One of the saddest images in a world today is that of a child caught up in a war, looking into the camera as if asking the viewer: “Why are you doing this to us? We are only children.”
This thought came to my mind as I read a report of the effects of the Syrian war on children, “A Devastating Toll: The Impact of Three Years of War on the Health of Syria’s Children,” prepared by Save the Children Fund, a health and human rights organization working in over 120 countries.
The reported numbers of suffering children are overpowering. At least 1.2 million children have fled Syria, and at least 4.3 million children are in urgent need of health and humanitarian assistance. More than 10,000 children have already lost their lives, and the numbers just keep increasing.
Those children killed or maimed are the result not only of bullets and bombs; they are also dying from a lack of basic medical care. What has happened is the result of the collapse of the health system in the country. It is even the case that most children today in Syria are unable to receive vaccination coverage for the most common vaccine-preventable diseases.
Before the conflict, Syria had a good health care system, with a child mortality rate of 15 per 1,000 births, down from 38 per 1,000 births in 1990. The country was on track to reach the Millennium Development Goal 4 – to reduce the child mortality rate from preventable diseases by two-thirds. The country also had almost universal coverage by skilled birth attendants and a high rate of institutional delivery.
Today those gains, and hopes, are shattered, as is the country’s health care system. Across the country, 60 percent of hospitals and 38 percent of health facilities have been damaged or destroyed, and nearly half of the doctors have fled the country. Aleppo, a city that should have 2,500 doctors, has now only 36. As a result, the remaining health facilities and health personnel struggle to cope with the large number of victims, many of whom remain unattended.
Most of the children arriving at health facilities come with injuries resulting from the war that is ravaging the country. Hospitals and clinics, however, do not have the personnel to take care of them. Many doctors, health personnel, and even patients have come under attack either on the way to health facilities or even inside of them. Many homes are being used as makeshift hospitals, and living rooms have been turned into operating theaters. In addition, production of essential drugs has fallen by 70 percent compared to prewar levels.
The consequences of these shortcomings are astonishing for a person living in a country at peace: newborn babies dying in their incubators because of electricity cuts; children having their limbs amputated because of lack of equipment and drugs to treat them; children with chronic diseases being left unattended; children and adults made forcibly unconscious by lack of anesthesia; parents arriving at a hospital or clinic having to hook up their children to intravenous drips themselves because of lack of medical and paramedical staff.
Vaccine programs in the country have all but collapsed. While during peacetime vaccine coverage was 91 percent it is probably less than 50 percent today. Deadly diseases such as measles and meningitis are on the rise. Even polio, which had been eradicated in Syria in 1995, is now present in up to 80,000 children across the country, raising concerns that it may spread beyond Syria’s borders.
In Syria today, children’s lives are at risk even before they are born. Pregnant women have poor antenatal, delivery and postnatal care. Ambulances are few and they are frequently stopped by roadblocks and checkpoints on their way to the hospital. As a result, unassisted births have increased dramatically, raising the likelihood of complications. Many women opt for cesarean sections, despite the risks provoked by a lack of drugs and trained personnel.
Syria’s conflict has been fueled by foreign intervention. Leaders of those countries and groups that have provoked and sustained the conflict should have the minimal decency to also help create the conditions necessary for proper humanitarian and health assistance, particularly for the most vulnerable in society, namely children.
Cesar Chelala, a medical doctor and international public health consultant, is a co-winner of an Overseas Press Club of America award. He wrote this commentary for THE DAILY STAR.