Let’s Not Forget the Health of the Syrians Within Their Own Country

Since 2011, the war in Syria has attracted great attention and concern, including that of the world media, human rights activists, international organizations, and academicians. More than four million Syrians of the 23 million population have fled as refugees to neighboring countries. Many—we don’t have an accurate estimate of their numbers—are currently fleeing using dangerous routes to Europe.

Less widely known about are the more than seven million Syrians who have left their homes for different locations and are currently internally displaced to areas that are relatively safer within the country. Originating mainly from the northeastern parts of the country, they escape severe fighting and the huge and dangerous threat of the Islamic State in Iraq and the Levant (ISIS). The internally displaced populations (IDPs) are taking shelters in large schools, in hastily built camps, or in proper rented houses, in Damascus and other governorates such as Lattakia and Tartous.

Despite efforts in Syria, these large IDPs have vulnerable lives and inhumane health conditions. Their needs are invisible to the world for many reasons: the news media have focused mainly on refugees outside of Syria, relevant authorities in Syria are not interested in disseminating this information, and those who are interested in contributing a global picture of the public health tragedy of the war lack the data to do so thoroughly. Moreover, there is the political bias of ignoring events occurring in the areas controlled by the Syrian government.

The health needs of the IDPs have been studied through several sources in Syria: (1) routine statistics or routine visits that are carried out by the Higher Relief Committee (HRC), (2) health surveys such as the one carried out on the nutritional status of IDPs by the Ministry of Health and the UNICEF office in Syria,¹ or (3) surveillance systems such as the Early Warning and Alert System (EWARS) established by World Health Organization and the Ministry of Health in 2012 covering the whole country with special focus on communicable diseases.² All those efforts are providing some information on IDPs, but they are influenced by funder interests and they often lack proper methodological rigor.

As of October 1, 2015, reports from EWARS are not showing an increase in the incidence of communicable diseases among IDPs. Nutritional status according to the nutritional survey has not been badly affected because of food subsidies. Efforts are being made to integrate the IDPs into their hosting communities with children attending schools, families accessing health centers, and in the absence of jobs for men or even absence of men, women trying to work and earn money. Nevertheless, reports from the HRC show that IDPs are living in very crowded settlements where there are shortages of basic needs such as water and electricity, causing vulnerability and suffering.

In conclusion, IDPs in Syria are the responsibility of the health system, which is overly burdened and is weakened by the loss of human resources. It is critical that the needs of IDPs should be assessed through accurate and systematic data collection so that services can be provided for both physical and mental health needs to alleviate this tragic situation.

Above all, efforts should be intensified to end the war and prevent further deaths, injuries, and mass displacements and migrations of families both within and outside Syria. It is a responsibility of the international public health community to advocate for an end of the fighting in Syria.