Increasing Refugees, Increased Risk of Communicable Diseases

by Alena M. James

Since the start of the Syrian crisis three years ago, refugees have fled to camps in Jordan, Iraq, Turkey, Egypt, and Lebanon. Last week the United Nations High Commissioner for Refugees (UNHCR) reported the number of refugees from Syria to Lebanon has passed one million.  According to the report, this influx has stretched Lebanon’s social and economic infrastructure thin in public services such as electricity, water, sanitation services, education, and the public health sector. Tourism, trade, and investment within the country has also decreased significantly. The increase in the population has led to decreased wages among competing workers.  Lebanese residents find themselves struggling financially; while the refugees find themselves struggling to build better lives.

The competition for depleting resources is not the only concern facing both residents and refugees.  A high influx of refugees into any state can lay the ground for increases risk of communicable diseases or outbreaks of emerging infectious diseases. With small Lebanese communities overwhelmed by the drastic increase in the population, public health services struggle to provide adequate health care, antibiotic treatments, immunizations, and other medical aid to those in need. Not only are critical public health services overextended, but the high volume of individuals seeking services creates the ideal transmission grounds for microbial organisms and viral agents.

In overcrowded populations with limited health resources, the risk of spreading diseases is incredibly high and transmission can occur in a variety of mediums. Direct or indirect contact, the release of respiratory droplets, ingestion of contaminated food and water sources, contact with mechanical  or biological vectors are all various modes by which pathogenic agents spread from person to person.

Direct contact occurs from direct exposure to the pathogenic source, for example, when a patient is bit by a rabid dog and develops rabies. Indirect contact occurs via exposure to septic fomites, for example, when an unsterilized syringe is used to dispense a treatment or drug intravenously into a patient.  Respiratory droplets allow illnesses like the common cold, influenza, and measles to spread at a rapid pace through sneezing or coughing on and around others. Ingestion of contaminated water and foods lead to major gastrointestinal complications and other illnesses. Mechanical vectors, like insect bodies, indirectly spread diseases. For example, flies feeding on fecal material can pick up and spread pathogens, via their feet, after landing on a patient’s untreated injury or open wound. Biological vectors like mosquitos transmit viral, bacterial, and other parasitic organisms to patients. The chances of these transmission modes being employed by pathogens remain high among densely packed populations lacking in substantial health care resources.

According to the U.S. Centers for Disease Control, there are several diseases that migrants to Lebanon are susceptible to if the proper vaccinations are not sought. Such diseases include Hepatitis A and B, Typhoid, Polio, and Rabies. Refugees from Syria also pose a dangerous risk of transmitting communicable diseases if they have not received proper immunizations before fleeing from their country. Malnourished refugees deprived of food and clean water are at risk of developing weakened immune systems which makes them even more susceptible to virulent pathogens.

Despite the three-year Syrian conflict, many humanitarian workers continue to immunize children against preventable diseases. UNICEF in particular is actively working towards the vaccination of more than 20 million children against Poliomyelitis. Last October, the WHO confirmed at least 10 cases of children infected with Polio in Syria. This past weekend UNICEF re-launched its campaign to help control the spread of this virus among other states impacted by Syrian refugees.  Iraq, Turkey, Jordan also pledged to join the campaign due to the threat of incidences of the virus occurring in their countries.  So far Iraq has reported one case of the disease while the UN has reported 27 cases among Lebanese children.

Approximately 500,000 Syrian refugees to Lebanon have been children–who are at the greatest risk of acquiring polio if no vaccination has been administered. The war in Syria and the displacement of refugees has made it difficult for medical personal to provide vaccinations needed to control the spread of this and other communicable diseases.  The continued fighting in Syria is likely to lead to more bloodshed, the displacement of more refugees, the depletion of public service resources in several states, and the spread of more communicable diseases if efforts to resolve the conflict are not soon reached.


Image Credit: AP Photo/Bilal Hussein

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