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Objective: The Syrian civil war since 2011 has led to one of the most complex humanitarian emergencies in history. The objective of this study was to document the impact of the conflict on the familial, educational, and public health state of Syrian children. Methods: A cross-sectional observational study was conducted in May 2015. Health care workers visited families with a prospectively designed data sheet in 4 Northern Syrian governorates. Results: The 1001 children included in this study originated from Aleppo (41%), Idleb (36%), Hamah (15%), and Lattakia (8%). The children's median age was 6 years (range, 0-15 years; interquartile range, 3-11 years), and 61% were boys. Almost 20% of the children were internally displaced, and 5% had deceased or missing parents. Children lacked access to safe drinking water (15%), appropriate sanitation (23%), healthy nutrition (16%), and pediatric health care providers (64%). Vaccination was inadequate in 72%. More than half of school-aged children had no access to education. Children in Idleb and Lattakia were at greater risk of having unmet public health needs. Younger children were at greater risk of having an incomplete vaccination state. Conclusions: After 4 years of civil war in Syria, children have lost parents, live in substandard life quality circumstances, and are at risk for outbreaks because of worsening vaccination states and insufficient availability of health care providers. (Disaster Med Public Health Preparedness. 2016;10:874-882)

BackgroundThe civil war in Syria including the deliberate targeting of healthcare services resulted in a complex humanitarian emergency, seriously affecting children's health. The objectives of this study are to document diagnoses and disease categories in Northern Syrian children after four years of conflict, and to document infectious diseases and injuries in this vulnerable population.MethodsIn a prospective cross-sectional observational sample study conducted in May 2015, healthcare workers registered demographics, comorbidities, and diagnoses (categorised according to the International Classification of Diseases version 10) in children visited at home and in internally displaced persons camps in four Syrian governorates.ResultsOf 1080 filled-out records, 1002 were included. Children originated from Aleppo (41%), Idleb (36%), Hamah (15%) and Lattakia (8%). Median age was 6 years (0–15; IQR 3–11), 61% were boys, 40% were younger than 5 years old. Children suffered from respiratory (29%), neurological (19%), digestive (17%), eye (5%) and skin (5%) diseases. Clinical malnutrition was seen in 4%, accidental injury in 3%, intentional injury in 1%, and mental disorders in 2%. Overall, 64% had features of infectious diseases (OR 0.635; CI 0.605–0.665). Most common comorbidities were chronic respiratory diseases (14, malnutrition (5%), acute flaccid paralysis (5%), and epilepsy (4%). Logistic regression analysis indicated that the risk for children to have communicable diseases was higher in Aleppo than in Idleb (OR 1.7; CI 1.2–2.3), Hamah (OR 4.9; CI 3.3–7.5), or Lattakia (OR 5.5; CI 3.3–9.3). Children in Aleppo and Lattakia were more at risk to be injured than in Idleb (OR 5.6; CI 2.1–14.3), or in Hamah (OR 5.9; CI 1.4–25.6), but more often from intentional violence in Lattakia. Mental problems were more prominent in Hamah.ConclusionsFour years far in the conflict, 64% of the studied children in four Northern Syrian governorates suffer from infections, mostly from respiratory, neurological and digestive origin, while 4% was injured or victim of intentional aggression. Substandard living conditions and the lack of paediatric healthcare put Syrian children at risk for serious infections, epidemics and morbidity, and ask for urgent international humanitarian relief efforts.

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Background: The Syrian civil war since 2011 is one of the most complex humanitarian emergencies in history. This protracted disaster has but negative aspects, especially on living, educational and health care infrastructure and services. The goal of this study is to document the impact of four years of war on Syrian children's social, educational and health status. Methods: A cross sectional observational study was conducted in May 2015. Health care workers, especially trained for this study, visited home by home in four Syrian governorates with a prospectively designed questionnaire. Results: Of 1080 filled-out questionnaires, 1001 were complete and included in this study. Most lived in the Aleppo governorate (n = 413; 41%), 359 in Idleb (36%), 147 in Hamah (15%) and 82 in Lattakia (8%). Median age was 6 years (IQR; 0-15), most were male (n = 611; 61%). Almost 20% of all children were Internally Displaced Persons (n = 196), 45 lost their father (5%) and 41 (4%) had their father missing, 19 (2%) lost their mother and of 27 (3%) the mother was missing. Of all, 855 (86%) had access to safe drinking water, and 775 (77%) could access appropriate sanitation. About 16% (n = 156) had interrupted access to nutrition. Almost 27% suffered from diseases related to malnutrition. Access to specific health care providers was disturbed in 64% (n = 646), and only 28% had an updated vaccination status. Of all school-aged children, 450 (51%) had no access to education at the time of the study. Most children suffered from respiratory (29%), neurological (19%) or digestive (17%) diseases, 4% was victim of injury or violence, and 2% suffered from mental problems. Discussion and conclusion: After four years of civil war in Syria, children have lost parents, live in substandard life quality circumstances, and are at risk for outbreaks because of worsening vaccination status and specific healthcare provider attention.