In this section
Syria’s pre-conflict population was 22.8 million (World Bank 2013). The main languages spoken are: Arabic, including the Levantine Arabic dialect, Kurdish, Armenian, and Turkmen. People from Aleppo and Damascus may also speak English and European languages.
Armed conflict began in the Syrian Arab Republic
(Syria) in March 2011, escalating quickly into civil war (details). Since the beginning of the conflict, over half the Syrian population has been displaced.
The greatest numbers of Syrian refugees are located in neighbouring countries (November 2017, UNHCR).
Large numbers of Syrians have reached Europe by land or sea. Key estimates include:
Living conditions for Syrian refugees in other
countries are difficult, with issues of overcrowding, poor sanitation, food scarcity, and variable availability of shelter - conditions are often even worse outside of established camps and settlements (EMRO). The large volume of refugees has also put significant strain on host countries’ health systems, public finance, and security, and has created tension between refugee and host populations (EMRO).
Within Syria, there has been significant
disruption of the health system, with 60% of public hospitals out of service, a significant drop in immunisation rates, a 60-70% reduction in pharmaceutical production, and over half of the doctors having left the country (see:
WHO - health sector news,
Save the Children and
Physicians for Human Rights).
Similarly, the education system has been disrupted – prior to conflict, Syria had almost 100% primary school enrolment and literacy rates over 90%. In 2015, there were 2.6 - 2.8 million children out of school, and school attendance was
<30% in 2013. UNICEF has reported more than 1 in 4
schools (5000 – 14,000 schools) have been damaged, or turned into shelters, storage facilities or military bases (see: UNICEF,
UNICEF - Children under siege and
World Vision). Recent health studies suggest low rates of education in adults.
Australia has provided
$213 million in humanitarian funding since the beginning of the conflict ($87.5 million to assist people inside Syria, $126 million to help refugees in the region and their host communities).
On 9th September 2015, the government announced Australia will accept 12,000 Syrian and Iraqi refugees as part of the Humanitarian
Program, in addition to Australia’s annual humanitarian intake of 13,750 people (which will also include people from Syria). The DIBP has indicated priority will given to those:
This large group is expected to start settling in
Australia from mid 2016.
All permanent migrants to Australia,
including Humanitarian entrants undergo pre-arrival
Immigration Medical Examinations (IME) 3-12 months prior to travel. Additional screening for LTBI in children 2-10 years was introduced in November 2015, including for all Humanitarian arrivals. Humanitarian entrants are offered an additional
Departure Health Check (DHC), which includes measles-mumps-rubella (MMR) immunisation for those aged 9 months – 54 years.
Additional measures for polio vaccination were implemented for Syrians travelling to Australia from May 2014.
Considering the nature of the Syrian conflict, the following areas are important:
Syrian children are at risk for poor nutrition, with high risk of both macronutrient (energy intake/protein) and micronutrient (vitamins and trace elements) deficiencies. Multiple sources have reported widespread malnutrition in child refugees in Lebanon and Jordan (see
World Food Programme (WFP), and
RCH Immigrant Health: Growth and nutrition.
There is remarkably little published information on oral health in Syrian refugees, although it was identified as a key priority in post-arrival health care in Canada (see Hansen et al, 2016).
High rates of post-traumatic
stress disorder (PTSD), depression, and anxiety are reported in Syrians and Syrian refugees arising from mass displacement, exposure to conflict and violence, including sexual violence, and with many people experiencing death or loss of family members. This conflict has produced a
high proportion of female-headed households – the loss of fathers and of family integrity creates acute and ongoing stress for mothers and children. In addition, many children have lost the physically, mentally, and socially protective environment that is provided by schools and education.
2014 International Medical Corps (IMC) assessment of 6357 Syrian IDPs and refugees in Lebanon, Jordan, and Turkey receiving mental health services in 2014 found:
Another recent study of Syrian refugees in Germany by the
German Chamber of Psychotherapists, (also see
media summary in English) found:
A 2013-14 multi-centre survey of 765 Syrian refugees in Jordan (86% aged 18-49 years) found one third had significant depression, and that 35-40% had comorbidities (see Gammouh et al, 2015)
The Syrian crisis has included
systematic gender-based violence against women and girls (see
media reporting). Accurate reporting and statistics is compromised by intense stigma and a “culture of silence” surrounding the issue.
In conflict situations, adolescent
girls are also at risk of forced and early marriage, although this may be seen as a means to physical and economic protection.
Rates of family violence were high in
the Syrian population pre-conflict.
Most of the relevant web-links are contained in the text of this page. Please let us know about other useful resources.
RCH Immigrant Health - additional information. Authors: Karen Kiang and Georgie Paxton, updated Georgie Paxton November 2017. Contact: email@example.com