Abstract
Introduction
War in Syria has lasted for nearly seven years, causing considerable displacement of the civilian population, extensive violence and countless deaths. Since November 2016, military operations in northeast Syria have intensified, resulting in a large influx of internally displaced people (IDPs) to Ein Issa camp, Raqqa governorate. Limited information is available on the humanitarian and medical needs of IDPs in this setting. We assessed the health status of recently arrived IDPs in Ein Issa camp.
Methods
We carried out a cross-sectional survey using simple random sampling between 8 and 18 Nov 2017, enrolling households who had arrived since 1 Oct 2017. We interviewed heads of household in Arabic using a structured questionnaire with a WHO-UNHCR mental health instrument, collecting data on demographics; mental health symptoms in the last two weeks; and exposure to violence and deaths amongst household members in the last year. We calculated prevalence estimates and mortality rates with 95% confidence intervals.
Ethics
This study was approved by the MSF Ethics Review Board.
Results
257 households were enrolled, including 1482 people (698 male; 784 female), with a median age of 12 years (IQR 6-30 years). Crude mortality rate (CMR) was 0.56 deaths/10000 people/day (95%CI 0.39-0.79). Conflict-linked violence was the most frequently reported cause of death (20/31, 64%). 469 (32%, 95%CI 29-34) participants reported having experienced at least one violent event in the previous year. 279 (19%, 95%CI 17-21) reported witnessing atrocities, such as flogging or executions, and 80 (10%, 95%CI 8-12) children under 15 years had witnessed such atrocities. In males aged over 14 years, 42 (16%, 95%CI 12-21) reported being detained or kidnapped and 30 (11%, 95%CI 8-16) tortured, beaten, or attacked. 485 participants (38%, 95%CI 35-40) reported that in the two weeks prior to interview they had been so distressed that they were inactive. 91 (20%, 95%CI 17-24) children aged 5 to 12 years had experienced bedwetting. 75 respondents (29%, 95%CI 24-35) reported feeling uninterested in things they used to like and 37 (14%, 95%CI 11-19) so hopeless that they did not want to carry on living.
Conclusion
We found a CMR almost five times higher than pre-war estimates. The majority of these deaths are directly linked to the conflict. The prevalence of mental health symptoms and distress across all age groups highlights the immense psychological impact of conflict on this population. We recommend to urgently reinforce mental health and psychosocial support activities in this region. Limitations include the potential for recall and survivorship biases as well as complexity of mental health assessment.
Conflicts of interest
None declared.
Larissa Vernier
Larissa Vernier is currently working as field epidemiologist with MSF. After completing her MSc in Epidemiology, and a Masters in Public Health, she worked in the Epidemiology of Emerging Diseases Unit at Institut Pasteur Paris, where she was managing projects on hepatitis C and Zika. Seeking more operational work, she then joined MSF at the end of 2016. After an initial project in Chad focusing on malnutrition assessment and hepatitis E outbreak response, she then went to North Syria, where she spent seven months as an epidemiologist.
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418 words
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