian assistance, only about half of households received help with shelter, water, hygiene, and other needs, she said at a symposium at the Johns Hopkins Bloomberg School of Public Health earlier this month.
“Everywhere within Syria, the greatest unmet need is food,” Doocy said. “We’ve heard that water has become a weapon of war in some areas, and there’s systematic efforts to deprive people of access to the most basic things.”
The situation is similar in Iraq, now in its 14th year of continued conflict. More than 3.4 million Iraqis are displaced within the country, many living in spontaneous settlements with no organized assistance.
People in these settlements live in unhygienic conditions in temperatures as high as 130 degrees, said Gilbert Burnham, a professor at the Bloomberg School of Public Health who studies displaced people in Iraq. More than 60 percent of pregnancies in informal settlements in central Iraq had complications, he told The Outline, and access to health services was limited, often requiring a vehicle to travel to hard-to-reach locations.
It’s common to see children with stunted growth in refugee camps.
The health impacts from devastation in Syria, Iraq, and elsewhere in the Middle East are long-lasting, Burnham said. Food insecurity may have long-term consequences on children’s growth and cognitive development, and psychological trauma will ripple across generations. Health care infrastructure will be difficult to recoup.
Hospitals, clinics, and camps in the region cannot meet the needs of a massive population exposed to war, displacement, and chaos, and this exacerbates conflict and the spread of disease. It is crucial for the countries including the United States to accept more refugees if this health crisis is to be alleviated. Once in their adopted country, resettled families can start to seek care for trauma and chronic conditions, and begin to build healthier lives. In 2016, only about 115,000 refugees were resettled worldwide out of 65.3 million displaced.
In December, Oxfam International released a report that found just 3 percent of the Syrian refugee population was resettled in rich countries. Of that number, most resettled in just two countries: Canada and Germany. Other wealthy nations, including the U.S., could do a lot more to help refugees — and stop an already-devastating health crisis from getting even worse.