Children walking through a neighbourhood in Zabadani, rural Damascus, in Syria [1]

Abdulhakim Ramadan

Introduction:

The World Health Organization (WHO) constitution in 1946 defined health as “A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” [2]. Various factors interact to affect the health of communities. According to the WHO, our health is linked to our circumstances and environment. Where we live, the state of our environment, genetics, education, income level, and our relationships with friends or family all have significant impacts on health. So, all the factors associated with our health condition are called determinants of health [3].One of the well-known models to describe the health determinants of people in the field of public health is Dahlgren and Whitehead (1991). This model divides the factors that affect the health of the community into layers. It was developed in the early 1990s by Göran Dahlgren and Margaret Whitehead and places the individual at the centre, surrounded by various layers of factors that can affect their health, such as their lifestyle, those of their community, the environment in which they live and work, and broader social conditions [4].

 

Figure 1: Dahlgren and Whitehead (1991) model of the determinants of health [5].

SHD in Syria:

Syria’s society has suffered unexpected losses as a result of the ongoing conflict since 2011. Different types of violence occurred, infrastructure was destroyed, unstable conditions predominated, and half the population was compelled to flee their homes to other countries or become internally displaced [6]. Because of these conditions, society’s health determinants have declined significantly, making the population more vulnerable to diseases and pandemics.

Figures talk:

According to OCHA’s report on 15th march 2021[6];

  • More than 500,000 people have died, including approximately 55,000 children.
  • A hundred thousand people have died under torture, and another hundred thousand are currently detained.
  • It is estimated that more than 3 million people live with a disability.
  • 45 million Syrian children are not in school, and 1.6 million are at risk of not finishing.
  • According to reports, more than 75% of Syrian refugees suffer from PTSD, and many of them have had to flee more than once.
  • Many people, including their children, have lost loved ones.
  • Given the rise in gender-based violence in the area, one in three women reports feeling insecure in their own homes.
  • Due to the war, 70% of the electrical infrastructure has been damaged.
  • One out of every three schools are destroyed or has been taken over by armed groups.
  • Only 58% of hospitals are operating at full capacity,
  • Current food prices in Syria are 33 times higher than the country’s average prices before the war due to the deteriorating value of the currency.
  • There are about 9 million people who could go hungry.
  • Humanitarian aid is required for 13 million people living in Syria and an additional 5.5 million Syrian refugees in the surrounding area.
  • Approximately 60% of Syrians lack access to wholesome meals.
  • In North Western Syria, 2.7 million people reside in camps that are not under the control of the Syrian government. One in three kids in some of these locations has been stunted.

 

Conclusion and recommendations:

The above facts make it very clear that Syrian society is exhausted at all levels mentioned in the Dahlgren and Whitehead diagram. Therefore, from my perspective as a public health practitioner, it is important to address these issues by working at multiple levels. Prioritizing how to intervene is crucial in reforming the social structure and health system.

  • First of all, a peaceful environment must be created. This can be accomplished by defending human rights and engaging insiders in the field to reduce damage to health, schools, and buildings, as well as reducing the number of injuries and other medical problems among people, thereby reducing the influx of displacement.
  • In parallel, it is important to improve conditions in IDP camps and rebuild infrastructure such as buildings, roads, and medical facilities. These interventions are crucial in providing healthy shelters, achieving access to health services, and reducing hazardous accidents.
  • To achieve effective application in public health, we also need to govern the health sector by adhering to health policies and mainstreaming health practices. In doing so, a systematic climate will be created in which we can advance agreed recommendations in healthcare.
  • It is necessary to provide economic assistance to residents through employment opportunities and microfinance projects that will increase their income and mobilize the resources to facilitate economic recovery. This recovery will have a positive impact on social equity among the population by reducing the disparities within and between countries, and ultimately lead to improved public health [8].
  • Also, it is important to support families with nutritional supplements in the form of baskets and kits, as this will reduce acute and chronic malnutrition in the community and enhance the healthy physiological state of individuals to resist multiple diseases.
  • It’s necessary to support the teachers in the camps and publish the schooler books. Higher education will improve the quality of life, healthy practices, and integration into the economic wheel by providing more employment opportunities, and that integration between factors will lead to improved health [9].
  • Finally, increasing health capability, a cornerstone linked to the other interventions will ensure the affordability of health services in the community. This can be achieved by refurbishing the health facilities and supporting them with medical instruments and supplies, in addition to maintaining the available medical staff.

In conclusion, we recognize that these limited recommendations do not cover all solutions, but they can guide us while highlighting these crucial problems and the required actions to resolve them.

 

References:

[1]        “Don’t lose focus on Syria, UN envoy tells Security Council | UN News.” Accessed: Dec. 20, 2023. [Online]. Available: https://news.un.org/en/story/2022/04/1117012

[2]        “Constitution of the World Health Organization.” Accessed: Dec. 20, 2023. [Online]. Available: https://www.who.int/about/accountability/governance/constitution

[3]        “Determinants of health.” Accessed: Dec. 20, 2023. [Online]. Available: https://www.who.int/news-room/questions-and-answers/item/determinants-of-health

[4]        “Determinants of health.” Accessed: Dec. 20, 2023. [Online]. Available: https://www.oecd-ilibrary.org/social-issues-migration-health/determinants-of-health_g25b6ac16-en

[5]        “Collective and individual responsibilities for health, both physical and mental | Health Knowledge.” Accessed: Dec. 20, 2023. [Online]. Available: https://www.healthknowledge.org.uk/public-health-textbook/disease-causation-diagnostic/2h-principles-health-promotion/responsibilities-health-physical-mental

[6]        “10 years on : 10 Facts that explain Syria’s conflict – Syrian Arab Republic | ReliefWeb.” Accessed: Dec. 20, 2023. [Online]. Available: https://reliefweb.int/report/syrian-arab-republic/10-years-10-facts-explain-syria-s-conflict

[7]        D. Rayes et al., “Policies on return and reintegration of displaced healthcare workers towards rebuilding conflict-affected health systems: a review for The Lancet-AUB Commission on Syria,” Confl. Health, vol. 15, no. 1, p. 36, May 2021, doi: 10.1186/s13031-021-00367-4.

[8]        “Recent Developments in Northwest Syria – Situation Report No. 19 – As of 21 August 2020 – Syrian Arab Republic | ReliefWeb.” Accessed: Feb. 01, 2024. [Online]. Available: https://reliefweb.int/report/syrian-arab-republic/recent-developments-northwest-syria-situation-report-no-19-21-august

[9]        “Recent Developments in Northwest Syria – Situation Report No. 17 – As of 13 July 2020 – Syrian Arab Republic | ReliefWeb.” Accessed: Feb. 01, 2024. [Online]. Available: https://reliefweb.int/report/syrian-arab-republic/recent-developments-northwest-syria-situation-report-no-17-13-july-2020