M. Fouad

Changing therapeutic geographies of the Iraqi and Syrian wars

The health consequences of the ongoing US-led war on terror and civil armed conflicts in the Arab world are much more than the collateral damage inflicted on civilians, infrastructure, environment, and health systems. Protracted war and armed conflicts have displaced populations and led to lasting transformations in health and health care. In this report, we analyse the effects of conflicts in Iraq and Syria to show how wars and conflicts have resulted in both the militarisation and regionalisation of health care, conditions that complicate the rebuilding of previously robust national health-care systems. Moreover, we show how historical and transnational frameworks can be used to show the long-term consequences of war and conflict on health and health care. We introduce the concept of therapeutic geographies--defined as the geographic reorganisation of health care within and across borders under conditions of war.

Syria: health in a country undergoing tragic transition

ObjectivesTo document the ongoing destruction as a result of the tragic events in Syria, to understand the changing health care needs and priorities of Syrians.MethodsA directed examination of the scientific literature and reports about Syria before and during the Syrian conflict, in addition to analyzing literature devoted to the relief and rebuilding efforts in crisis situations.ResultsThe ongoing war has had high direct war casualty, but even higher suffering due to the destruction of health system, displacement, and the breakdown of livelihood and social fabric. Millions of Syrians either became refugees or internally displaced, and about half of the population is in urgent need for help. Access to local and international aid organizations for war-affected populations is an urgent and top priority.ConclusionsSyrians continue to endure one of the biggest human tragedies in modern times. The extent of the crisis has affected all aspects of Syrians’ life. Understanding the multi-faceted transition of the Syrian population and how it reflects on their health profile can guide relief and rebuilding efforts’ scope and priorities.

Socio-demographic correlates of psychiatric morbidity among low-income women in Aleppo, Syria

Interest in mental morbidity as an important component of health is increasing worldwide. Women generally suffer more than men from common mental disorders, and discrimination against women adds to their mental sufferings. Studies looking into the socio-demographic correlates of womens mental morbidity are lacking in most Arab countries. In this study we wanted to determine the spread and socio-demographic correlates of mental distress among low-income women in Aleppo, Syria. A sample of 412 women was recruited from 8 randomly selected primary care centers in Aleppo. Response rate was 97.2%, mean age of participants 28 + 8.4 years, where married women constituted 87.9%. A special questionnaire was prepared for the study purpose, utilizing the SRQ-20 non-psychotic items and questions about background information considered relevant to the mental health of women in the studied population. Interviews were conducted in an anonymous one-to-one fashion. The prevalence of psychiatric distress in our sample was 55.6%. Predictors of womens mental health in the logistic regression analysis were; physical abuse, womens education, polygamy, residence, age and age of marriage. Among these predictors, womens illiteracy, polygamy and physical abuse were the strongest determinants of mental distress leading to the worse outcomes. Our data show that mental distress is common in the studied population and that it is strongly associated with few, possibly modifiable, factors.

A Cost Effectiveness Analysis of Salt Reduction Policies to Reduce Coronary Heart Disease in Four Eastern Mediterranean Countries

Background Coronary Heart Disease (CHD) is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey. Methods and Findings Three policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG) over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy). All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30%) resulted in estimated cost savings of

Social norms and attitudes linked to waterpipe use in the Eastern Mediterranean Region.

235,000,000 and 6455 LYG in Tunisia;

Religion-based tobacco control interventions: how should WHO proceed?

39,000,000 and 31674 LYG in Syria;

Health workers and the weaponisation of health care in Syria: a preliminary inquiry for The Lancet–American University of Beirut Commission on Syria

6,000,000 and 2682 LYG in Palestine and

Water pipe smoking and human oral cancers.

1,3000,000,000 and 378439 LYG in Turkey. Conclusion Decreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives.

Women and Waterpipe Tobacco Smoking in the Eastern Mediterranean Region: Allure or Offensiveness

Waterpipe tobacco smoking (WTS) is on the rise globally, particularly among vulnerable populations such as youth and women. Increasing knowledge about toxicant yield from waterpipe tobacco and deleterious health effects points to the potential for a health epidemic. WTS is often viewed as a safe alternative to cigarette smoking. Though the original objective of the research was to explore the social norms and attitudes that lead to waterpipe being a more acceptable form of tobacco smoking for women than cigarettes in the Eastern Mediterranean Region, the use of a qualitative research methodology resulted in rich data that helped to understand more generally the phenomenon of waterpipe smoking. Both focus group discussions (FGDs) and key informant interviews were used. Participants were recruited to represent genders, various age groups, socioeconomic status, waterpipe smoking status, and residents of urban and rural areas. A total of 81 FGDs and 38 in-depth interviews were conducted in 2007. Thematic analysis was used to analyze the transcripts. A total of ten themes emerged: socio-cultural norms, gender differences, motivation to smoke, sensory characteristics of waterpipe, metaphors, consumerism, indicators of dependence, comparison between cigarettes and waterpipe, health effect of smoking, and intervention. Results indicated that WTS has socio-cultural dynamics associated with it that are far more pronounced than health considerations. An increased socio-cultural acceptability, the perceived reduced harm and the advent of the fruity Moassel tobacco are among the many reasons for WTS acceptability. Findings point to the need for a unified strategy to address this health issue at all levels of the ecological framework and have important implications for future policy and practice.

Epidemiology of Type 2 diabetes mellitus in Aleppo, Syria

Using religion to improve health is an age-old practice. However, using religion and enlisting religious authorities in public health campaigns, as exemplified by tobacco control interventions and other activities undertaken by WHOs Eastern Mediterranean Regional Office, is a relatively recent phenomenon. Although all possible opportunities within society should be exploited to control tobacco use and promote health, religion-based interventions should not be exempted from the evidence-based scrutiny to which other interventions are subjected before being adopted. In the absence of data and debate on whether this approach works, how it should be applied, and what the potential downsides and alternatives are, international organizations such as WHO should think carefully about using religion-based public health interventions in their regional programmes.