General
Nurses’ flight worsens Middle Eastern health crisis
The flight of health workers, including nurses from conflict zones in the Middle East and North Africa, is contributing to an alarming decline in the region’s health services.
The exodus of health workers due to conflict is particularly serious in Syria, Iraq, Libya and Nigeria, says a report by the Safeguarding Health in Conflict Coalition of international non-government organisations.
In Libya, 80 per cent of foreign nurses, who were the backbone of the country’s medical staff before 2011, have been evacuated since rebels overthrew the government in 2011.
Half of the health workers who practiced in Syria before the outbreak of war in 2011 have left the country. In Iraq, 45 per cent of health workers have emigrated since 2014.
In northern Nigeria, almost all health workers have fled areas controlled by the Islamic extremist group Boko Haram, resulting in the closure of 450 health facilities.
The health care crisis in the Middle East and North Africa was discussed at the recent annual conference of Global Nurses United, an international coalition of nursing unions including the NSWNMA.
Wars and political unrest appear to have reversed much of the progress in health outcomes experienced in the region, particularly Egypt, Jordan, Libya, Syria, Tunisia and Yemen, according to a recent study reported in Lancet Global Health (June 2016).
“Before 2010, these countries were experiencing increased life expectancy as well as reduced infectious disease burdens and infant and maternal mortality,” wrote University of Washington professor Ali H. Mokdad, who co‐authored the study.
“Today, however, disruptions to their health systems have compounded the trauma and misery that have arisen from the region’s many conflicts.”
On Syria, for example, the study found that if the 1990‐2008 rate of increase for life expectancy had continued, it would have been five years higher for women and six years higher for men than it is now.
Equally alarming, Syria’s infant mortality rate has risen by 9.3 per cent in recent years after declining at an average annual rate of 5.6 per cent between 1990 and 2010.
In Libya, life expectancy declined by six years for women and nine years for men.
Areas neighbouring conflict zones are also increasingly burdened by the largest refugee crisis in 70 years.
“The flood of people into camps in Lebanon and Jordan has overwhelmed sanitation measures, leading to outbreaks of infectious diseases and resurgence in some areas of diseases that had been nearly eradicated, such as polio among Syrian refugees in Iraq,” said professor Mokdad.
“A resumption of progress in the region is impossible without political solutions that reduce violence and social unrest.”
Negative health trends in the Middle East and North Africa are apparent even in countries at peace and experiencing economic growth, the study finds.
There has been a rapid increase in the burden of mental and drug-use disorders. Both Qatar and the United Arab Emirates are experiencing increased drug and alcohol use, for example.
“Mental health is not viewed as a major burden by many countries and is not discussed in the agendas of many international agencies and health ministries,” Professor Mokdad said.
He said the rapid rise in non-communicable diseases such as diabetes and heart disease is also alarming.
Commenting on the study in The Lancet, Iraqi public health specialist Dr Riyadh K Lafta observed that most eastern Mediterranean countries are “in a state of epidemiological transition”.
They display health problems common to developing countries, such as infectious diseases related to sanitation and nutrition.
At the same time, their populations are starting to have health problems more typical of developed countries, such as heart disease, cancer, road-traffic injuries and psychological problems.
“This transition has increased the burden of diseases on the community and exhausted the health system,” Dr Lafta said.
Sanctions worsen health crisis
Before war broke out in Syria in 2011, the country’s immunisation program was one of the best in the Eastern Mediterranean region.
Since then, routine vaccination coverage has dropped from 95 per cent to below 50 per cent with polio briefly returning to parts of Syria in 2013, reports the World Health Organisation (WHO).
The WHO says almost two-thirds of Syrians have no access to clean water, putting them at risk of diseases like typhoid and cholera.
Despite this dire emergency, sanctions on Syria are blocking access to life-saving medicines and medical devices, a United Nations report reveals.
The leaked report describes the sanctions as exceptionally harsh “regarding provision of humanitarian aid”.
Before the war, Syria produced almost all its own medicines.
Today, most pharmaceutical factories are either non-operational or destroyed, so the country must import almost all medical equipment, medicines and pharmaceutical products.
Of thousands of medical items and medicines identified by the WHO many are subject to some level of EU export control or US sanctions embargo.
Sanctions “make the import of medical instruments and other medical supplies immensely difficult, nearly impossible. It also makes it far more expensive,” said a European doctor quoted in the UN report.