Coronavirus 2019 and health systems affected by protracted conflict: The case of Syria
Coronavirus 2019 and health systems affected by protracted conflict: The case of Syria
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DOI：
10.1016/j.ijid.2020.05.003
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发表时间：
2020-07-01
影响因子：
8.4
通讯作者：
Tarakji, Ahmad
中科院分区：
文献类型：
--
作者：
Abbara, Aula;Rayes, Diana;Tarakji, Ahmad
简介：根据《国际卫生条例（2005）》，全球三分之二的国家没有做好应对突发卫生事件的准备，叙利亚等受冲突影响的国家尤其脆弱。对疫情准备、应对和报告的政治影响也可能对叙利亚的SARS-CoV-2控制产生不利影响。叙利亚于2020年3月22日报告了第一例病例;然而，人们担心这一报告被推迟，报告不足的情况仍在继续。讨论：叙利亚的冲突使其战前人口的一半以上流离失所，造成670万人在国内流离失所。随之而来的过度拥挤--水、卫生设施和医疗保健（包括实验室能力）不足--可能导致叙利亚出现SARS-CoV-2传播的理想条件。政治变革导致叙利亚境内至少形成了三个卫生系统，每个系统都有自己的治理、能力和规划。这种各自为政，彼此之间几乎没有互动，可能导致资源分配不良，并对控制产生不利影响。因此，COVID-19可能会使卫生系统（特别是重症监护能力）不堪重负，导致整个人口的高死亡率，特别是对最脆弱的人群，如被拘留者。结论：需要在叙利亚各地采取可在当地实施的干预措施，快速建立WASH和卫生系统能力，以确保早期发现和管理COVID-19病例。(C)2020由Elsevier Ltd代表国际传染病学会发布。
Introduction: Two thirds of countries globally are unprepared to respond to a health emergency as per the International Health Regulations (2005), with conflict-affected countries like Syria being particularly vulnerable. Political influences on outbreak preparedness, response and reporting may also adversely affect control of SARS-CoV-2 in Syria. Syria reported its first case on 22 March 2020; however, concerns were raised that this was delayed and that underreporting continues.Discussion: Syria's conflict has displaced more than half of its pre-war population, leaving 6.7 million people internally displaced. The consequent overcrowding - with insufficient water, sanitation and healthcare (including laboratory capacity) - could lead to conditions that are ideal for spread of SARS-CoV-2 in Syria. Political changes have led to the formation of at least three health systems within Syria's borders, each with its own governance, capacity and planning. This fragmentation, with little interaction between them, could lead to poor resource allocation and adversely affect control. As such, COVID-19 could overwhelm the health systems (particularly intensive care capacity), leading to high deaths across the population, particularly for the most vulnerable such as detainees.Conclusions: Locally implementable interventions that rapidly build WASH and health system capacity are required across Syria to ensure early detection and management of COVID-19 cases. (C) 2020 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.