The Refugee Health Crisis: Syria

The health of forcibly displaced people across the globe is often overlooked by mainstream media as a result of their marginalised status. However, multi-disciplinary analyses of the barriers to health faced by refugees are important to give populations a voice. This segment in a series of articles, entitled 'The Refugee Health Crisis', will provide on an overview of the health crisis of Syrian refugees in the Middle East.

Migration and global health is a reality, and it is one of the defining issues of our time. With two billion people living in countries affected by civil unrest and ongoing conflict, the numbers of forcibly displaced persons are at some of the highest ever recorded. Though distinctions between persons on the move can be blurred, this series will take the identity of a 'refugee' to refer to populations of forced migrants who have fled their country of origin to seek protection from human rights violations in their nation state.

Since 2011, the regional geopolitical dynamics that frame the Syrian Civil War have created a power struggle between multiple competing hegemonies. No singular faction has been able to assert complete authority and secure its interests, and these clashing dynamics have resulted in a hugely protracted conflict. The war is proceeding with little regard for civilian life or infrastructure, and one of the defining features of the war is the repeated government-led attacks on hospitals and health-care facilities. When a nation-state fails to enact protective measures on its people, the global landscape is such that international non-governmental organisations take responsibility for the lives of those who lack health care access. However, denial of humanitarian aid has also become a military tactic of the oppressive regime. A direct power system has emerged in which harm caused by physical violence is compounded by diplomatic restraints. There is an increased climate of fear regarding medical treatment and its associated dangers; people are being forced to decide between their own safety and everyday medical choices.

"As a consequence of these violences, internally displaced Syrian refugees in the Middle East face challenges relating to access, a lack of security and shortages in staff and supplies."

As a consequence of violence, internally displaced Syrian refugees in the Middle East face challenges relating to access, a lack of security, and shortages in staff and supplies. These factors have all combined to create a problem for the management of non-communicable (otherwise known as chronic) disease. Médecins Sans Frontiéres, an international medical humanitarian organisation, identified as early as 2012 that the treatment for chronic disease in Syria was already a pressing concern as a result of access insecurity and the high cost of drugs. Most notably, the World Health Organisation has found an increased prevalence of cardiovascular disease, cancer and chronic respiratory diseases, thought to be due to the extreme socioeconomic conditions affecting the lives of displaced persons. The lack of health care in this repressive climate is a driving force for many to leave Syria, resulting in a huge influx of displaced persons to Lebanon, Jordan and Turkey. Upon reaching one of the host countries, the Syrian refugees find themselves in a physically safer environment, but one that perpetuates the structural violence they have previously been exposed to.

Unlike in many settings, a large majority of Syrian refugees live outside camps and are integrated into low-income neighbourhoods in the neighbouring states of Jordan and Lebanon. This puts additional pressures on already strained services and creates tensions within host-communities. Poor economic indices are creating sources of unfreedom in which individuals cannot afford to access basic necessities or medical care. With an absence of social security arrangements and a denial of responsibility by not only the government of their nation-state Syria, but then of their host countries, the prevalence of chronic diseases has been allowed to proliferate. These factors are compounded by the unsettling reality that refugees can be forced to wait months before they receive official refugee status which would enable them to access any medical care. This problem is an explicit example of how a harmful co-existence of politics and violence can prevent individuals from achieving a quality of life that would otherwise have been possible. It is important to understand how the structural barriers causing this suffering can be disabled, and how the multiple sources of unfreedom and social deprivation can be removed.

"When abandoned by their nation-state government, a resultant non-value is placed on their lives."

The health of refugee populations cannot be considered in isolation from political, social and economic forces that conspire to produce adverse health indices. When abandoned by their nation-state government, a resultant non-value is placed on their lives. A common issue when discussing refugee health is the lack of accountability; a situation has arisen in which the poor health indices of displaced Syrian people is exposing them to extreme suffering, and yet it is near impossible to point the finger at any one political or governing body. Unfortunately, at many of these stages of repression, the political and economic systems in place have maintained the drastic health disparities. The violence produced by the government - physical and structural - has forced people to flee, and to therefore acquire the status of a refugee. And, as a result, they have then been denied the political and social rights that are associated with a welfare state. The suffering that defines the refugee crisis must be understood to be linked to discriminatory conditions which determine who suffers from human rights violations. Only when their voices are heard, and when responsibility is taken for these lives, will we start to see a positive change in the long-term health of Syrian refugees.

This article has been adapted from my final year undergraduate research project: 'The Refugee Health Crisis: Biopolitics and Structural Violence. A Case Study of Syrian and Rohingya Refugees'. For further information on refugee health news, visit the WHO, UNHCR and Mèdicine Sans Frontières.

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