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The Epidemic in Syria

To the Editors:

The depth and the scope of the humanitarian consequences of Syria’s brutal war are difficult to fathom: more than three million Syrians have fled the country, another six million are displaced within it, and some eleven million are in need of humanitarian assistance. In August, the UN High Commissioner for Refugees called Syria “the biggest humanitarian emergency of our era.” What is the best way to reach those in need, particularly in the opposition-held parts of northern Syria that have been the target of the Syrian military’s indiscriminate barrel bombs and are now increasingly subject to control by the unspeakably brutal ISIS?

I explore this question through the particular issue of international efforts to contain northern Syria’s polio epidemic in “Syria: The Other Threat,” a recent article on the New York Review of Books website [NYRblog, August 12]. Challenges of this enormity require clear-eyed pragmatism, but too often the international community’s response has allowed other institutional priorities to stand in the way. Until the UN Security Council’s long-awaited resolution in July, authorizing cross-border humanitarian aid for at least six months, the major UN agencies, WHO and UNICEF, were prevented from providing direct support to northern Syria without the consent of the Syrian government, which it withheld. That led UNICEF to send polio vaccines to several international NGOs, hoping that they would arrange for the vaccines to be administered to the children of northern Syria. But as I reported, a large number of these vaccines became unusable and were never distributed.

Even now, after the Security Council resolution, UN agencies give priority to relations with Damascus, where they continue to have major operations, over meeting the acute needs of civilians in northern Syria, reducing the effectiveness of these agencies. Moreover, WHO still clings to a test for the presence of polio—requiring the timely collection of stool samples and the sending of them across dangerous front lines to a recognized laboratory—that is utterly inappropriate to the wartime conditions of Syria. By failing to supplement this test with one that relies on clinical diagnosis, WHO missed the chance to diagnose polio at the beginning of the epidemic in 2013 and to put in place remedies that could have prevented the spread of the virus to other countries.

The good news is that a remarkable response to polio has been mounted by a task force organized by the humanitarian arm of Syria’s exiled opposition, the Assistance Coordination Unit (ACU). Health workers and volunteers from the ACU have vaccinated some 1.5 million children across northern Syria in seven separate vaccination rounds since the beginning of 2014, with two more to follow. They are the only ones consistently to have negotiated access even to ISIS-controlled territory, in both Syria and Iraq, although the Syrian government’s deliberate attacks on health facilities and workers serving people in opposition-held territory and the resulting exodus of medical personnel have greatly complicated this work. There are now, for example, only two surgeons serving Deir ez-Zor, a city of about 50,000 people. Moreover, even as cross-border humanitarian operations have expanded, the UN reports increasing difficulty reaching people from government-controlled areas who are perceived as hostile to Assad’s regime, such as those in besieged areas of eastern Ghouta and southern Damascus.

The public health problems extend well beyond polio. There are also substantial outbreaks of such vaccine-preventable infectious diseases as measles, pertussis, rubella, and tuberculosis. Chlorine, used to make drinking water safe for two centuries, is now being used by the Syrian government as a chemical weapon, while untreated tap water carries typhoid and other water-borne diseases.

To meet these escalating challenges, the ACU should be an essential partner. International organizations should be a source of both funding and technical expertise, but the ACU along with other Syrian groups like al-Seeraj both have the proven capacity to deliver in these difficult wartime circumstances, and they remain the best hope of building a viable public-health system for Syria’s future.

Annie Sparrow

Assistant Professor and Deputy Director of the Human Rights Program
Icahn School of Medicine at Mount Sinai
New York City