Refugees of the Syrian Civil War: Impact on Reemerging Infections, Health Services, and Biosecurity in Turkey

Abstract

After the Arab Spring uprising, Syria descended into a civil war in 2011. By March 2016, the United Nations reported that 13.5 million Syrians required humanitarian assistance, including 6.6 million internally displaced persons and more than 4.8 million refugees outside of Syria. Turkey is currently hosting the largest number of Syrian refugees-more than 2.7 million. A limited number of refugees are living in camps settled around the border, and others are spread throughout Turkey. This explosive and unexpected increase in the Syrian population in Turkey has had several negative impacts on health and social determinants. The overload of healthcare facilities has led to shortages in childhood immunization programs, drugs, and access to clean water and food supplies. According to Ministry of Health data, more than 7.5 million Syrians were examined at outpatient clinics, and 299,240 were hospitalized; most of those hospitalized were injured and wounded victims who require and have been occupying intensive care units. The refugees generally live in crowded and unsanitary conditions, which may lead to the spread of respiratory, skin, gastrointestinal, and genital system infections. Currently, measles, poliomyelitis, leishmaniasis, and multidrug-resistant tuberculosis are the reemerging infections being most frequently recorded. Multidrug-resistant gram-negative bacterial infections seem to be an increasing problem in gunshot or surgical wounds. Hepatitis A, malaria, and varicella have been seen with a high incidence among the refugees. There are many problems waiting to be resolved for health and living standards in Turkey.

Hepatitis A among refugees, asylum seekers and migrants living in hosting facilities, Greece, April to December 2016

“…The notification rates by age group in the Syrian refugee population indicate that the seroprevalence of Syrian children and young adults might be lower than described in the literature and seroprevalence data for these age groups are needed. High incidence of HA among Syrian refugees has also been reported from Turkey [17], while a HA outbreak among Syrian refugees in northern Iraq has been documented [18]. Moreover, most children have asymptomatic HAV infection; thus, the number of infections that occurred during the study period was probably much higher than reported.…”

"Reflection of Syrian Refugees to Pediatric Surgery"

“…As reemerging infections measles, poliomyelitis, leishmaniasis, and multidrug-resistant tuberculosis were most frequently seen in Syrian refugees [13] . Multidrug-resistant gram-negative bacterial infections were seen with high incidence in gunshot or surgical wounds.…”

Overview of Zoonotic Diseases in Turkey: The One Health Concept and Future Threats

“…Currently, Turkey has been affected from illegal animal and human movements. In particular, regional conflicts in the countries neighboring Turkey has led to massive refugee and illegal human movements during the past 30 years (15)(16)(17). In addition, Turkey has highly variable climatic conditions, vegetation structures, wildlife, and particularly many sanctuaries for immigrant birds.…”