Factors influencing the occurrence of infectious disease outbreaks in Lebanon since the Syrian crisis

ABSTRACT

Since the beginning of the Syrian crisis in 2011, the region has witnessed a major population displacement. Lebanon, a country with a population of 4.2 million, has welcomed around one million refugees. A rise in the incidence of Measles, Hepatitis A and Leishmaniosis was noted. This paper aims to document the incidence of outbreaks along with the factors that contributed to their emergence in Lebanon. A comprehensive literature review was conducted using electronic databases and (non) governmental reports, including studies reporting the state of Syrian refugees in Lebanon and those reporting on infectious outbreaks in Lebanon and Syria. Primary outcomes were defined as incidence or prevalence of Measles, Hepatitis A, and Leishmaniosis in both populations. Secondary outcomes were set to be the risk factors for the outbreaks. As of February 2016, Lebanon registered a total of 1.067.785 refugees. Infectious outbreaks were reported in Lebanon just after initiation of Syrian migration, with 1760 new measles cases, 1551 hepatitis A cases, and 1033 Leishmania cases in 2013. Local factors probably contributing to the emergence and dissemination of the outbreaks include living conditions, water and sanitation, nutritional state, and immunization. The outbreaks were not only reported in regions with higher refugee concentration, but also within other Lebanese regions. This was attributed to deficiencies in immunization of measles, low socioeconomic status and poor living conditions. The Syrian crisis has led to considerable impact on the demographic, economic, and political systems in Lebanon, next to an important burden on the healthcare system.

KEYWORDS:

• Syrian crisis
• outbreaks
• refugees

Acknowledgments

This publication is the result of a thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Disaster Medicine (European Master in Disaster Medicine).

Disclosure statement

The authors have read and understood the policy on declaration of interests, and declare to have none. All authors have completed the COI “Declaration of Interests” form.

Contributorship statement

Conceived and designed the study: MH, GvB, KY. Main investigators: MH, GvB. Analyzed the data: MH, KY. Wrote the paper: MH, GvB, KY. Corrections to the final text: GvB. Guarantor for the study: MH.

All authors had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. MH, the manuscript’s guarantor, affirms that the manuscript is an honest, accurate, and transparent account of the review being reported; that no important aspects have been omitted; and that any discrepancies from the review as planned have been explained.

MH: Mariana HELOU

GvB: Gerlant VAN BERLAER

KY: Kaisar YAMMINE

Recommendations

In coping with the overwhelming immigration from Syria, the Lebanese healthcare system and humanitarian relief efforts should focus on proper housing conditions, immunization campaigns (especially for Measles and Hepatitis A) among both the local population and immigrants, provision of safe drinking water, and improving the access to unrestricted basic health care services. An international effort to end the crisis and subsequently stop the migrant crisis would allow final solutions in the whole region.

Additional information

Funding

This work received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.