Doctor: More than 200 residents in besieged East Ghouta have tuberculosis

Hospitals and clinics in the regime-encircled Damascus suburbs of East Ghouta ran out of tuberculosis medication in December, leaving 224 patients without treatment for the past two months.

Of these residents, 100 were diagnosed with tuberculosis (TB) in 2016 alone, Dr. Saif Jabiya, a health expert on East Ghouta’s Local Council, which administers civilian affairs, tells Syria Direct’s Bahira al-Zarier.

Tuberculosis, a bacterial infection most often affecting the lungs, is spreading in the besieged rebel enclave because residents, whose immune systems are weak due to malnourishment, are spending prolonged periods in cramped, humid underground shelters to avoid bombings, says the doctor.

Symptoms of TB include coughing, fever, night sweats and weight loss, according to an October 2016 World Health Organization fact sheet. Without treatment, up to two-thirds of infected people can die.

The last TB medication delivery from the Syrian Arab Red Crescent (SARC) to East Ghouta occurred in late 2015, says the doctor. Now, more than one year later, there is none left, and TB residents who had partially recovered risk a complete relapse.

Patients with TB usually take anti-microbial drugs for nine months. Even if the symptoms initially improve, if patients stop treatment prematurely or if their immune systems are weak, they can get worse.

One of those patients is Umm Dima’s 13-year-old daughter, who “had completely recovered,” but relapsed at the end of 2016, just as doctors ran out of medication.

“We’re afraid that patients won’t recover because we can’t provide them with any medication,” says Dr. Jabiya.

Q: Why are residents getting sick?

In besieged areas, tuberculosis spreads because of many factors. In East Ghouta, it’s cold and people are malnourished. Because of the bombings, residents are spending prolonged periods in underground shelters and basements, which are humid.

Also, we have neither the tools to diagnose tuberculosis patients early nor the medicine to treat them.

 The lung of a current TB patient in East Ghouta. Photo courtesy of Dr. Jabiya.

Q: When was the last time East Ghouta received TB medication? How much medicine do you have left?

The last TB medication delivery was in late 2015, though we did receive TB vaccines three times in 2016. Vaccines are given to newborn children; they are preventative measures to keep children from getting sick.

Once a person is infected, however, they need medicine for treatment—not vaccines.

We have completely run out of tuberculosis medication.

Q: With no TB medication, which treatment alternatives can you present to patients? Are you reaching out to aid organizations?

There are no alternatives for treatment—we need TB medication.  

We’re waiting for aid deliveries from the UN and the Syrian Arab Red Crescent (SARC). We reached out to SARC, since it’s responsible for delivering medicine to East Ghouta. But at the end of the day it’s a political decision. SARC, in cooperation with the UN, only delivers aid to areas after receiving approval from the Syrian regime.

Q: How are sick residents dealing with the lack of medicine? Have they sought treatment elsewhere?

They’re afraid of relapsing, and then dying.  Some have tried leaving Ghouta via tunnels to seek treatment outside. But there are many risks, like getting arrested.

Q: How many people in East Ghouta are sick with tuberculosis?

We’ve registered 224 people. About 100 of them got sick in 2016. They underwent some treatment, but they still need medicine because the treatment period is nine months. Otherwise, they could relapse.

Q: What are you afraid may happen to these 224 patients if they aren’t treated?

If the anti-microbial drugs are not taken for the entire nine-month treatment period, the tuberculosis bacterium may become resistant to the medication.

We’re also afraid that patients won’t recover because we can’t provide them with any medication. This puts us doctors in a difficult and uncomfortable position.

In these circumstances, tuberculosis could spread. Since we have no vaccines or medicine, we wouldn’t be able to control a TB outbreak. Many residents are afraid that infection will spread.

In addition to a lack of treatment, we’re facing poverty and malnutrition.

Q: We spoke with a resident whose 13-year-old daughter has tuberculosis. After taking medicine for nine months, she relapsed. Why did this happen?

Usually TB is treated for a period of time between three and nine months. But a relapse may occur if a patient stops treatment early, the medicine is ineffective or the child’s immune system is weak. In these cases, the patient becomes infected once again.   

**

Umm Dima, 38, Douma resident, whose 13-year-old daughter has tuberculosis

A year ago, a lump appeared on my daughter’s neck. I took her to an infectious-disease clinic in Douma for a biopsy. The test results said that she had non-contagious, lymph node tuberculosis. After taking medication for six months, the swelling in her neck decreased, but didn’t totally disappear. Her doctor advised her to take medication for three more months. After that, she had surgery to completely remove the lump. She had completely recovered.

A year later, I took her back to the clinic after she found a lump on the other side of her neck. This time the doctor couldn’t give her TB medicine because he didn’t have any. He suggested that she get another surgery to remove the mass from her neck. So that’s what my little girl did, because there was no medicine for her to take.

It was my daughter’s fate to become infected with tuberculosis. She’s suffering from the siege, bombing and a lack of medicine to help her. 

Bahira al-Zarier

Bahira is from Damascus. She studied business and marketing before moving to Jordan in 2013. She did volunteer work in support of many refugee organizations before joining Syria Direct.

Jessica Page, Reporter/Translator

Jessica was a 2013-2014 Georgetown University Qatar Scholarship Program fellow in Doha, Qatar. She received her BA in both Arabic and International & Area Studies from Washington University in St. Louis. She has worked and studied in Jordan, Oman, and Qatar.