On 8th December 2024, the Assad regime fell, leaving the country devastated by years of protracted conflict and widespread damage to infrastructure, including health and public health infrastructure. More than half of the pre-conflict population of 22 million has been forcibly displaced with a rapid decline in social determinants and their impacts –– this has had profound impacts on health, including infectious diseases.
Since 27 November 2024, more than one million people have been displaced due to the fighting; Aleppo, Hama, Homs and Idlib governorates are the most affected governorates but others have also been affected. Vaccination rates and associated vaccine preventable diseases and infectious diseases risks are present across all areas with newly-liberated areas having limited data on vaccination coverage; where available, it indicates low coverage for measles, DTP (Diphtheria, Tetanus, and Pertussis) and polio.
There are recent and ongoing outbreaks of measles (across all geographies) and cholera (since 2022, particularly in northern areas) with seasonal increases of ILI (influenza like illnesses.) There is also high risk of waterborne/faeco-orally transmitted diseases e.g. diarrhoeal illnesses, acute jaundice syndrome (AJS)(suggestive of acute, infectious hepatitis) enteric fevers, and an ongoing threat from polio in the context of documented outbreaks of both wild-type and vaccine derived poliovirus outbreaks in the past 11 years. Risks of TB (Tuberculosis) across Syria are high, including drug-resistant TB (particularly among detention survivors but also other populations) with official figures reported to WHO (World Health Organization) an underestimate. Leishmaniasis rates across Syria have also increased exponentially during the conflict with current outbreaks in northeast Syria; the Mentor Initiative is the main actor responding.
In the immediate period, for displaced and host populations and for new returnees, water and sanitation (WATSAN), nutrition and shelter need to be prioritised, as with any immediate humanitarian response; this is particularly so for IDPs and returnees. Vaccination campaigns for newly displaced populations should consider multiantigen campaigns which include measles containing vaccines, DTP and polio to support catch up for the likely substantial proportion of infants who will not have received routine vaccination at the scheduled times. Additionally, there needs to be an early focus on catch up vaccination campaigns. In the early to medium term, strengthening surveillance systems, outbreak investigations and responses, and diagnostics will be key to identifying and tackling infectious diseases outbreaks; this needs to occur alongside addressing social determinants of infectious diseases.
