Editorial

www.thelancet.com Vol 382 August 31, 2013 743

Syria: the neglected health crisis deepensLast week, the confl ict in Syria reached another shameful milestone—the Offi ce of the UN High Commissioner for Refugees and UNICEF reported that 1 million Syrian children are now refugees across Lebanon, Jordan, Iraq, Turkey, and Egypt. In Syria itself, 3 128 000 children are currently living in poverty, situations of displacement, or are caught in the line of fi re. UNICEF’s Executive Director, Anthony Lake, was unusually undiplomatic—”the global community has failed in its responsibility...We should stop and ask ourselves how, in all conscience, we can continue to fail the children of Syria.” Syria has presented the world with a geopolitical crisis. The global community must not ignore the health crisis that continues to deepen.

After 3 years of decimation to Syria’s health system—and an estimated 100 000 deaths—the global com-munity fi nally now seems to be waking up to the seriousness of this confl ict for civilians. Ban Ki-moon, UN Secretary-General, was “shocked” by the new allegations of chemical weapons use and is now talking about its “serious consequences”. Just how serious the international community will be in protecting the lives of Syrians remains to be seen. There is an urgent need to investigate the veracity of these latest events and the claims that sarin gas was deployed. WHO has a crucial part to play in verifying the cause of death of so many civilians.

But beyond the immediate urgency of these latest events, the chronicity of the humanitarian catastrophe in Syria and neighbouring countries must not be forgotten. The disruption to routine health services for children, women, and those who rely on stable supplies of medicines and health services—eg, patients receiving insulin, undergoing regular dialysis, or receiving treatment for cancer—will inevitably cause substantial increases in preventable mortality. The cruelty of the destruction of the health system is one of the deepest tragedies for Syria today. The medical humanitarian response to these desperate predicaments is being hampered by lack of coordination and insuffi cient funding, and above all a lack of access to all parts of the population, as reported recently by Adam Coutts and Fouad M Fouad in The Lancet.

Coutts and Fouad also warned that the Syrian refugee situation in Jordan and Lebanon would become so acute that the humanitarian response would be fi nancially unsustainable if refugees’ health needs and the immense pressures on domestic health systems were not addressed

urgently. In an imploring letter to The Lancet from Jordan’s Ministry of Health on July 3, a plea was made for US$180 million to expand and upgrade existing facilities, together with around $135 million in 2013 (readjusted for 2014 and beyond) to meet the health care needs of Syrian refugees. Jordan reports that as many as 3500 refugees are entering the country each day. Health services for this population are “dangerously overstretched”.

For the 1·5 million Syrian refugees in Lebanon, people who are enduring a large burden of disease on a background of undernutrition, Marwan Refaat and Kamel Mohanna propose a three-stage emergency plan in today’s issue. Similar plans will be needed for neighbouring countries too. And in Turkey, Pinar Döner and colleagues report this week that of 201 032 registered refugees, 27 640 are children, 4984 of whom have actually been born in Turkey. A more desolate and bleak beginning to these new lives could hardly be imagined.

What should we conclude from the health crisis in Syria? The world should be truly shocked by the civilian costs and consequences of this confl ict—the simply unacceptable toll on health workers who struggle to maintain what few health services and facilities remain. The health community needs to more forcefully raise awareness about the sanctity of health workers and health services under international law, as well as the obligations of all governments to those who are trying to deliver health services. Political leaders must not only acknowledge but also pay tribute to the tremendous work being done by Syrian health workers, international agencies (especially WHO and UNICEF), and non-governmental organisations working in massively challenging settings. Those tributes must extend to those in neighbouring countries who have shown their commitment to ameliorating this emergency. All of us should take a few silent moments to remember and thank our colleagues and those they are serving.

Anthony Lake has rightly indicated the implications of 1 million Syrian refugee children. Yet the inescapable conclusion today is that this confl ict may require the intervention of outside forces. While The Lancet does not take a position on whether or not a military solution to the Syrian crisis is right or wrong politically, we agree with Mr Lake—the slow and now accelerating asphyxiation of an entire population cannot continue. ■ The Lancet

For Anthony Lake’s statement see http://www.unicef.org/media/media_70225.html

For Adam Coutts and Fouad M Fouad’s see World Report Lancet 2013; 381: 2242

For Jordan’s letter to The Lancet see Correspondence Lancet 2013; 382: 206

For more on health professionals delivering care in Syria see Correspondence Lancet 2013; 382: 679

See Correspondence pages 763 and 764

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