By Fadi El-Jardali (Professor of Health Policy & Systems at the American University of Beirut & Health Systems Global Board Member) & Racha Fadlallah (health systems researcher and member of Health Systems Global)
The Syrian crisis has been described as the worst humanitarian crisis of our current time. It is estimated that 7.5 million people are internally displaced within Syria, and 4.8 million have fled to neighboring countries. This a horrifying fact on any day, but on International Migrant Day we are reminded of the international community’s failure to act. This policy of inaction is simply unforgivable.
As the crisis approaches its sixth year and we watch the events in Aleppo unravel, we can no longer ignore the critical issues related to the ongoing crisis, and to the many others gone before. Our world leaders need to move far beyond humanitarian funding to assume a stronger political role in saving lives, protecting healthcare systems, sharing the burden of refuge, and addressing the root causes of the Syrian crisis.
A case in point: Lebanon, a country of just 4.4 million is hosting more than 1.5 million Syrian refugees and around 450,000 additional Palestinian refugees, making it the country with the highest per-capita concentration of refugees worldwide, where one person out of four is a refugee. The huge influx of Syrian refugees into Lebanon since 2011 has placed unprecedented increase of demand and pressure on the already stretched health system, rendering provision of health services to this large number of people a real challenge.
The government was able to respond by designating primary health care as the main platform for response and promoting coordination of service delivery across different providers. In 2015, the Ministry of Public Health partnered with key stakeholders to establish 20 new public health centers and directly support 100 private health centers, thus increasing capacity of primary care by 40 per cent. Despite all the challenges, the Lebanese health system has demonstrated resilience in areas related to prevention of spread of communicable diseases and major outbreaks, and maintenance of low maternal and Child Mortality rate among Lebanese and Syrians.
Nonetheless, the persistence of the Syrian crisis till today is putting a huge strain on Lebanon’s health system. For how long, then, can a health system be resilient when the pressure continues to increase?
While it is essential to ensure that Syrian refugees continue to have access to quality health services, it is equally important to realize that the capacity of host countries is fragile. The international response to the Syrian humanitarian situation has been largely financial, albeit, insufficient to meet the requirements of the Syrian crisis given its global scale. For instance, the United Nation’s humanitarian appeal of USD $4.54 billion for Syrian refugees reached only 56 per cent of the estimated request in 2016.
Beyond humanitarian funding, disengagement of the global community from the Syrian crisis has contributed to a vicious cycle of health systems inequity. This is because, while the international refugee system was established on the premise that refugees are a global responsibility (not only the responsibility of the country of first asylum), it is the developing countries that continue to host a staggering 80 per cent of the world refugees. Unsurprisingly this places a disproportionate burden of forced migration on already weak systems, not the least, health systems. This is paralleled by a growing deterioration in living conditions and protection space of the most vulnerable refugees, further exacerbating access to health services and inequities in health among both refugees and host communities.
Beyond host communities, hospitals and health care facilities throughout Syria including health workers are being targeted and destroyed in the face of a silenced health system community and a broken international humanitarian law. This creates a need to bring the issue of health systems to the forefront of the debate and demand healthcare facilities to be treated as sanctuaries in wartime, similar to bans on the use of chemical weapons.
There is a dire need for a stronger and a more comprehensive global governance approach to effectively address the Syrian crisis. Providing adequate financial assistance and sharing the burden of refuge are critical components of this global responsibility; however it should be reminded that these are temporary solutions aimed at alleviating the symptoms of the problem rather than treating the problem itself. This is where significant reductions in deaths tolls and in the number of children being buried alive under rubbles can be achieved. At the same time, we need allocate resources to rejuvenate the infrastructure and systems of Syria and plan for a safe return of Syrians, as Syria can only be revived by the return of its people to rebuild the country once the crisis is over.
Addressing the root causes of forced migration and putting an end to the Syrian crisis through diplomatic negotiations is where true global leadership lies. If we wait any longer, the costs of inaction will be unforgivable, if they are not already. Indeed, the more time that is wasted before action is taken, the more forced migration will happen, and the more suffering people and systems (not just health systems) will have to endure.