Syrian Refugees: Health Context

By: Yasmeen Mansoor and Sujin Im (BSc.), MD Candidates, Class of 2019, University of British Columbia 

Prior to the conflict, Syria was a lower middle-income country with a relatively young population. 90% of the population in the country had access to clean water and sanitation at the time, and vaccination coverage was estimated at 90%. Infectious disease rates in the country had been low compared to higher-burden countries (Source: WHO).

Since the conflict in 2011, displaced Syrian refugees faced issues such as limited access to food and clean water, limited protection from extreme weather, unsanitary and overcrowded environments, and limited access to vaccinations. These factors have increased their chances for certain illnesses (Source: PHAC). Below is a list of some health concerns to be aware of in the Syrian refugee population. 

Immunization

  • Immunization records may not be available for most refugees. Age-appropriate vaccinations according to the provincial vaccination schedule, and seasonal influenza vaccines, should be provided if vaccination statuses are uncertain.
  • Note that no significant outbreaks or transmission rates of infectious diseases have been reported in countries that have accepted Syrian refugees. As such the refugee population does not pose a health risk to Canadians (Source: PHAC).

Tuberculosis, Hepatitis B, Hepatitis C, HIV, Strongyloides

  • Refer to the CMAJ article Caring for a newly arrived Syrian refugee family for evidence-based recommendations regarding screening and treatment for the above infections

Injuries and Disabilities

  • Injuries: 5% of health care consultations in Jordan and 1% in Lebanon were for injuries in 2013 (UNHCR-Review). Injuries may be war-related, and may have resulted in physical disability.
  • Disabilities: 1 in 10 refugee households in Jordan had at least 1 family member with a disability - 41% are children (UNHCR-Review). 

Other Acute Health Issues

  • Wound care, issues of malnutrition, and dental health issues may be common in this population (PHAC)

Chronic Illnesses

  • Hypertension (7.6%), diabetes (2.2%) and cardiovascular disease (0.9%) were the hree most common chronic diseases detected by the Citizen and Immigration Canada (CIC) during an Immigration Medical Exam in a cohort of Syrian refugees (Source: CIC).
  • Refugees may have experienced interruptions in their treatments for chronic illnesses due to conflict and resettlement.

Mental Illness and Trauma

  • The most significant clinical problems in populations affected by collective violence and displacement include depression, prolonged grief disorder, posttraumatic stress disorder, and various forms of anxiety disorders.
  • Common traumatic events faced by Syrian refugees may include losing family members, concern about missing family members, being subject to or witnessing violence, suffering from torture, facing indiscriminate bombardment and shelling, losing personal possessions and homes, and facing perpetual uncertainty due to displacement.
  • 43% of Syrian refugees were categorized under the Survivor of Violence and/or Torture category in 2013 & 2014 (UNHCR-Review)
  • Upon re-integrating into a new society, Syrians may also face a sense of isolation, loss of identity as they integrate themselves in foreign societies, discrimination, financial stress, and stress from seeking supportive environments.
  • Management of mental health issues: Symptoms can arise several months after resettlement and thus may require adequate follow up. Non-clinical interventions such as improving living conditions may have more significant impact than psychological or psychiatric interventions.
  • Source and additional detailed information on providing mental health care to Syrian refugees: http://www.unhcr.org/55f6b90f9.pdf

Sexual Violence

  • Due to underreporting and/or delayed reporting, the prevalence and severity of sexual violence experienced by the Syrian refugee population is unclear
  • The act or fear of rape and other forms of sexual violence may have affected women, girls, men or boys in detention facilities, household searches, military raids, checkpoints, and in asylum countries
  • Cultural considerations: Refugees may consider speaking about this subject socially unacceptable. In particular, it may be difficult for women to speak about these issues with male family members present.

References

UNHCR-Country Profile: The United Nations Refugee Agency. 2015 UNHCR country operations profile – Syrian Arab Republic.

CIA: Central Intelligence Agency. The World Factbook – Syria. Date modified: December 10, 2015

CIC: Citizenship and Immigration Canada. Population Profile: Syrian Refugees. Published: November 2015

UNHCR-Refugee Response: The United Nations Refugee Agency. Syria Regional Refugee Response – Inter-agency Information Sharing Portal. Date modified: 17 Dec 2015

WHO: World Health Organization. Syrian Arab Republic – Tuberculosis Profile. Modified January 10, 2016

PHAC: Public Health Agency of Canada. Health Status of Syrian Refugees. Accessed: January 7, 2015 

UNHCR-Review: United Nations High Commissioner for Refugees. Culture, Context and the Mental Health and Psychosocial Wellbeing of Syrians: A Review for Mental Health and Psychosocial Support Staff Working with Syrians Affected by Armed Conflict – 2015.