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Syrian refugees take the final hit in a brutal war

by Cesar Chelala

The number of Syrian refugees continues to grow at an alarming rate, and no end is in sight for those affected by the conflict.

What makes their plight even more painful is that of all the countries directly or indirectly involved in the conflict, Russia, the United States, China, Iran, Britain and France have so far been reluctant to take those refugees into their own countries. Instead, Syrian refugees have overburdened the health and social services of neighboring countries Lebanon and Jordan.

According to Antonio Guterres, the United Nations High Commissioner for Refugees, the number of people fleeing the conflict has reached an average of 6,000 a day during 2013, a rate not seen since the Rwandan genocide nearly two decades ago.

Nawaf Salam, Lebanon’s ambassador to the U.N., warned that the number of Syrian refugees coming into Lebanon could surpass 1 million by yearend and have serious consequences on the ability of social services to help those in need. Since Lebanon has a population of about 4 million, that number would be the equivalent of 75 million refugees coming into the U.S.

“Pressures are mounting, and the needs of the Syrian refugees may surpass Lebanon’s capabilities,” said the ambassador. As he was asking the U.N. Security Council for help in dealing with the situation, he said Lebanon “will not close its border in front of refugees fleeing violence and destruction, and we will not stop delivering aid.”

Also worrisome, said Salam, is that the “increasing cross border fire and incursions from Syria in Lebanon threaten the security and stability of Lebanon.”

Some countries are already restricting the flow of Syrian refugees. Such is the case in Egypt. According to the U.N. High Commissioner for Refugees, Syrians trying to enter Egypt are being turned away. Egypt’s change in policy follows events in Iraq, Turkey and Jordan, all of whom are trying to stem the refugee inflow.

The 1951 U.N. Convention on the Status of Refugees has established the rights of refugees and the obligations of host countries. Although Egypt is a signatory, its latest decision goes against the tenets of the treaty and the principle of refoulement, according to which “No Contracting State shall expel or return (“refouler”) a refugee in any manner whatsoever to the frontiers of territories where his life or freedom would be threatened on account of his race, religion, nationality, membership in a particular social group or political opinion.”

Fear that Syrian refugees will also bring political problems has led countries such as Iraq to close its borders to incoming refugees. “Basically the government is citing security concerns and fear of spillover of the Syrian conflict into Iraq as the main reason for its policy,” stated Natalia Prokopchuk, a UNHCR officer in Baghdad.

An estimated 5 million people out of Syria’s 21 million have become displaced within their own country. In addition, almost 7 million people are in need of humanitarian assistance inside Syria. Also, based on arrival trends since the beginning of 2013, it is now estimated that 3.45 million Syrian refugees will be in need of assistance by the end of the year.

More than half the refugees fleeing Syria are children, traumatized by the conflict that has left them without homes, family members and social support from friends and extended family. Many children affected by the conflict will need long-term psychological support since as a result of post-traumatic stress disorder.

Refugee children’s health may be affected in other ways. As stated by Maria Calivis, UNICEF Regional Director for the Middle East and North Africa, “Without enough safe water and sanitation, the likelihood will rise that children in Syria and those living as refugees around the region will come down with diarrhea and other diseases.” Up to 2 million children inside Syria’s borders run the risk of not receiving lifesaving vaccinations and other medical care.

American Frederic Prokosch, in his novel “The Asiatics,” wrote that “Aleppo was a large and terrifying town.” The same can now be said of all of that suffering country. As U.N. aid chief Valerie Amos said, “The world is not only watching the destruction of a country but also its people.”

Cesar Chelala, M.D. and Ph.D., is an international public health consultant.