On 28 October 2013, the news came that health experts across the Middle East had been dreading. Doctors in north-eastern Syria confirmed that two young children — a six month old girl named Saja, and Hassan, a nine month old boy — had contracted the crippling and incurable polio virus. After a fourteen-year absence, a disease most people in the region thought had been banished forever had resurfaced.

A few months later, a single case of polio was confirmed in Iraq. The outbreak had crossed international borders.

In truth, the return of diseases like polio was only a matter of time given the turmoil sweeping both countries, displacing millions of people, and preventing health services from reaching towns and villages where the fighting was most intense.

Four years into the Syria conflict, just one third of its hospitals and health centres continue to function. The rest have been destroyed or damaged, their equipment smashed or stolen. Doctors and other qualified personnel have fled and many have been killed.

According to Physicians for Human Rights, more than 560 medical personnel have been killed since the conflict began.  In one part of Aleppo, Syria’s largest city, 20 doctors remain to serve the needs of about 300,000 civilians.

This collapse in the country’s health infrastructure – including hitherto robust routine immunization programmes — has left Syria’s children largely unprotected against diseases like measles, polio, pneumonia and diarrhea. Medicine production has fallen by 70 per cent, pushing prices beyond the reach of most of the population.

“We are working to reach every woman and child, even in conflict areas, while rebuilding a health system which has been partially destroyed,” says Dr. SM Moazzem Hossain, UNICEF Regional Health Advisor.

 Children’s health under threat

As the Syria crisis has steadily deepened, the health and nutritional status of children and women has become increasingly fragile. Millions of people have been forced to exchange their homes and communities for overcrowded communal shelters and public buildings, where access to safe water and proper toilets is scanty at best.

As health authorities and communities grappled with the effects of this profound crisis, a range of international agencies – including UNICEF – has come to their aid.

The polio outbreak was a particular priority, because of the danger that it might spread far across the region. That risk triggered an unprecedented mobilization of health resources. In 2014, 22.5 million children were immunized in 7 countries, including some 3 million children inside Syria.

Heroism of polio volunteers

That success owed much to the bravery of volunteers and community leaders who delivered polio vaccines to children even in previously inaccessible parts of rural Damascus, Damascus, Aleppo, Hama and Homs. As of today, 36 children in Syria have been confirmed to have polio, but no new cases have been reported since January 2014.

But the danger is not yet over. It is estimated that as many as 80,000 young children remain inaccessible and have missed out on scheduled polio vaccinations. Further immunization rounds will therefore continue in Syria and around the region during 2015.

The prolonged conflict has crippled the economy and families’ livelihoods. It has also sent food prices soaring and cut supplies of food items children need for their growth and development. Many communities that were once self-sufficient are finding it harder to grow or import food.

As a result, nutrition-related illnesses among very young children and pregnant women are in danger of increasing.

To identify and treat children suffering from malnutrition and vitamin deficiency, UNICEF has established nutrition centers in 11 Syrian Governorates. The centres screen children for malnutrition and distribute preventive and therapeutic products.

“We estimate that there are around four million women and children in Syria who need preventative and curative nutrition assistance,” says Dr Hossain. “Young children need micronutrients, pregnant women and lactating mothers need counselling and multiple food supplements. We must do everything possible to reach them.”

Meanwhile, the task of providing ongoing health care in a country wracked by violence continues day by day. By partnering a number of local NGOs, UNICEF has helped establish 56 mobile medical teams and more than 50 fixed health centres, some of them in opposition-controlled areas. In 2014, the primary health care services they delivered reached more than 600,000 vulnerable children and women in 14 Syrian governorates.

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