Violence and Health
Unintentional injuries are among the leading causes of death and disability globally. They place a considerable economic burden on countries, and can have long-term physical and psychosocial consequences (Skolnik, 2020).
Conflict and terror is the leading cause of death and disability in Syria with road injuries as the 8th leading cause of death. Unintentional injuries is rated 13th and transport injuries 15th in causes of disability (IHME, n.d.). There are multiple forms of unintentional injury, but collective violence is the main form noted in Syria. Collective violence is described as "the instrumental use of violence by people who identify themselves as members of a group - whether the group is transitory of a group or has a more permanent identity - against another group or set of individuals, in order to achieve political, economic or social objectives" (WHO, 2020, para. 2). The impact of violence on health affects the mortality, morbidity, and disability of the population.
​
The Syrian war continues with no end in sight. Children are among the worst affected, but little is understood of the effects on them. Numerous child right violations have been reported by the United Nations. The effects of the conflict causes death and displacement. It increases food insecurity, which leads to malnutrition. Data is lacking on accurate information relating to malnutrition, but is considered to be poor. Communicable disease, vectors and pathogens tend to increase. There is a lack of surveillance systems, prevention programs, infrastructure, and impaired immunity due to the conflict. Water supplies, healthcare, and schools have all been targeted . These are all acute effects. What about the long-term health effects? Lasting disability and mental scars will effect the health, social, and economic outcomes in children. Research is finding high and increasing levels of mental distress, but accurate figures are difficult to obtain. Malnutrition alters the growth of a child and increases their risk for illness and long-term disability. Community structure is broken down with many children taking on adult roles and not able to receive an education (Devakumar, et al., 2015). These factors all play into the health of the population.
​
The conflict in Syria has destroyed over half of the basic infrastructure and caused a lack of access to energy systems, clean water, and basic essentials. These factors all increase the risk for diseases to spread. Health care facilities have been destroyed and medical personnel targeted, which caused people to die from injuries and illnesses that are treatable and preventable and lack of specialized services. It is estimated that 3 million are living with injuries and disabilities with very limited access to rehabilitation services. The ruined infrastructure increases the rates for water borne disease, and the mountains of rubble provide a habitat for sand flies and increase in leishmaniasis and uncleared wastes. Psychological stress is high, but there are less than 100 psychiatrists (Overton & Dathan, 2019).
​
The World Health Organization is working at detecting and responding to disease outbreaks, delivering medical supplies, using mobile teams, restoring local health care, training health workers, adding mental health services, supporting the disabled, and increasing health coordination and efficiency (WHO, 2019). Along with this comes the challenges of strict information sharing protocols, limited data sharing, duplication of key activities, lack of leadership and coordination, limited non-governmental capacity, and little UN support. The Syrian government regulates and prohibits aid into the contested and opposition-held areas. Most international non-government organizations (NGOs) are illegal to operate in these areas. Many international NGO groups work remotely with local organizations. These conditions affect the quality and effectiveness of aid being provided (Diggle, et al., 2017).
Environment and Health
Environmental health issues are a major risk factors relating to the global health. Around 20% of disease are related to the environment with the burden being greater in poorer countries and have a negative consequence on productivity (Skolnik, 2020).
Information from IHIME, 2017
The environment has been negatively affected by the civil war and carries many of same health concerns as the above section. The pie graphs provide a little overview into the environmental differences of Syria and the United States of America. The levels of pollution and unsafe WASH is significantly higher in Syria than in the United States.
​
A long and severe drought affected the Fertile Crescent in 2006-2007, which has been linked to the civil war. During this period of time, the country experienced a heightened social vulnerability by the collapse of agriculture, which caused more people to move to the cities, and created a competition for resources and jobs. Prior to 2007, Syria was self-sufficient in food production. The next five years brought mismanagement of resources by reduced subsidies for agriculture. Now, government forces are destroying food stocks and agricultural machinery to starve out rebel groups, which has plunged the country into long-term food shortage with high prices (Karak, 2019). This has pushed a large percentage of the population into poverty and food insecurity. Malnutrition and lack of adequate resources increase the risks for diseases and infections.
​
The environment and natural resources are all under increased pressure. There has been major destruction of oil refineries and storage facilities to prevent rebel groups from using the resources for support. This created locals to make their own makeshift refineries and expose thousands to toxic fumes and hazardous substances. Most of these makeshift refineries were shut down in 2017 due to community protests. Now the areas have abandoned refineries, pools of oil waste and tar lakes. How is this affecting the ground and surface water? The war has destroyed or damaged water sources, agriculture, forestry, wildlife, and biodiversity. Military groups target irrigation systems, which are needed for agriculture and food security. They target water pumping and filtration stations, which provide clean water and help prevent diseases. Sewage plants are destroyed or overwhelmed with the influx of displaced people. The waste is affecting ground water through leachate and air pollution from waste being burnt. The United Nations Development Program is working with the government to help better waste management but not in non-government controlled areas. There is vast amounts of rubble with industrial and medical waste mixed in the debris. People are exposed to hazardous chemicals or heavy metals when cleaning up communities. Deforestation is occurring due to firewood collection, charcoal production, and uncontrolled commercial logging. This is creating erosion and destroying the natural landscape and habitat for wildlife (Zwijnenburg, 2019).
​
Damage and disruptions to the environment has a negative impact on the water, sanitation, and hygiene (WASH) services and facilities. It is estimated that 7.6 million people are in acute need for WASH services. This is causing re-emergence and outbreaks of water-borne diseases. The high cost of rebuilding the pre-crisis, high-standard services continues to be a major challenge in the country. UNICEF is working at improving the WASH services to protect and meet the needs of the vulnerable (Syrian Arab Republic, n.d.). The crowded, unsanitary internally displaced persons camps are breeding grounds for diseases and poor quality of health.
​