Measles spreads through rebel-held south Syria after two years without vaccinations

AMMAN: A measles outbreak in opposition-held regions of southern Syria has infected nearly 150, mostly newborns and young children, because of a two-year absence of vaccinations, two doctors who are treating the outbreak told Syria Direct. 

The doctors documented 60 measles infections in the rebel-held Daraa countryside and 70 cases in adjacent, opposition-controlled Quneitra province in the month of May alone, Dr. Yarub a-Zouabi, a pediatrician in the eastern Daraa countryside, told Syria Direct.

“We cannot give any firm statistics because every day more and more infected residents come to our health centers,” Dr. Yasser al-Farouh, a pediatrician in the western Daraa countryside, told Syria Direct. Both a-Zouabi and Farouh are regional coordinators for the Early Warning Alert and Response Network (EWARN), a public health organization tracking epidemics in opposition-held areas of Syria.

The first signs of the recent measles outbreak appeared in March in rebel-held Quneitra, a southwestern province bordering the Israeli-occupied Golan Heights. At the time, medical professionals in the opposition-controlled areas of Daraa had only documented a handful of suspected measles cases, said a-Zouabi.

But since that time, measles symptoms spread to the eastern and western Daraa countryside due at least in part to overcrowding and internal displacement in rebel-held areas of the province. The main reason for the outbreak is that most infants and young children in opposition areas of the province are not vaccinated.

Two doses of the measles vaccine are necessary to properly immunize children against the viral disease: the first during infancy and the second at four to six years of age.

Measles disproportionately affects young children, and often with a fever, rash and potentially lethal complications that can be prevented by immunization.

Children who are already symptomatic cannot be given a vaccine, and antiviral treatment does not currently exist for measles. This means that doctors can only resort to palliative measures such as painkillers, antipyretics and IV fluids to ensure that the condition of patients does not worsen.

“The measles vaccine reduces occurrence of this potentially fatal viral infection by more than 99 percent, with children the primary victims of this wholly preventable disease,” Dr. Homer Venters, an epidemiologist and Physicians for Human Rights’ director of programs, told Syria Direct on Monday.

Since the outbreak of the Syrian war in 2011, Physicians for Human Rights (PHR) has documented the spread of disease, attacks on medical personnel and infrastructure and reports of chemical weapons use across the country.

“Death and disability from measles infection is a stark reminder that armed conflict harms health beyond the impact of bullets and bombs,” the doctor added.

The recent outbreak of measles “boils down to the shortcomings of vaccination programs, which are still controlled by the Syrian regime’s Ministry of Health,” said pediatrician Farouh. 

Vaccines must be administered by a trained professional and require specific conditions for storage and distribution. In Syria, the Ministry of Health organizes vaccination campaigns with the assistance of the World Health Organization (WHO) and the Syrian Arab Red Crescent (SARC). But the government ministry retains control over areas and quantities of vaccine distribution, and SARC requires regime permission to enter any opposition-held areas.

The Ministry of Health launched an anti-measles campaign on May 21 aimed at vaccinating “children between seven months and five years of age,” state news agency SANA reported at the time.

But the campaign was too late to stop the spread of the infection in the opposition-held south, and only a small quantity of vaccines entered the Daraa countryside, said a-Zouabi.

The vaccination campaign did not provide any mobile teams and only set up distribution stations in a small number of health centers, the pediatrician added. “Those who didn’t hear [about the campaign] were once again deprived of their right to vaccines.”

The last time Daraa residents had access to the measles vaccine—prior to last month’s campaign—was in May 2015, said both a-Zouabi and al-Farouh.

Syria Direct contacted the Damascus branch of the World Health Organization for details about vaccine distribution in opposition-areas. The office did not comment.

‘Terrified of being infected’

In his clinic in the eastern Daraa countryside, a-Zouabi distributes Vitamin A supplements to any patients displaying symptoms of measles.

He sends serum samples to a laboratory established by the Early Warning Alert and Response Network (EWARN), the public health program a-Zouabi works with, last month.

“With each new case that comes to the health center, we are overcome with worry and fear that it will be confirmed as a measles infection,” he says.

For Abu Hadeel, a 35-year-old resident of the rebel-held east countryside, the physicians at his local hospital confirmed that his two daughters, who are not vaccinated, had contracted the viral infection last month.

Physicians at a hospital in the eastern Daraa town of al-Hirak confirmed the presence of the disease with a blood test. They gave him vitamins and medicine for fever and diarrhea for his daughters—ages two and eight months.

“I tried to isolate my daughters as well as I could, as the hospital staff instructed me,” Abu Hadeel told Syria Direct on Monday.

“I live in one house with three other families” the father said. “I’m scared that this infection cannot be contained.”