Public Health and Syria: An Epidemiological Perspective on the Increasing Prevalence of Civil War

           The deteriorating civil war in Syria has been one of the greatest public health and humanitarian disasters in the last decade.  The UN has registered 2.9 million people as refugees, with an additional 6.5 million displaced internally, and an estimated 10.8 million in need of humanitarian assistance.^[1]  This alone would qualify it as a global emergency.  But even more horrifying is the rise of the Islamic State, which started as a collection of radical Salafist Islamist groups rebelling against Bashar Al-Assad’s rule in Syria but has grown into an entity that Al Qaeda could only have imagined.

            

             In addition to the physical casualties of the conflict, the UN Human Rights Council warns of additional psychological traumatization, abuse of children and disadvantaged groups, lack of basic services over wide areas either affected by conflict or intentionally denied in areas controlled by the Islamic State, and further displacement of peoples and the creation of a new permanent refugee population.^[2]

Above: Zaatari Refugee Camp in Jordan Sept 2012

            

            The Public Health consequences of this escalating situation are obvious, but it is also important to keep in mind the historical and social context.  Only by examining the historical, social, economic, and political context can we identify why this conflict and this organization have arisen with such ferocity and resilience at this time and place.

Above: Zaatari Refugee Camp in Jordan Today

            

            Globalization has had numerous positive benefits, including lowering rates of poverty for wide swathes of humanity and the reduction of mortality rates as health services and technology have spread around the world.  But my studies of this phenomenon have also revealed potent negative side effects.  The integration of national and regional economies into a global marketplace has greatly harmed areas that weren’t structured to fill a niche and compete with the rest of the world.  And the reduction in mortality rates without the accompanying reduction in birth rates has placed intense demographic pressures on these same areas.

            According to the International Energy Agency, the Middle East saw the highest rate of population growth in the world from 1990-2010.^[3]  The combination of economic and social disruption combined with historical legacies of oppression make it hard for those who live in the Middle East to see why the current system should be preserved.  And so, in December of 2010, a young man in Tunisia, economically and socially disadvantaged and politically oppressed, set himself on fire.^[4]  Moving from country to country finding the demographic, economic, social, and political situations to be ample kindling, the flames from that first protest haven’t stopped spreading yet.

Above: The current extent of the Islamic State

            
            The combination of globalization and demographic pressures that have altered the social and economic dynamics of the region is quite possibly what has given both the civil war in Syria and the Islamic State so much resilience and potency thus far and provides and explanation as to why these events have occurred now.  And it shows why we in Public Health have a responsibility to be advocates for social equality, not just for ourselves at home, but globally.

References:

1. United Nations Human Rights Council. “8^th Report of Commission of Inquiry on Syria.”  Report of the Independent International Commission of Inquiry on the Syrian Arab Republic.  Pg. 30. August 13, 2014.  http://www.ohchr.org/EN/HRBodies/HRC/RegularSessions/Session27/Documents/A_HRC_27_60_ENG.doc.  Retrieved: November, 14, 2014, 1:16PM.
2. United Nations Human Rights Council.  “Rule of Terror: Living Under ISIS in Syria.” Report of the Independent International Commission of Inquiry on the Syrian Arab Republic.  November 14, 2014. http://www.ohchr.org/Documents/HRBodies/HRCouncil/CoISyria/HRC_CRP_ISIS_14Nov2014.pdf.  Retrieved: November 14, 2014, 1:11PM.
3.  International Energy Agency.  “CO2 EMISSIONS FROM FUEL COMBUSTION”  IEA Statistics 2013 Edition.  Pg. 91.  http://www.iea.org/publications/freepublications/ publication/CO2EmissionsFromFuelCombustionHighlights2013.pdf.  Retrieved: November 14, 2014, 1:34PM.
4. Fahim, Kareem.  “Slap to a Man’s Pride Set Off Tumult in Tunisia.” New York Times January, 21, 2011. http://www.nytimes.com/2011/01/22/world/africa/22sidi.html.  Retrieved: November 14, 2014, 1:07PM.