Background War in Syria has lasted for more than eight years, causing population displacement, collapse of medical and public health services, extensive violence and countless deaths. Since November 2016, military operations in Northeast Syria intensified. In October 2017 a large influx of internally displaced persons (IDPs) arrived to Ein Issa camp, Raqqa governate. Médecins Sans Frontières (MSF) assessed the health status of recently arrived IDPs in Ein Issa camp. Methods MSF carried out a cross-sectional survey using simple random sampling between 8 and 18 November 2017, enrolling households who had arrived to Ein Issa camp since 1 October 2017. A questionnaire collected data on demographics, history of displacement, retrospective one-year mortality, two-week morbidities, non-communicable diseases, exposure to violence in the last year and two-week psychological distress symptoms among all household members as well as vaccination status in children aged 6 to 59 months. The latter were also screened for malnutrition. Prevalence estimates and mortality rates were calculated with their 95% confidence interval. Mortality rates were calculated as the number of deaths/10,000 persons/day using the individual person-day contribution of all household members. Results MSF surveyed 257 households (1482 participants). They reported 31 deaths in the previous year, resulting in a crude mortality rate of 0.56 deaths/10,000 persons/day (95%CI: 0.39–0.80). Conflict-related violence was the most frequently reported cause of death (64.5%). In the previous year, 31.7% (95%CI: 29.4–34.2) of the participants experienced at least one violent episode. The most frequent type of violence reported was witnessing atrocities (floggings, executions or public body displays); 18.9% (95%CI: 17.0–21.0) of the population and 9.8% (95%CI: 7.9–12.0) of the children under 15 years had witnessed such atrocities. In men over 14 years, 15.8% (95%CI: 11.9–20.8) were detained/kidnapped and 11.3% (95%CI: 8.0–15.8) tortured/beaten/attacked. In the two weeks prior to interview, 14.4% (95%CI: 10.6–19.3) of the respondents felt so hopeless that they did not want to carry on living most of the time. Conclusions High levels of mortality, exposure to violence and psychological distress were reported. These survey results increase understanding of the impact of the conflict on the IDP population in Northeast Syria.

Background In June 2017, the U.S.-backed Syrian Democratic Forces (SDF) launched a military operation to retake the city of Raqqa, Syria, from the so-called Islamic State. The city population incurred mass numbers of wounded. In the post-offensive period, the population returned to a city (Raqqa) contaminated with improvised explosive devices (IEDs) and explosive remnants of war (ERWs), resulting in a second wave of wounded patients. Médecins Sans Frontières (MSF) supported a hospital in Tal-Abyad (north of Raqqa) and scaled up operations in response to this crisis. We describe the cohort of blast-wounded cases admitted to this hospital in order help prepare future humanitarian responses. Methods We retrospectively extracted data from clinical charts in the MSF-supported hospital. We included all new admissions for blast-wounded patients with key data elements documented. We performed comparative analyses from the offensive period (June 6, 2017 to October 17, 2017) and the post-offensive period (October 18, 2017 to March 17, 2018). Results We included 322 blast related injuries. There were more than twice the number of cases with blast injuries in the post-offensive period as the offensive period (225 vs. 97, p = <.001). The offensive period saw a significantly higher proportion of female patients (32.0%, n = 31 vs. 11.1%, n = 25, p < 0.001) and paediatric patients (42.3%, n = 41 vs 24.9%, n = 56, p = 0.002). Blast-injured patients in the post-offensive period included more cases with multiple traumatic injuries (65.8%, n = 148 vs. 39.2%, n = 38, p < 0.001). The treatment of the blast-injured cases in the post-offensive period was more labor intensive with those patients having a higher median number of interventions (2 vs 1, p = <0.001) and higher median number of days in hospital (7 vs 4, p = < 0.001). Conclusions In the wake of the Raqqa offensive, the MSF-supported district hospital received an unpredicted second, larger and more complex wave of blast-wounded cases as the population returned to a city strewn with IEDs and ERWs. These findings indicate the high risk of traumatic injury to the population even after warring factions have vacated conflict zones. Medical humanitarian actors should be prepared for a continued and scaled up response in areas known to be highly contaminated with explosive ordnance.

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Background: Crimean-Congo haemorrhagic fever virus (CCHFV) is a member of the Nairovirus genus belonging to the family Bunyaviridae, which consists of diverse RNA viruses. CCHFV has the propensity to cause nosocomial infections with a high fatality rate and is endemic in South Africa. Handling of the virus requires biosafety level 4 (BSL-4) conditions, which limits diagnostic capacity. Advances in molecular techniques have allowed preparation of safe recombinant antigens that are useful in diagnosis and serosurveillance of CCHFV. The purpose of this study was to examine the global nucleic acid and amino acid diversity between isolates worldwide; clone and express a recombinant CCHFV nucleoprotein (NP) from a southern African CCHFV and distantly related Greek CCHFV strain and determine the antigenic cross-reactivity between the two isolates.Methods & Materials: Phylogenetic analyses based on NP gene of 45 isolates was performed. Nucleotide sequence diversity and amino acid diversity between groups, within groups and pairwise distances were calculated. A previously expressed codon optimized NP from a South African isolate, SPU 415/85 was subcloned into pColdTF vector and was expressed in a bacterial system. Similarly, the gene encoding the NP of a Greek isolate AP92 was codon optimized and expressed in Escherichia coli host cells. Recombinant NP were used to develop in house ELISA to detect IgG antibody against CCHFV in South African patients who survived infection Results: Phylogenetic analyses using nucleotide and amino acid sequences of the NP revealed six different groups. The most diverse strain, AP92, displayed the greatest amino acid difference with SPU415/85 (8.7%). Both proteins were expressed with the aid of a chaperone and were purified from the soluble phase. A total of 14/14 sera reacted with the South African recombinant NP and 13/14 reacted with the Greek recombinant NP. The cross reactivity suggests the presence of highly conserved epitopes.Conclusion: Phylogenetic analyses reveal a high genetic diversity and lower amino acid diversity which suggested synonymous changes in nucleotides, resulting in fewer differences at protein level. The serological cross-reactivity of the two NP antigens suggests that recombinant antigens prepared from geographically specific CCHFV strains will have diagnostic and epidemiological applications worldwide.