RUNNING

HEAD: Syrian Refugees

The Syrian Refugee Crisis: Why Women and Children Experience the Most Severe Health
Disparities
by
Lindsey Helms
Western Washington University
Global Health

(UNICEF, 2014)

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The Syrian Refugee Crisis: Why Women and Children Experience the Most Severe Health
Disparities
The United Nations states that the war in Syria is the worst humanitarian emergency of
the 21st century (Samari, 2015). Since the beginning of the war in 2011, civilians have been the
primary victims, turning this tragedy into a huge public health crisis. It is estimated that close to
three million refugees have fled the country and are now living in neighboring areas such as
Jordan, Lebanon, and Turkey, as well as many other countries around the world (Samari, 2015).
In 2014 it was estimated that over three-quarters of the refugee population was comprised of
women and children (Sami, Williams, Krause, Onyango, Burton, & Tomczyk, 2014). In addition
to the refugee population, over six million people in Syria are still in need of humanitarian
assistance. The numbers of those in need of assistance and those who will be displaced is only
expected to rise. Furthermore, less than half of the total funding requested for Syria has been
received (Sami et al., 2014). Efforts to lend aid and refuge in this tragic situation should be a
global health priority.
A body of research suggests that women and children are disproportionately impacted by
war. Women are at an increased risk of experiencing gender-based violence and poor access to
reproductive healthcare during conflict (Samira et al., 2014). Women and children refugees are
likely to suffer from food insecurity at some point during this conflict, if not for an extended
period of time. The trauma that children experience living during war has long-term psychosocial
implications (Devakumar, Birch, Rubenstein, Osrin, Sondorp & Wells, 2015). Additionally,
many children lack access to basic medical care (Devakumar et al., 2015). This paper
investigates the health disparities experienced by Syrian refugee women and children, and the
potential long-term negative health consequences of this conflict.

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Health Implications for Women and Young Girls

Evidence from past refugee crises demonstrate that women and young girls are at a
higher risk of negative health outcomes related to sexual violence and lack of access to
reproductive healthcare (Sami et al., 2014). Although many humanitarian efforts are working to
meet the healthcare needs of the Syrian refugee population, there are many barriers that prevent
women and young girls from accessing services. Many Syrian women are forced to take on the
role of head of household and fill in a variety of roles they are not accustomed to in a patriarchal
society. It is challenging, if not impossible, for these women to take on the role of providing for
their families and meeting their own reproductive healthcare needs. In countries such as
Lebanon, 75% of healthcare costs are covered for refugees. However, the out of pocket expenses
are sometimes still too high for Syrian women, some who have zero income, to afford. In
Lebanon, Syrian women report a combination of health problems including infections of the
reproductive tract, menstrual irregularities, pelvic pain, and dysmenorrhea (Samari, 2015).
Women are forced to make the decision between feeding their families and seeking medical
attention for gynecological needs. Additionally, added barriers include traveling long distances
in unsafe or foreign areas to see doctors, as well as a shortage of female providers. Many Syrian
women do not feel comfortable seeing a male doctor for obstetric care and will choose to seek no
care if that is the only option (Sami et al., 2014).
There are specific cultural dynamics that influence health disparities experienced by
women and children refugees of Syria (Samari, 2015). Women and children experience an
increased vulnerability to disaster secondary to the relationship between gender and class in a
patriarchal society. Due to the culture in this and many other regions of the world, women and
children do not have the same status, and therefore access to resources, as men. The nature of

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this specific conflict has put Syrian women at a higher risk. For example, in the early stages of
the war rape was used as a weapon, which has lead to increased intimate partner violence in a
region where it was already prevalent (Samari, 2015). It is as if sexual violence against women is
becoming normalized in this culture as a by-product of the war. Consequences of displacement
in this setting are not limited to rape, but also include sexual slavery, forced prostitution, human
trafficking, forced marriage at an early age, sexual and physical assault, genital mutilation, and
sex in exchange for basic needs such as food and shelter (Samari, 2015). It is important to note
that conflict does not always lead to violence against women. However, this is an area of the
world where women experience a greater degree of gender inequality in times of peace, leading
to even worse circumstances in times of war (Samari, 2015).
In addition to sexual violence, young female refugees are at risk for even greater
marginalization due to early marriage (Samari, 2015). There are a number of issues that
influence the occurrence of early marriage. Many families feel that they are protecting their
daughters by wedding them at a young age in an effort to help carry on family traditions and
escape the war torn environment. Other young women seek marriage to escape abusive or
dangerous living situations. As was previously mentioned, the incidence of sexual violence in the
refugee camp setting is high, thus many young women marry for fear of dishonoring their family
after being raped. Young women in this culture are more likely to be married at a younger age
than Western women for religious reasons. However, the war in Syria has further exacerbated
this issue. The high rate of marriage under the age of 18, further leads to an increase in maternal
and neonatal complications (Samari, 2015).
In Syria it is estimated that 1.7 million women need, but do not have access to,
reproductive services (Sami et al., 2014). There is currently an increase of women having

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caesarean deliveries or giving birth at home, both of which increase the likelihood of
complications for the mother and baby (Sami et al, 2014). Caesareans are surgical deliveries,
where women are cut open and the baby physically pulled from the uterus. Not only are there
more risk factors associated with having a caesarean delivery, but the lack of access to resources
and follow up care are also factors that contribute to negative outcomes. Additionally, despite the
high birth rate (estimated 100 babies per month) of Syrian women in Lebanon, many report that
they do not access prenatal care because of the high costs (Samari, 2015). According to an article
published by the Medecins Sans Frontieres (MSF), or Doctors Without Borders, if a refugee in
Lebanon cannot pay 25% of the cost of delivery, she could be turned away from the hospital, or
even worse, have her refugee card confiscated (MSF USA, 2013). Without a valid refugee card,
Syrians loose access to food vouchers. This has lead to an increase of women giving birth alone
and scared, and often in unsanitary, unsafe locations. Marjie Middleton, a MSF midwife reports
that many Syrian women residing in Lebanon do not have the basic food necessary to stay
healthy during pregnancy. This prevalence of malnutrition among pregnant women and new
mothers is a contributing factor to Middletons reports of providing care for malnourished
newborns (MSF USA, 2013).
Health Implications for Children
The lasting impact of conflict on Syrian children is another concerning health issue to
recognize. It is widely accepted that children are often the worst affected by war (Devakumar,
Birch, Rubenstein, Osrin, Sondorp & Wells, 2015). However, the full extent of their suffering is
not fully understood. In 2013 it was estimated that 11,500 children had been killed in the war,
with the numbers expected to rise. In May of 2015, over five and a half million children were in
need of support. Not only are children in this area experiencing death and displacement, but they

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are also faced with food insecurity, mental anguish, and an increased likelihood of exposure to
communicable diseases (Devakumar et al., 2015).
The nutritional status of children living outside of Syria in neighboring countries and
refugee camps is concerning, and has the potential to be compromised by minimal income and
lack of access to healthy foods (Bilukha, Jayasekaran, Burton, Faender, Kingori, Amiri, Jessen,
& Leidman, 2014). The World Health Organization (WHO) conducted a study to assess the
nutritional status of children, ages 6 to 59 months, and non-pregnant women of child bearing age,
15 to 49 years, in both the Zaatari refugee camp and within the host community of Jordan. The
Zataari camp is the largest refugee camp in Jordan, with about 79,000 refugees. It is estimated
that about 500,000 refugees are living elsewhere in Jordan. There was a high incidence of
anemia reported in the Zaatari camp among women and children, 44.8% and 48.4%,
respectively. Interestingly, the incidence of global acute malnutrition among children living in
the Zataari refugee camp and in the Jordanian community was relatively low, 1.2% and 0.8%,
respectively. However, the rate of chronic malnutrition or stunting was higher in children living
within the refugee camp at 17% versus just 9% in the Jordanian community. A program
supported by the United Nations Childrens Emergency Fund (UNICEF) aimed at infant and
child nutrition has had an impact in the region. However, despite a relatively low report of global
acute malnutrition amongst Syrians living in Jordan, the current rates of anemia are concerning
(Bilukha et al., 2014).
The stress of war can cause many long-term problems for children (Devakumar, Birch,
Rubenstein, Osrin, Sondorp & Wells, 2015). Syrian children experience direct violence, illness,
and many have no access to education. The trauma experienced by Syrian children is likely to
negatively impact psychological and psychosocial health in the long run. Exposure to violence

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has been shown to contribute to multiple mental illnesses including Post Traumatic Stress
Disorder (PTSD) and anxiety. Although gathering data on the current rates of mental illness
among Syrian refugee children has proven challenging, research does suggest a rise in mental
distress. For example, a study of child refugees in Lebanon showed a 76% rate of PTSD
(Devakumar et al., 2015).
According to UNICEF (2014), Syrian children are at an increased risk of contracting
preventable diseases such as polio and measles. With an astonishing sixty percent of hospitals in
Syria being destroyed, and the country lacking basic necessities to support health such as
medicine and vaccines, it is not surprising that there have been an emergence of diseases such as
polio and measles that were once eradicated. Additionally, there has been an increase in the
incidence and severity of illnesses such as pneumonia and diarrhea. Many children and families
are living in substandard conditions without access to clean water and adequate hygiene, creating
opportunities for infections and the spread of communicable diseases. Along the same lines, the
crumbling medical infrastructure is leaving children who suffer from chronic diseases in a
terrible predicament. Many of these children do not have access to medication and treatments
that they need to survive (UNICEF, 2014).
Conclusion
With various humanitarian efforts exhausting their resources and no real end to the
conflict in sight, the Syrian refugee crisis continues to be a global health disaster. Despite many
countries offering aid and accepting fleeing refugees, there are still so many who are suffering
and failing to have their basic needs met. In times of conflict women and children are more
vulnerable to health disparities and violence. Syrian women are now more prone to being victims
of sexual violence and have been targeted as such since the beginning of the war. They are being

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forced to take on roles that are not only foreign, but outside of their cultural and religious norms.
All the while these women lack access to basic antenatal and obstetric care. The unmet health
needs of Syrian women directly impact the health of their children. Syrian women and children
experience high rates of anemia, which can lead to long-term negative health outcomes. Children
are exposed to violence that has the potential to leave them with a lifetime of mental health
issues. Once eradicated diseases are causing even more unnecessary pain, suffering, and death in
refugee camps, where people are forced to live in squalid conditions. Although there is global
support for Syrian women and children, it is not enough. The lack of infrastructure to support the
physical and psychosocial needs of this population will lead to long-term damaging effects to an
entire country. As a result, there is a need for increased awareness about the disparities
experienced by these vulnerable populations, and more work to be done to create positive
changes.

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References

Bilukha, O.O., Jayasekaran, D., Burton, A., Faender, G., Kingori, J., Amiri, M., Jessen, D.,
Leidman, E. (2014). Nutritional status of women and child refugees from Syria Jordan,
April May 2014. Morbidity and Mortality Weekly Report 63(29), 638-639.
Devakumar, D., Birch, M., Rubenstein, L.S., Osrin, D., Sondorp, E., & Wells, J.C.K. (2015).
Child health in Syria: recognising the lasting effects of warefare on health. Conflict and
Health 9(34). doi: 10.1186/s13031-015-0061-6
Medecins Sans Frontieres (2013). Syrian refugees in Lebanon: Pregnant women often have no
idea where to go. Retrieved from http://www.doctorswithoutborders.org/newsstories/field-news/syrian-refugees-lebanon-pregnant-women-often-have-no-idea-wherego
Samari, G., (2015). The response to Syrian refugee womens health needs in Lebanon, Turkey,
and Jordan and recommendations for improved practice. Humanity in Action. Retrieved
from http://www.humanityinaction.org/knowledgebase/583-the-response-to-syrianrefugee-women-s-health-needs-in-lebanon-turkey-and-jordan-and-recommendations-forimproved-practice
Sami, S., Williams, H.A., Krause, S., Onyango, M.A., Burton, A., Tomczyk, B. (2014).
Responding to the Syrian crisis: the needs of women and girls. The Lancet 383(9923),
1179-1181. doi:10.1016/S0140-6736(13)62034-6
United Nations Childrens Emergency Fund (UNICEF) (2014). Under siege: the devastating
impact on children of three years of conflict in Syria. Retrieved from
http://www.unicef.org/publications/files/Under_Siege_March_2014.pdf