Diggle Emma, Welsch Wilhelmina, Sullivan Richard, Alkema Gerbrand, Warsame Abdihamid, Wafai Mais, Jasem Mohammed, Ekzayez Abdulkarim, Cummings Rachael, Patel Preeti
Save the Children, London, UK.
Office of the High Commissioner for Human Rights, London, UK.
Confl Health. 2017 Dec 22;11:33. doi: 10.1186/s13031-017-0134-9. eCollection 2017.
The Syrian armed conflict is the worst humanitarian tragedy this century. With approximately 470,000 deaths and more than 13 million people displaced, the conflict continues to have a devastating impact on the health system and health outcomes within the country. Hundreds of international and national non-governmental organisations, as well as United Nations agencies have responded to the humanitarian crisis in Syria. While there has been significant attention on the challenges of meeting health needs of Syrian refugees in neighbouring countries such as Jordan, Lebanon and Turkey, very little has been documented about the humanitarian challenges within Syria, between 2013 and 2014 when non-governmental organisations operated in Syria with very little United Nations support or leadership, particularly around obtaining information to guide health responses in Syria.
In this study, we draw on our operational experience in Syria and analyse data collected for the humanitarian health response in contested and opposition-held areas of Syria in 2013-4 from Turkey, where the largest humanitarian operation for Syria was based. This is combined with academic literature and material from open-access reports.
Humanitarian needs have consistently been most acute in contested and opposition-held areas of Syria due to break-down of Government of Syria services and intense warfare. Humanitarian organisations had to establish de novo data collection systems independent of the Government of Syria to provide essential services in opposition-held and contested areas of Syria. The use of technology such as social media was vital to facilitating remote data collection in Syria as many humanitarian agencies operated with a limited operational visibility given chronic levels of insecurity. Mortality data have been highly politicized and extremely difficult to verify, particularly in areas highly affected by the conflict, with shifting frontlines, populations, and allegiances.
More investment in data collection and use, technological investment in the use of M- and E-health, capacity building and strong technical and independent leadership should be a key priority for the humanitarian health response in Syria and other emergencies. Much more attention should be also given for the treatment gap for non-communicable diseases including mental disorders.
叙利亚武装冲突是本世纪最严重的人道主义悲剧。冲突导致约47万人死亡，1300多万人流离失所，继续对该国的卫生系统和健康状况产生毁灭性影响。数百个国际和国家非政府组织以及联合国机构已对叙利亚的人道主义危机作出响应。虽然人们高度关注在约旦、黎巴嫩和土耳其等邻国满足叙利亚难民健康需求的挑战，但关于2013年至2014年期间叙利亚境内的人道主义挑战，记录却很少，当时非政府组织在叙利亚开展行动，几乎没有得到联合国的支持或领导，尤其是在获取信息以指导叙利亚的卫生应对措施方面。
在本研究中，我们借鉴在叙利亚的行动经验，分析2013 - 2014年从土耳其收集的、用于叙利亚冲突地区和反对派控制地区人道主义卫生应对的数据，当时针对叙利亚的最大规模人道主义行动以土耳其为基地。这与学术文献及开放获取报告中的资料相结合。
由于叙利亚政府服务的崩溃和激烈的战争，叙利亚冲突地区和反对派控制地区的人道主义需求一直最为迫切。人道主义组织不得不建立独立于叙利亚政府的数据收集系统，以便在叙利亚反对派控制地区和冲突地区提供基本服务。社交媒体等技术的使用对于促进叙利亚的远程数据收集至关重要，因为由于长期存在的不安全状况，许多人道主义机构的行动能见度有限。死亡率数据已被高度政治化且极难核实，特别是在受冲突影响严重、前线、人口和效忠对象不断变化的地区。
在数据收集和使用方面加大投资、在移动和电子卫生应用方面进行技术投资、开展能力建设以及提供强有力的技术和独立领导，应成为叙利亚及其他紧急情况人道主义卫生应对的关键优先事项。还应更加关注包括精神障碍在内的非传染性疾病的治疗缺口。
