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The war has left tens of thousands of children unvaccinated

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Children in many parts of Syria have not been vaccinated against preventable diseases. Sara Ferrer, a nurse who is coordinating the medical projects of Médecins Sans Frontières (MSF) in areas of Aleppo governorate, explains the risks.

Why is it so important to focus efforts on vaccinating children in Syria?

The war in Syria has been terrible because of the violence, but also because of serious side effects that go unnoticed. Since the conflict escalated in 2012, the vast majority of children born in many parts of Syria are unvaccinated and this is very worrying. Mass displacements of people mean medical authorities and non-governmental organisations (NGOs) have been unable to focus their efforts on these activities or have no resources for it. The most that some children have received is one or two doses in isolated campaigns. Syrian children are not vaccinated against a range of preventable diseases such as measles, rubella, tetanus or pneumonia.

Before the war, children were normally vaccinated in Syria. However, we are now faced with a rather widespread problem of unvaccinated children, especially in the areas controlled by the opposition where we are working.

The information we have obtained from monitoring the medical condition of displaced children from areas under Islamic State (IS) control is that they have not been vaccinated, although we do not know if it is a generalised issue. We do not have access to areas controlled by the government of Syria, despite having requested permission. According to data from some medical authorities operating there, there are some vaccination activities.

Have many cases of these infections been documented? How worrying is it?

Cases of measles, meningitis and pneumonia have been documented and treated in time but consolidated data is missing. The EWARN (Early Warning System, reporting to the health authorities) reports cases of infections throughout the country (in the provinces of Raqqa, Idlib, Aleppo, rural areas of Damascus...).At the moment, they are limited.The risk we face is that factors such as a generalised lack of immunisation and mass population displacements are brought together. Some of these infections are transmitted through the air, so we may find ourselves in a situation where infections spread as an epidemic that we cannot control. During the winter, people choose not to move much because of the cold. With the arrival of good weather, it is expected that people will try to return to their places of origin where the conflict has ceased, as in the city of Aleppo, or areas such as Al Bab where the situation is changing.

Medical care on the frontline - North Syria
Since the Syrian conflict escalated in 2012, the vast majority of children born in many parts of Syria have not been vaccinated against preventable diseases such as measles, rubella, tetanus or pneumonia. Here, an MSF nurse in Al Salamah hospital vaccinates a child as part of an expanded immunisation programme (EPI).

What is MSF doing?

In our Al Salamah hospital (Azaz district, Aleppo governorate), we have been carrying out an expanded programme of immunisation (EPI) for several years, once a week. In July of last year we also started sending teams to the camps for displaced people in the northern part to curb the risk of outbreaks of infections. We concentrate on an area with an estimated population of 200,000 people, of whom 17 per cent (around 34,000) are under the age of five. It is a process that involves three rounds and we are still working in collaboration with other humanitarian workers responsible for implementing vaccination. MSF provides the vaccines, ensures the maintenance of the cold chain through a monitoring process and trains the vaccinating teams. 

In the last year we have launched two measles vaccination campaigns. The most recent was in January, after seven cases were confirmed in the camp for displaced people in Shamareek. The vaccination campaign was led by MSF and joined by the World Health Organization (WHO) and local medical organisations. In 12 days, 6,540 children under the age of 15 were vaccinated, 93 per cent of the target. At the moment we are studying the possibility of expanding our action to other places. In the three districts of the northern part of Aleppo governorate where we are working we estimate that there are about 143,000 children under the age of five.

What problems do our teams face when it comes to vaccination?

At times, we have met some resistance from the population. The work of health promotion teams, who talk to mothers so they understand the benefits of these preventive measures for their children, is critical. Usually they are well accepted and families that have several children and have already gone through this understand the need.

Why are there not many other organisations vaccinating in Syria?

These are programmes require a lot of human resources and are expensive. It is also not easy to get the vaccines or maintain the cold chain so they don’t spoil. This happened to us in the city of Aleppo. It was impossible to introduce vaccines there because of the siege between July and December 2016. We did not have a specialised supervisor to offer guarantees that the cold chain would be maintained, ensuring the quality of the vaccines.

What should be done?

We believe that WHO, other UN agencies and other medical players should press for an increased population coverage for vaccinations. Small steps are being taken, such as an immunisation programme for children under one year old in the provinces of Hama and Idlib. But it's not enough. Syrian children deserve greater protection against a complicated future. 

Between July 2016 and February 2017, MSF vaccinated a total of 35,907 children under the age of five in four districts in the northern governorate of Aleppo in the framework of an expanded immunisation program (EPI). In addition, 5,733 women of childbearing age (between 15 and 45) have been vaccinated for tetanus. MSF also conducts vaccination initiatives in several other governorates of Syria.