Providing healthcare in crisis: Strained systems and insufficient funding for Syria

Earlier today the Harvard School of Public Health convened a forum to discuss the realities of the Syrian conflict and implications for the humanitarian response in coping with the millions displaced by the war. The two and a half year long war has led to a staggering exodus of people from their homes, with an estimated 2 million refugees fleeing to the neighbouring countries of Turkey, Lebanon, Jordan and Iraq.  Many more millions are displaced within Syria’s own borders. This quote from IRIN news aptly summarizes the situation: Across the region, countries neighbouring Syria are struggling to cope with the staggering number of refugees, who have strained health, education and other infrastructure. As more refugees stream over the border every day, the UN is being forced to prioritize the most vulnerable due to lack of funds. The healthcare infrastructure and capacity required to meet the needs of refugees and national citizens alike, and the severe lack of funding to do so, are two key themes that also arose in today’s forum. Moderated by Aaron Schachter, Assignment Editor at PRI’s The World, the panel consisted of Jennifer Leaning, Jeanne Guillemin, Michael VanRooyen, Paul Spiegel, and Recep Akdag (click on names for bios). With the majority of recent attention focused on the chemical weapon attacks VanRooyen made the important observation that the  “issue of chemical weapons is a distraction” and that they account for only 2% of casualties in Syria Rather, attention needs to be paid to the healthcare needs of refugees both in terms of war/trauma injuries and emergency obstetric care, but also to the long-term healthcare provision for those...

Exploring non-communicable disease risk factors among Middle Eastern adolescents

The Middle East and North Africa edition of The Global Burden of Disease, Generating Evidence, Guiding Policy identifies dietary risks, high blood pressure, high body mass index, and smoking as the leading risk factors for premature death and disability in the region. These risk factors can be attributed to health behaviours that are adopted during childhood and adolescence, with the burden of disease extending and worsening into adulthood.  Hence, adolescence is an opportune time for targeted interventions promoting healthy, protective behaviours. Several studies published this month aim to quantify the prevalence and predictors of these risk factors among cohorts of youth and recommend policy for intervention: Time trends of cigarette and waterpipe smoking among a cohort of school children in Irbid, Jordan, 2008 -2011 in the European Journal of Public Health Results synopsis: The longitudinal study documents patterns of tobacco use among school children according to age, gender, and tobacco use method. Boys reported higher smoking rates than girls for both cigarettes and waterpipe smoking, and girls generally displayed a 2-year delay in smoking acquisition compared to their male counterparts. Smoking patterns were characterized by “a predominance of waterpipe smoking and steeper age-related increase in cigarette smoking”. Based on these findings, the authors suggest that youth are initially introduced to smoking and tobacco use through waterpipe smoking, which later facilitates tobacco dependence and cigarette smoking. As such tobacco-control strategies should target waterpipe initiation and use at early ages. Physical activity and perceived barriers among highschool students in Muscat, Oman in Eastern Mediterranean Health Journal Results synopsis: This cross-sectional survey studying the patterns and determinants of physical activity among secondary school students...

Education key to preventing FGM and child marriage in the Arab region

October 11th, 2013 marks the second commemoration of International Day of the Girl Child. The theme for this year is “Innovating for Girls’ Education”, premised on the notion that educating girls is a “powerful transformative force for societies and girls themselves: it is the one consistent positive determinant of practically every desired developed outcome, from reductions in mortality and fertility, to poverty reduction and equitable growth, to social norm change and democratization.” (United Nations) I add to this list education’s role in preventing two controversial practices affecting young women and girls in certain areas of the Middle East and North Africa – female genital mutilation and child marriage. The extent to which FGM exists in the Arab world has not been well quantified outside of Egypt, and much of what is known is based on circumstantial evidence from news reports and bloggers emerging from Iraq, Iran, Saudi Arabia, Oman, the UAE, and Yemen. The health effects of FGM are myriad, ranging from immediate complications such as pain, haemorrhage, infection, and septicaemia to an extensive list of long terms consequences that include recurrent bladder and urinary tract infections, menstrual and urinary disorders, painful sexual intercourse, fistulae, obstructed labour, and infertility. A study published this month exploring pathways related to the decline of female circumcision in Egypt provides robust evidence that mothers’ education is significantly associated with their daughters’ circumcision status, and it remains so across various scenarios in which other observed and unobserved determinants are accounted for. Furthermore, the researchers’ considered and thoughtful analyses suggest a causal relationship between FGC risk and maternal education; they note “the generation of women...

Obesity associated with gender, area of residence, and household welfare in study of Algerian and Tunisian adults

A new study published in PLOS ONE this week reflects findings elsewhere that women exceed men for prevalence of obesity in the Middle East North Africa region. Results from the analysis found that the prevalence of obesity among women and men in Algeria was 30.1% and 9.1% respectively, and  37.0% and 13.3% in Tunisia. Obesity was more prevalent in urban versus rural areas in Tunisia. Despite obesity increasing with household welfare, especially in Tunisia and among women, obesity was still prevalent among the lowest welfare quintile of women in both...

World Mental Health Day 2013: A look at mental health in the MENA region

The Global Burden of Disease: Generating Evidence, Guiding Policy – Middle East and North Africa reports that major depressive disorder is the 5th leading cause of death and disability in MENA compared to the 11th cause globally. The policy report also found that depression tends to rank higher in high-income countries in the region such as Bahrain, Qatar and the UAE than in their low and middle-income counterparts. Data from the Institute for Health Metrics and Evaluation reveals depression to be the leading cause of DALY’s among women in the region, and the 8th for men. However, when ranked against other regions of the world, both MENA’s men and women rank highest for major depressive disorder, and have the highest percentage differential between men and women except for that in Latin America and the Caribbean. Reasons for the high prevalence of depression among women in the Middle East are yet to be ascertained. A 2009 literature review conducted by researchers at Sultan Qaboos University, Sultanate of Oman is one such attempt at synthesizing information on the prevalence of depression among women in the region, accompanied by a discussion of Islam, the changing sociocultural roles of women, reproductive health factors, and methodological constraints. A medical view of mental health disorders in the Middle East and regionally appropriate treatment approaches is available...
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