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Of Bullets and Bombs

Children in Syria Bear the Brunt of War

by CESAR CHELALA

One of the saddest things in the world today, ravaged by brutal wars, is a child, looking nowhere, 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, 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 the country, 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 keep increasing.

Those children killed or maimed are the result not only of bullets and bombs: they are also dying from lack of basic medical care. What has happened is the result of the collapse of the whole health system in the country. Most children today in Syria are even 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 skill 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 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 cases, many of whom remain unattended.

Most of the children arriving at health facilities come with injuries resulting from the war 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 previous levels.

The consequences of these shortcomings are mind-blowing 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 are being made forcibly made unconscious by lack of anesthesia; parents arriving at a hospital or clinic having to hook up their children to intravenous drips 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 today. Deadly diseases like measles and meningitis are on the rise. Even polio, which had been eradicated in the country in 1995, is now present in up to 80,000 children across the country, raising concerns about its international spreading.

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 the way to the hospital. As a result, unassisted births have increased dramatically, raising the possibilities for complications. Many women opt for cesarean sections, despite the risks provoked by lack of drugs and trained personnel.

In its report, “Under Siege – the devastating impact on children of three years of conflict in Syria,” UNICEF confirms the seriousness of the situation for children’s health and quality of life. According to the children’s agency, nearly three million children in Syria and neighboring countries are unable to go to school on a regular basis. Older children in Syria today are acting as teachers, caregivers and counselors for younger children.

Surviving children are forced to grow up too soon. And in the process they have become victims of abuse and exploitation. Those children needing specialized treatment are at particular risk. Many of their families intensively search for medicines and transfusion facilities.

Ten-year-old Fatima, now living as a refugee in Jordan, talked about her situation. “Sometimes I dream,” she said, I dream that I am carrying a dead man. And when I look at the children here, I feel like they have lost their hearts.” For children like them, fear has become a way of life. As UNICEF Executive Director Anthony Lake says, “For Syria’s children, the past three years have been the longest of their lives. Must they endure another year of suffering?”

Cesar Chelala, MD, PhD. is an international public health consultant and a co-winner of an Overseas Press Club of America award