March 07, 2017

Doctors Without Borders/Médecins Sans Frontières (MSF) nurse practitioner Sara Ferrer currently serves as coordinator of MSF's medical projects in areas of northern Syria's Aleppo Governorate. Here she discusses the importance of vaccination campaigns for children in the war-ravaged country.

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 worrisome. Mass displacements of people mean medical authorities and non-governmental organizations (NGOs) have been unable to focus their efforts on these activities or have no resources for them. The most that some children have received is one or two doses in isolated campaigns. Syrian children are not prepared for 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, especially in the areas controlled by the opposition where we are working. The information we have obtained after monitoring the medical condition of children displaced from areas under Islamic State (IS) control is that they have not been vaccinated, although we do not know if it is a generalized issue. MSF does 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 have been documented? How worrisome is the situation?

Cases have been documented, though consolidated data is missing. The EWARN [Early Warning System, reporting to the health authorities] reports cases of infections (such as measles or meningitis) in different areas of the country. At the moment they are limited but do occur. The risk we face is that factors such as a generalized lack of immunization 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 that are changing control in the framework of offensives.

How is MSF responding?

On the one hand, in our Al Salamah Hospital (Azaz District, Aleppo Governorate) we have been carrying out an expanded program of immunization (EPI) for several years, once a week. In July of last year we also started sending teams to the displaced camps 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 which 17 percent are under the age of five (about 34,000 children). It is a process that includes three rounds and we are still working in collaboration with other humanitarian actors responsible for implementing vaccination, while MSF provides the vaccines, ensures the maintenance of the cold chain (keeping vaccines at the appropriate temperature) through a monitoring process, and trains the vaccinating teams.

On the other hand, in the last year we have launched two specific campaigns of vaccination of measles, the last of them in January after seven cases were confirmed in the displaced persons' camp of Shamareek. The vaccination campaign was led by MSF and was also joined by the World Health Organization (WHO) along with local medical organizations. In 12 days, 6,540 children under the age of 15 were vaccinated, 93 percent of the target group. At the moment we are studying the possibility of expanding our actions to other places. In the three districts where we are working in the northern part of Aleppo Governorate we estimate that there are about 143,000 children under the age of five.

What challenges do MSF teams face when it comes to vaccination?

Sometimes we have met some resistance from the population. The work of health promotion teams to talk to mothers to understand the benefits of these preventive measures in their children is critical. Usually the acceptance is good and those families that have several children and have already gone through this quickly understand the need.

Why aren't there more organizations providing vaccinations in Syria?

These are programs that cost a lot in terms of both human resources and funding. It is also not easy to get the vaccines or maintain the cold chain to ensure they do not spoil. This happened to us, for example, 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 specialized supervisor to offer guarantees that the cold chain was maintained and, therefore, couldn't guarantee the quality of the vaccines.

We believe that WHO, other UN agencies, and other medical actors should press for increased population coverage in vaccinations. Small steps are being taken, such as an immunization program for children under one year old in the provinces of Hama and Idlib. But it's not enough. Syrian children deserve greater protection as they face 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 immunization program (EPI). MSF also vaccinated 5,733 women of childbearing age (between 15 and 45) against tetanus. MSF also conducts vaccination initiatives in several other governorates of Syria.

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