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Refugees fill cans with water inside a camp in Baalbek, Lebanon, for Syrians who have fled the fighting in their country. (Getty Images)

As Doctors Leave Syria, Public Health Crisis Looms

Jun 29, 2013 (Weekend Edition Saturday)

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The death toll in Syria's ongoing civil war may now be as high as 100,000. As the violence mounts, another emergency is looming: a public health crisis across the region.

That's the conclusion of a new study published by the British medical journal The Lancet. Syria's health care system is near collapse. Outbreaks of disease are on the rise in the country, and refugees sheltered beyond the border are also at great risk.

One medical clinic in a poor neighborhood in Beirut is always busy. The two-story building is up a narrow street of cinder-block homes. Syrian refugees have moved in, adding to the crowding and the caseload, Dr. Abdul Kader Abbas says. He says he's treated 758 Syrian families here — many already sick when they arrived in this densely packed neighborhood.

"With the additional numbers," Abbas says, "we are afraid that any disease could spread easily in such circumstances." That's the same warning spelled out in the latest Lancet report.

Seventy percent of Syria's medical professionals have fled the country. Public health researchers Dr. Adam Coutts and Dr. Fouad Fouad say there has been a dramatic rise in communicable disease.

For example, Coutts says, there were 7,000 cases of measles in northern Syria in the past few months after a vaccination program was disrupted by war, and the list is growing to include TB, leishmaniasis, typhoid and cholera, which will come up during the summer months.

Leishmaniasis is spreading so fast among the displaced people inside of Syria that it is now called the "Aleppo boil" — for the running skin sores transmitted by sand fleas. Fouad says with the collapse of Syria's health care system, many Syrians have not had any medical care or medicine for more than two years.

When you consider chronic diseases like diabetes, Type 1 and 2, and cancer, Fouad says, you start to see that more people are dying of disease rather than war.

Disease moves easily across boundaries along with the refugees. Coutts and Fouad warn this could lead to a public health crisis for the entire region. By the end of this year, the Syrian refugee population is expected to reach more than 3 million.

In Jordan, the patient load in hospitals has jumped 250 percent in the past five months. Lebanon's health system is under strain with more registered refugees than any of its neighbors.

"With this huge influx of refugees now in Lebanon," Fouad says, "the number will come to change the whole system."

One expected change is in the school system. U.N. officials estimate that when school starts in the fall, Syrians will outnumber Lebanese kids in the country's public schools. That worries Hayda Mohammed Al Jeeshi, the nurse at the health care center.

She says many Syrian kids missed childhood vaccinations before they fled to Lebanon and that puts Lebanese children at much greater risk. The measles outbreak that started in northern Syria is now showing up among the refugee community in Lebanon.

Scrambling to care for one of the world's largest refugee populations is another burden of the Syrian war. The U.S. government has upped its contribution to host countries to more than $800 million, with an additional $300 million pledged this month for food, shelter and health care.

"Diseases don't care whether you're for Assad, or against Assad, or uninterested in politics," says Anne Richard, the U.S. assistant secretary of state for refugees, who was in Lebanon this week. "It strikes everyone, as an equal opportunity."

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