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Q+A: Where Syrians Are Dying of Infectious Disease

Dr. Annie Sparrow is a critical care pediatrician and an assistant professor in global health at Mount Sinai Hospital in New York. Her interest in refugees, human rights and public health has taken her to Afghanistan, Somalia, Darfur and beyond.

Written by Susannah George Published on Read time Approx. 3 minutes

Recently, she worked in Turkey and Lebanon with communities of Syrians fleeing the civil war next door. She wrote about what she saw for the New York Review of Books, in a piece called “Syria’s Assault on Doctors.” She spoke with Syria Deeply’s Susannah George about the medical situation unfolding on the ground.

Syria Deeply: From a public health vantage point, what do you see happening in Syria right now?

Annie Sparrow: [When] we were on the Lebanon-Syrian border. I was surprised because I was expecting to document all of the excess deaths from deprivation of medicines for health disease and cancer drugs because those are … some of the top 10 diseases in Syria before the war.

But, what is very clear now is how we’re seeing Syria transform from a very well off, middle-income country with diseases like cancer and asthma and cardiovascular disease, into [a country] where people are dying of infectious diseases.

That’s what we call the reversal of the epidemiological transition, because as countries improve the standard of living and introduce public health measures [like] sanitation … then the standard of living improves and people stop dying from infectious diseases like measles and so forth, and instead start dying of diabetes and heart disease.

The doctors keep saying to me: “We’re seeing diseases we don’t even know how to treat because they weren’t in our medical school text books; whether it’s leishmaniasis or polio, these are diseases of poverty and war.

It’s a very profound transformation, a very shocking one.

SD: You titled your piece for the New York Review of Books: “Syria’s Assault on Doctors.” What do you mean by that?

AS: Right from the very beginning doctors were threatened or arrested [by the Syrian government]. That was how it began. And [it’s now] a strategy where doctors were no longer allowed to treat civilians who are living in all [opposition-controlled] areas, basically huge chunks of the country.

If i were in Syria now I would be regarded as a terrorist for treating anyone not directly associated with the regime or living in an area that is perceived to be pro-government. We know that there were [about] 30,000 doctors [in Syria] before the war; now there can’t be more than 15,000 or 16,000 left at best. And those who are actually able to work as doctors are very few; many are in hiding.

SD: This damage to the public health infrastructure, are we seeing this on both sides of the conflict?

AS: The hospitals in government-held areas are still functioning, but they’re also suffering because they [are also dealing with] the lack of specialists who used to be there. And the devaluation of the Syrian pound means that it’s much harder to replace machinery or buy the drugs for cancer, diabetes and so forth. But [government-controlled hospitals] still have electricity and blood.

SD: Looking to the immediate future, what are you most concerned about?

AS: We’re now approaching the third winter, and now people are much more vulnerable because of the [government blockades] of so many [rebel-held] areas. So what’s happening is that we’re seeing many people who are really vulnerable to not only dying from starvation but dying from measles and polio. Allowing in medical aid … that’s going to be crucial for winter.

SD: What are your suggestions for ways to roll back this public health crisis?

AS: Polio itself is a very clear product of what happens from this strategy of targeting doctors and attacks on facilities: the erosion of public health, lack of treated water, lack of vaccines. Polio is highly contagious. [It] can’t be managed by vaccinations alone, it requires improved water and sanitation.

We need to not only contain the polio, but also manage it, because it is so infectious and it’s not going to respect borders. We have to open corridors of aid in order to provide the support that it’s going to take to deal with this polio. It’s only the tip of the iceberg.

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