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. 2023 Sep;10(1):e001636.
doi: 10.1136/bmjresp-2023-001636.

Impact of the Syrian conflict and forced displacement on respiratory health: an analysis of primary data from a humanitarian organisation

Lena Basha  1 , Alex Socarras  2 , Mohammed Waseem Akhter  2 , Mohamed Hamze  3 , Ahmad Albaik  3 , Imad Hussein  3 , Ahmad Tarakji  2 , Mufaddal Hamadeh  2 , Randa Loutfi  2 , Mazen Kewara  3 , Aula Abbara  2   4
Affiliations

Impact of the Syrian conflict and forced displacement on respiratory health: an analysis of primary data from a humanitarian organisation

Lena Basha et al. BMJ Open Respir Res. 2023 Sep.

Abstract

Background: Despite a decade of conflict, there has been little exploration of respiratory health in Syria, notwithstanding the known impacts of conflict on lung health. Our aim is to explore the burden and trends of respiratory consultations in Syrian American Medical Society (SAMS) facilities in northwest Syria through an ecological analysis.

Methods: We performed a retrospective review of routinely collected data relating to respiratory presentations in SAMS' facilities between March 2017 and June 2020; we compared data by facility type, infectious versus non-infectious aetiologies and age.

Results: Data were available for 5 058 864 consultations, of which 1 228 722 (24%) were respiratory presentations, across 22 hospitals, 22 primary healthcare centres, 3 mobile clinics and 1 polyclinic. The median number of respiratory consultations per month was 30 279 (IQR: 25 792-33 732). Key findings include: 73% of respiratory consultations were for children; respiratory presentations accounted for up to 38% of consultations each month, seasonal variation was evident; respiratory tract infections accounted for 91% of all respiratory presentations. A steep decrease in consultations occurred between the end of 2019 (160 000) and the first quarter of 2020 (90 000), correlating with an escalation of violence in Idlib governorate.

Conclusion: This study presents the largest quantitative analysis of respiratory data collected during the Syrian conflict. It supports the need for improved measures to aid the prevention, diagnosis and management of respiratory conditions during conflict as well as further research to explore the impact of conflict on respiratory health.

Keywords: Asthma; COPD epidemiology; Respiratory Infection.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(A) Time frame in which data were available for each facility. (B) The number and type of SAMS facilities which were open (and provided data) each month. (C) The number of total monthly consultations per month (y-axis) in each type of facility by year (x-axis). (D) Total consultations from all facilities per month recorded during the study period. PHC, primary healthcare centre; SAMS, Syrian American Medical Society.
Figure 2
Figure 2
(A) The percentage of respiratory cases as a proportion of the total consultations per month recorded from all facilities in the study. (B) The total number of respiratory cases in children and adults per month. (C) Scale adjusted: the number of infectious and non-infectious respiratory presentations in adults and children in each facility type. (D) Scale adjusted: the trends in each disease category in each facility type. PHC, primary healthcare centre.
Figure 3
Figure 3
(A) The number of non-infectious respiratory disease cases per month in each hospital included in the study (outlier highlighted in red). (B) The number of asthma cases per month in all facilities. (C) The number of asthma cases per month in all facilities in adults and children. (D) Scale adjusted: the number of asthma cases per month in adults and children in the different facility types. PHC, primary healthcare centre.
Figure 4
Figure 4
(A) The total number of cases per month related to inhalation of chemicals, gases, fumes and vapours. (B) Respiratory cases as a percentage of the total monthly consultations in each type of facility. (C) The total number of respiratory cases in children and adults per month in each facility type. (D) Scale adjusted: the number of facilities that provided data for the study each month. PHC, primary healthcare centre.
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