Increase in vector-borne disease reporting affecting humans and animals in Syria and neighboring countries after the onset of conflict: A ProMED analysis 2003–2018

Abstract

The protracted and violent conflict in Syria has resulted in large-scale displacement of people and destruction of health and sanitation infrastructure. The aim of this study was to examine epidemiological trends in vector-borne disease (VBD) outbreaks before and following the onset of the Syrian conflict (2011). Methods: ProMED, a digital disease surveillance tool, was queried for VBD outbreak reports affecting humans and animals in Syria and select bordering countries between 2003 and 2018. Data were normalized by dividing the number of unique VBD events by the total number of unique outbreak events reported by ProMED for each year. Suspected and confirmed case counts and deaths were manually extracted. Results: Reports on VBDs increased from a mean of 2.9/year pre-2011 to 12.8/year post-2011, a 343.5% (p < 0.05) increase. After normalization, reports increased by 485.5% (p < 0.05) over the time periods. Post-2011, the most commonly reported VBDs were leishmaniasis, Crimean-Congo hemorrhagic fever, and lumpy skin disease. Reported numbers of suspected and confirmed cases and deaths increased during the conflict period. Conclusions: VBD outbreak events in ProMED increased in Syria and select bordering countries after the onset of the Syrian conflict in 2011. Enhanced disease surveillance is critical to detect and manage outbreaks in conflict settings.

Syndromic surveillance of respiratory infections during protracted conflict: experiences from northern Syria 2016-2021

“…This study uses available data from EWARN and COVID-19 dashboards to report trends in ILI, SARI, and SARS-CoV-2 in northern Syria, an area of protracted conflict. We noted increases in both ILI and SARI trends over the time period studied; this is consistent with other studies from Syria, which report increases in emerging and reemerging infectious diseases during the conflict ( Mowafi, 2011 ;Doganay and Demiraslan, 2016 ;Nimer, 2018 ;Raad et al, 2018 ;Tarnas et al, 2021 ). These findings support previous work in other settings where respiratory infections are important causes of excess morbidity, mortality, and case fatality among populations affected by protracted conflict ( Goniewicz et al, 2021 ;Moradi-Lakeh et al, 2018 ;Guha-Sapir and van Panhuis, 2004 ;Bellos et al, 2010 ).…”

The impact of conflict on infectious disease: a systematic literature review

“…The current review identified and analysed six studies on multiple infectious diseases published between January 2000 and October 2023 [ 56 – 61 ] (Table 8 ). Higher incidence rates of several infectious diseases were reported in Iraq [ 56 ], in the Southwest region of Cameroon [ 57 ], in Syria and neighbouring countries [ 61 ], in Jordan [ 59 ], in Ukraine [ 58 ], and in DRC [ 60 ]. During the peak years of the war in Iraq, particularly during the US military surge (2007–2009), the incidence of infectious diseases increased significantly [ 56 ].…”

“… Implemented : • Vaccine rollouts were made in a targeted fashion to displaced children • Engagement of community health workers in providing a continuity of care Suggested : Local, national, regional, and global authorities must work together to develop risk-mitigating interventions in settings with armed conflicts to preserve the delivery and utilisation of health servicesservices. Tarnas et al, 2021 [ 61 ] Syria, Turkey, Lebanon, Jordan, and Iraq, 2003–2018 Population of Syria, Turkey, Lebanon, Jordan, and Iraq • Disruption of WASH infrastructure • Mass displacement • Overcrowding in health systems that were not equipped to handle an influx of forcibly displaced people • Interruption of standard health services including routine childhood vaccination Implemented : Not mentioned Suggested : Not mentioned Malik et al, 2021 [ 59 ] Jordan, early October 2017 to January 2018 Children under-five living in Jordan • A massive influx of Syrian refugees in Jordan placed immense pressure on the country’s over-stretched resources and affected the country’s health care system with exerted demand. • People coming through conflict-driven displacement had no or low access to healthcare and lack basic healthcare facilities.…”

“…In Syria and neighbouring countries, the number of vector-borne disease outbreaks reported among human and animal populations increased significantly following the onset of conflict in Syria [ 61 ]. Conflict-related factors that led to the spread of infectious diseases were the disruption of WASH infrastructure and standard health services, migration, and overcrowded healthcare systems not equipped to handle a surge of forcibly displaced people [ 61 ].…”

“…Conflict and violence have long been associated with the introduction, transmission, and propagation of infectious disease pathogens. Overall, major overarching pathways reported in the studies identified within this review included population displacement [ 9 – 11 , 15 , 24 , 18 , 20 , 27 , 28 , 29 , 34 , 33 , 46 , 50 , 51 , 56 , 57 , 58 , 55 , 62 ], disruption of vital infrastructure and of the healthcare system (including reduced surveillance, diagnostic delays, interrupted vaccinations [ 58 , 61 , 63 ], and disruption of disease control programmes) [ 9 , 26 – 28 , 31 , 42 , 43 , 50 , 53 , 56 , 57 , 58 ], and increased population vulnerability to infection [ 9 , 12 – 22 , 24 , 27 , 32 – 35 , 41 − 43 , 45 , 50 ]. Disease-specific pathways were also reported such as water contamination for cholera [ 17 , 14 , 21 – 23 ], poor injection safety [ 13 ], sexual exposure [ 13 ], risky practices for HIV [ 13 ], creation of potential mosquito-breeding sites for Dengue [ 53 ] etc.…”