A lack of water and sanitation in displaced communities leads to a rise in communicable diseases

Publicado: 24 julio 2014 11:08 CET

By Penny Sims, IFRC

Polluted water supplies, hot weather and serious water shortages are bringing the threat of disease to vulnerable communities in Syria. Clinics and health volunteers are already seeing an increase in hepatitis A, typhoid and diarrhoea, and skin complaints, especially from internally displaced people (IDPs) living in communal shelters.

A toxic combination of crowded unsanitary living conditions, cuts to some regular water supplies and contamination of alternative water sources makes for a worrying situation.

Syrian Arab Red Crescent (SARC) health co-ordinator Dr Tarek Tanira says the cases of diarrhoea seen in some shelters is more serious than people think. “We saw a case recently that was so severe we thought it might be cholera. Thankfully it wasn’t. This was a family in a shelter, all four children and their mother had to be hospitalised it was so bad. Cholera is a worry, but it’s not happening here yet. We are seeing more cases of typhoid and hepatitis A.

“The main problems are diarrhoeal diseases and people’s general lack of food, which means they are more susceptible to any illness. Diarrhoeal diseases in children particularly worry me. This is one of the main causes of death in children under 12 months old – not many people realise that, but small children are particularly vulnerable. We’re seeing people using contaminated water to mix baby formula for example, and this can make babies very ill.

Dr Jeya Kulasingham, IFRC health delegate in Syria, said that shelters housing displaced family can post a particular risk. “Some shelters may get water tanked in, but if the roads are inaccessible due to fighting this isn’t an option. When you can’t wash, you can’t take proper care of your personal hygiene and this leads to problems such as scabies and lice, which love hot conditions where people are living close together and can’t wash their clothes or themselves regularly,” he says. “SARC volunteers have undertaken de-lousing in some shelters, which involves combing out lice with a fine-tooth comb.”

Increase in skin diseases

One of the skin conditions increasing in shelters is leishmanisis, which is now spreading to more areas. Dr Tarek says: “We’re seeing an increase in skin diseases. Leishmanisis in particular, which is spread by sand fly bites. Sand flies seem to be in more areas now – they used to be a problem in a restricted area, but you see these flies in many places, they’re breeding and spreading, you see them even in Rural Damascus. Before the crisis they were under control, but this is one of the things that has changed.”

The symptoms of the disease are mainly cosmetic but serious, and if not caught and treated it has the potential to be deadly. “The infection causes scarring. In bad cases we see it spread to cover the whole face, and it’s deforming, sadly it’s a permanent scar,” Dr Tarek says. “In the most serious cases it can infect the blood and the brain, especially in children with low immunity. It can kill, but only rarely. At the moment the cases in Rural Damascus are mild but our volunteers see cases with bad scarring in places like Aleppo, Dier Ezzor and Raqqa.

“We’re trying to help with water tanks, water purification tablets, also we do hygiene promotion so that people use the tablets correctly, and understand the importance of handwashing and careful food preparation. We try to educate people what water can be used for washing, and what is for drinking.”

Seasonal growth

Mobile health units are an important part of the response, going into communities to do early detection. “If we catch these complaints early enough, they can often be treated. We have special health teams who visit shelters every day or every other day and refer any severe cases to clinics. They’re a sort of SWAT team dedicated to early detection of infectious diseases to halt any outbreaks. We work with health authorities to keep an eye on the situation.”

In normal circumstances, the health team said they would expect a small increase in diseases such as leishmanisis over the summer, but nothing like the rise they have seen this year.

Tartous is one area that has seen a recent influx of IDPs from nearby areas. The coastal town is a holiday resort, but now people fleeing areas like Homs and Aleppo have crammed themselves into some of the swimming huts along the coastline, living without proper sanitation. The local water authorities and SARC volunteers are trying to improve the situation.

Issa Dona, a SARC health volunteer in Tartous works with communities in shelters. He is training other volunteers in hygiene promotion. “The situation is becoming a catastrophe in these communities now,” he said. “People are suffering. They need help. The hygiene promotion work we are learning now needs to happen soon. Maybe we can help reduce these communicable diseases, but we need to start as soon as possible.”

Photo gallery

In pictures - Water shoratges and poor sanitation in displaced communities

A woman collecting washing at the Al Adlieh shelter in Rural Damascus, Syria. Living in close...