Bronchitis outbreak slams Atma encampment along Turkish border

Doctors serving a collection of informal border camps straddling the Syrian-Turkish border in northern, rebel-held Syria are now receiving 100 bronchitis patients a day, most of them children under the age of two.  

The outbreak of bronchitis—a contagious inflammation of the bronchial tubes in the lungs usually caused by viral infection—began earlier this month. It is spreading among infants and toddlers in Atma camp because residents are crammed into tight quarters and using firewood to heat their closed tents, says Dr. Muhannad Khalil, an internal medicine specialist at Atma Charity Hospital.

The 60,000 Atma camp residents, such as Abu Mohammed, whose two-month-old son recently contracted bronchitis, live in threadbare tents, rely on aid deliveries and survive without developed water and sewage infrastructure.

“I’m worried he may infect his siblings who have developed a cough,” Abu Mohammed tells Syria Direct’s Shefaa Yasin and Mohammed al-Falouji.

“Living conditions inside the camp are dire,” says Dr. Khalil.

Dr. Muhannad Khalil, an internal medicine doctor at Atma Charity Hospital

Q: How many patients are you receiving daily, compared to a month ago?

We used to see around 20 or 25 patients each day. But over the past month we’ve seen a huge increase in the amount of bronchitis patients. We’re currently receiving 90 to 100 patients a day.

All of the patients have come directly from Atma camp; we haven’t documented any bronchitis cases outside the camp.

 A bronchitis patient at Atma Charity Hospital on January 23. Photo courtesy of Atma Charity Hospital.

Q: Does this amount include old patients you’re still treating?

This includes new patients as well as patients who have relapsed and need to return to the hospital for treatment.

Q: Why has the number of bronchitis patients drastically increased? Is it because of the living conditions at the camp?

It’s because of the crowding inside the camps. People are living in small, cramped quarters. Bronchitis, which spreads through contact with respiratory fluids or saliva, is easily contracted since people are in close contact with each other.

[Ed.: Syria Direct reported on the immense overcrowding and lack of general services in the camp last February.]

In addition, the way people are heating their homes—using firewood, for example—is contributing to an increase in cases.

Q: Is it mainly children who are being affected?

The vast majority of bronchitis patients are nursing infants ages two or younger. This is because the diameter of their bronchi is small, so the membranes lining them are more prone to mucus clogs.

We have a few elderly patients as well.

Q: How are you treating patients, considering the lack of medicine and supplies?

There aren’t any hospitals inside Atma camp, just medical points that carry medicine such as painkillers and anti-inflammatories. So patients must rent a car and drive 12km to one of the hospitals inside Atma town.

At Atma Charity Hospital, where I work, we have a scarcity of IVs and ventilators. To compensate for the lack of supplies, we give patients smaller IV doses and shorten the amount of time a patient spends on a ventilator by half.

Also, another hospital in the city opened a clinic specifically to treat bronchitis patients.

Q: What happens if patients don’t get treated?

Without treatment, the bronchial tubes of the patient could swell and block his airway, which could lead to death.

Several patients, especially those in critical condition, were transferred to intensive care clinics in Turkey because we’re strapped for hospital rooms and medical supplies to treat them.

Q: What advice have you given patients about ways to prevent developing bronchitis?

I told parents not to smoke near their children and to wash their hands thoroughly before touching them. I also told parents to keep their children away from those who have a cough or cold.

But the living conditions inside the camp are dire. Asthma patients are also suffering from the same symptoms, and we’re trying to treat them with what we have.

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Abu Mohammed, who lives in a tent in Atma with his family. His two-month-old son Ali has bronchitis.

Five days ago, my son Ali developed a cough and started to have trouble breathing. When I took him to a pharmacist near the camp, he told me to take him to Atma Charity Hospital to get treated for bronchitis. After the doctor put him on a ventilator, he became stable. Ali is the only person in my family with bronchitis, but I’m worried he may infect his siblings who have developed a cough.

I’m certain Ali got sick from living inside our crowded tent. I live with my wife and four children in a small tent, and we use firewood for heating.