Imagine your child is bleeding from a severe wound. The hospital lacks the necessary medical equipment to stop it, and you are told that amputation is the only option, but the hospital has no anesthesia. Imagine losing a newborn baby, not for any medical reason, but because a power outage cut off the heat to your child’s incubator. Sadly, these are not infrequent tragedies in a number of Middle Eastern countries. In Syria, as in other areas of conflict across the region, it’s not just bombs, bullets, and shells that are killing and maiming children and others. People are also dying because health systems have collapsed, and they thus lack treatment and preventative care. The destruction of health infrastructure in conjunction with poor sanitation, malnutrition, and displacement has caused a resurgence of communicable diseases. Conflict has also impeded the treatment of chronic diseases, illnesses, and injuries that would otherwise be treatable with very basic medical care. The lack of available care has been especially detrimental to the health of vulnerable groups such as children and pregnant women.
Save the Children found that by 2014, 60 percent of hospitals and 38 percent of primary health facilities in Syria, for example, had been destroyed. Of the remaining hospitals, only half are able to treat childhood diseases, and the medications and equipment used to treat chronic illnesses are seldom obtainable. It is likely that thousands of children have died from chronic illnesses like cancer, diabetes, asthma, and kidney failure—simply because of reduced access to treatment and medication. Even without a chronic health problem, a child can still be in danger. As Assistant Secretary of State Anne Richard recently remarked, “The leading causes of death for children under five in developing countries are measles, diarrhea, malaria, and respiratory infections. In wars and emergencies, children succumb to the same preventable diseases. But in countries torn by conflict they are more likely to get sick and more likely to die.” Furthermore, the chronic stress experienced by children living in conflict situations takes a toll on their mental health and education, which will have an impact on their future development and economic opportunities. This threatens to create a lost generation that will grow up much more likely to suffer from mental illness and display aggressive behavior. These children are losing valuable years of their education because it is not safe enough to go to school or because they are too stressed to learn.
Giving birth in an area affected by conflict or as a refugee is also incredibly stressful, especially considering that those wounded in battle have been prioritized over other groups, such as pregnant women. Mothers in Syria have faced a large increase in unassisted births, from 96 percent assisted to less than a quarter assisted. More and more frequently, women are opting for medically unnecessary cesareans, which they request out of fear of giving birth in an insecure situation, despite the fact that it makes them vulnerable to infection. It can be difficult or expensive to access care in the surrounding states, so some refugee women have even been forced to return to Syria in order to give birth.
A critical issue constraining the international community’s ability to respond to the Middle East’s health crisis in Syria, Yemen, and elsewhere has been an insufficient supply of financial and material resources as well as personnel. This is related to the difference in the response required for a conflict that becomes protracted over a period of years versus the response required for a sudden onset disaster. While both require humanitarian intervention to provide lifesaving care in the short term, a protracted conflict requires a more sustained effort by the international community, including steps to help all affected countries recover and return to a path of development. It requires a long-term commitment to providing funding for replacing broken health systems, rebuilding infrastructure, and strengthening the national capacity to a point where the health system is sustainable.
In today’s world, where such crises are multiplying, we need to develop innovative approaches that combine humanitarian and development strategies and funding streams, and we need to address the needs of refugees and host country nationals simultaneously. Refugees have been an important focus for Save the Children and other NGOs, but it is important to recognize that the influx of refugees into countries like Turkey, Lebanon, and Jordan has placed a burden on poor host country communities, particularly in urban areas. Caring for both refugees and host populations is a strategy that the U.S. State Department has recently embraced, having just announced an extra $360 million toward helping all those affected by the Syrian crisis, inside and outside of the country. Unfortunately, the $8.4 billion dollar appeal by the United Nations for Syria continues to be seriously underfunded.
Although the current situation presents many challenges, these challenges also represent the opportunity for all stakeholders to work together in developing innovative solutions and partnerships across the Middle East and beyond. There are many examples of such success stories. For example, at The Middle East Institute’s conference on the health care crisis in the region, Laila Bugaighis described a partnership between her hospital, Benghazi Medical Center, and a hospital in Boston. This partnership enabled Benghazi Medical Center to develop stronger emergency services. Another team from Memphis, Tennessee stepped in to perform 200 heart surgeries at the same hospital. In addition, Rabih El Chammay of the Lebanese Ministry of Health discussed how the influx of Syrian refugees has created an impetus for Lebanon to build a national mental health strategy from scratch, benefitting both Lebanese and refugees. And Inka Weissbecker, a senior advisor for the International Rescue Committee, worked with the World Health Organization to develop training programs, e-learning courses, and self-care tools to better the mental health of those affected by conflict. The No Lost Generation Partnership, of which Save the Children is a member, has helped put refugee children back in school and has established child-friendly spaces, but it needs significantly more support. Meanwhile, thousands of Polio Control Task Force volunteer immunizers have reached an estimated 1.4 million children, preventing a polio outbreak despite the risk to their own lives.
In the long run, rebuilding collapsed health systems in the Middle East will not be easy, but making investments, developing innovative solutions, assisting countries that host refugees, and forming partnerships to ensure access to health services will go a long way toward improving the lives of children, women, and other vulnerable individuals suffering in these conflicts.
Michael Klosson, vice president of policy and humanitarian response at Save the Children, moderated the panel at the MEI conference on caring for the most vulnerable populations.
 Save the Children Staff, “A Devastating Toll: The Impact of Three Years of War on the Health of Syrian Children,” Save the Children, March 2014, http://www.savethechildren.org.uk/sites/default/files/images/A_Devastating_Toll.pdf
 Anne Richard, “Health Needs of Refugees and IDP Children Including Vaccination,” U.S. Department of State, March 3, 2015, http://www.state.gov/j/prm/releases/remarks/2015/238765.htm.
 Save the Children Staff, “A Devastating Toll.”
 Karen Leigh, “Syria ER: Pregnant in War, A Growing Women's Health Crisis,” Syria Deeply, September 19, 2013, http://www.syriadeeply.org/articles/2013/09/2491/syria-er-pregnant-war-growing-womens-health-crisis/.
 “New U.S. Humanitarian Assistance to Respond to Syria Crisis,” U.S. Department of State, June 25, 2015, http://www.state.gov/r/pa/prs/ps/2015/06/244374.htm.
“Caring for the Most Vulnerable Populations,” Middle East Institute, June 25, 2015, http://www.mei.edu/sites/default/files/Panel%202%20Transcript.pdf.
 Jason Motlagh, “Fighting Polio Amid the Chaos of Syria’s Civil War,” National Geographic, March 5, 2015, http://news.nationalgeographic.com/2015/03/150305-polio-syria-iraq-islamic-state-refugees-vaccination-virus-jihad/.