Forced Migration and the Spread of Infectious Disease: Impact of Syrian Refugee Movements on Disease Prevalence in the European Union
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Scowcroft Paper No. 10 Forced Migration and the Spread of Infectious Disease: Impact of Syrian Refugee Movements on Disease Prevalence in the European Union By Christine Crudo Blackburn1 & Paul E. Lenze, Jr.2 1Postdoctoral Researcher, Scowcroft Institute of International Affairs, Texas A&M University 2Senior Lecturer, Department of Politics & International Affairs, Northern Arizona University November 2017 For more information: bush.tamu.edu/Scowcroft/ Forced Migration and the Spread of Infectious Disease: Impact of Syrian Refugee Movements on Disease Prevalence in the European Union By Christine Crudo Blackburn1 & Paul E. Lenze, Jr2. 1Postdoctoral Researcher, Scowcroft Institute of International Affairs, Texas A&M University 2Senior Lecturer, Department of Politics & International Affairs, Northern Arizona University Introduction The causes of the Syrian Civil War are publicly expressed as sectarianism, anti- The Syrian Civil War is a conflict of authoritarianism, and poor economic and which the consequences will be felt for agricultural policies (Gleick, 2014; Lesch, generations. It began in March 2011 during 2017). Armed conflict can cause problems the Arab Spring protests against Syrian beyond regional instability, violence, and President Basher al-Assad. Al-Assad and food insecurity, however. It can also impact his father, Hafez, are Alawites, a minority the health of people living in the conflict- Shi’a sect, ruling over the majority Sunni ridden countries, as well as people living in population of Syria since 1970. Rising the countries hosting large numbers of income inequality as a result of Baathist migrants. The latter problem is the subject of statism, dissatisfaction with this paper. With hundreds of thousands of authoritarianism, increasing corruption, and people migrating from Syria into Europe, a lack of jobs brought Syrians into the European governments are now facing streets. There were nationwide challenges of how to deal with re-emerging demonstrations in major cities throughout diseases like cutaneous leishmaniasis. What Syria. In response, the Assad regime impact will migration have on the presence deployed the Syrian Army to quell the of infectious diseases in the EU? How can uprising with soldiers firing on EU member states simultaneously address demonstrators. After months of military security and public health concerns resulting sieges, the protests evolved into armed from forced migration? rebellion. On one side was the Baathist Drawing upon existing government of Assad, on the other were environmental security and public health opposition forces composed of army literatures, we hypothesise that the increased defectors and civilian volunteers. prevalence of infectious diseases occurs as a As the conflict grew, Al-Qaeda and result of public health breakdowns during ISIS made their presence known. Due to and following armed conflict. Moreover, Al-Qaeda and ISIS involvement, the Syrian mass migration leads to the emerging and government lost large swaths of eastern re-emerging of infectious diseases in a host Syria. Moreover, Hezbollah, Iran, Turkey, country. While the Syrian refugee crisis has Saudi Arabia, and the Gulf Emirates, along put real and imagined strains on EU member with Russia and the United States, took states’ immigration systems, a coordinated interest in the sectarian struggle. By 2016, policy response, as outlined below, will approximately 400,000 Syrians had been mitigate the crisis and offer solutions for a killed and more than 3.8 million Syrians fled way forward. as refugees. Forced Migration and the Spread of Infectious Disease Conflict and Health Literature Review professional medical care and failing to do so continues to put the infected individual Political scientists have studied the and the rest of their community at risk. impact that conflict has on a number of In addition to the destruction of elements of the political sphere, including health care facilities and supplies, many how it impacts the health of the individuals countries affected by conflict lose their in the affected region. Armed conflict trained health care workers as they flee with impacts health through destruction of other refugees and migrants (Kalipeni and infrastructure, flight of health care workers, Oppong, 1998; Gayer, et al., 2007). Once interruptions in vaccination programs, properly trained health professionals begin disruption in infection control practices, and to leave the country, individuals still living decreases in governmental health funding in-country no longer have access to adequate (Gayer, et al., 2007). These breakdowns do care. This creates a different, but equally not only increase the risk of chronic troubling problem. Even if the hospital or diseases, they also open the door for clinic is still functioning, individuals in the problems with acute infectious disease country are still not able to receive outbreaks. Looking first at the problem of appropriate care. The personnel left infrastructure destruction, many war-torn working the hospitals and clinics may not be countries throughout the world have able to recognise many infectious diseases experienced the destruction of their health and, even if they can identify the disease, care facilities and supplies (Kalipeni & they may not have any knowledge about Oppong, 1998). This is particularly true in appropriate treatment procedures places that experience high levels of (Beracochea, et al., 1995; Thaver, et al., bombing, like Syria. In heavily bombed 1998). Inappropriate or incomplete areas, health care facilities are fully or treatment procedures, particularly ones that partially destroyed. Even if the facility is use antibiotics, can create anti-microbial only partially destroyed, it may no longer be resistant strains of the disease. able to adequately function to care for Infectious disease also becomes a patients. problem in countries with sustained armed This problem with a lack of access to conflict because fighting disrupts health care can also refer to possible fear of vaccination and infection control programs. traveling to a still existing health care Many developing countries have made great facility because of a threat of violence. This strides in improving vaccine coverage for means that many people wait until their diseases like polio; however, once armed disease has progressed significantly before conflict erupts it can be extremely difficult seeking help. The longer an individual waits to continue regular vaccinations. This to seek treatment for an infectious disease, problem was seen after the 2001 US the more likely it is that the disease will invasion of Afghanistan, where vaccination spread. In some cases, they may even try to rates in areas of high conflict remain much treat the disease themselves as Gele and lower than rates in the rest of the country Bjune (2010) found to be the case with because vaccine campaign workers are tuberculosis patients in conflict zones. With targeted by armed groups (Norris, et al., almost all infectious diseases affecting 2016). Even the simple logistical difficulties conflict-ridden regions, it is not possible to of a vaccine campaign in areas of conflict treat the disease without seeking can make conducting the campaign 2 Forced Migration and the Spread of Infectious Disease impossible. The logistical challenges of Even if refugee camps are working getting vaccines into areas of conflict has to keep conditions as sanitary as possible led to lack of vaccination in Somalia, and make sure incoming residents are Pakistan, and Ethiopia (Pallansch and properly protected through vaccination Sandhu, 2006). As armed conflict leads to programs, the massive overcrowding that falling vaccination rates, more people begin often exists in these camps can cause large suffering and dying from vaccine- outbreaks under the right circumstances. preventable diseases. This was the case with a large measles Countries plagued with sustained outbreak that took place from 2000-2001 armed conflict also see a decrease in the among four Burundi refugee camps in amount of government resources dedicated Tanzania. The four camps had been long to health. “Long-term consequences of civil closed to new refugees, but when fighting war can affect entire countries (such as began to increase again, they opened their Angola, the Democratic Republic of Congo, doors and began admitting new individuals. or Afghanistan) because of chronic lack of Shortly afterward, an outbreak of measles investment in health, education, and public swept through the camps, eventually leading works” (Gayer, et al., 2007, p. 1625). to over 1000 cases of the disease Money that may have originally been (Kamugisha, Cairns, and Akim, 2003). allocated for public health or infectious Although vaccination rates for measles in disease control programs can, and often is, the camps were good, new arrivals did not redirected to the war efforts. What have the same vaccination history and the sometimes becomes a chronic lack of health outbreak was a continuation of the measles funding only exacerbates the problems of outbreak in Burundi that had begun a few infrastructure destruction, loss of trained months earlier (Kamugisha, Cairns, and personnel, and the breakdown of vaccine Akim, 2003). programs. Finally, armed conflict often leads to Although armed conflict has the mass migration of individuals seeking numerous in-country impacts, it doesn’t only asylum in other countries. Mass migrations impact the internal health of a country. The are not