Sara Ferrer (Barcelona, 1954), a nurse practitioner, has worked for almost ten years for Doctors Without Borders/Médecins Sans Frontières (MSF). She began her career in the Democratic Republic of Congo, "a real training camp". There, sudden outbreaks of diseases such as measles, cholera, or meningitis require rapid emergency mobilization. After a professional tour including several African countries and also Yemen, Ferrer is currently coordinator of the medical projects MSF has in areas of Aleppo governorate in northern Syria.
Why is it so important to focus efforts on vaccinating children in Syria?
The war in Syria has been terrible because of the violence, but also because of serious side effects that go unnoticed. Since the conflict escalated in 2012, the vast majority of children born in many parts of Syria are unvaccinated and this is very worrisome. Mass displacements of people mean medical authorities and non-governmental organizations (NGOs) have been unable to focus their efforts on these activities or have no resources for it. The most that some children have received is one or two doses in isolated campaigns. Syrian children are not prepared for a range of preventable diseases such as measles, rubella, tetanus or pneumonia.
Before the war, children were normally vaccinated in Syria. However, we are now faced with a rather widespread problem, especially in the areas controlled by the opposition where we are working. The information we have obtained after monitoring the medical condition of displaced children from areas under Islamic State (IS) control is that they have not been vaccinated, although we do not know if it is a generalized issue. We do not have access to areas controlled by the Government of Syria, despite having requested permission. According to data from some medical authorities operating there, there are some vaccination activities.
Have many cases of these infections been documented? How worrisome is it?
Cases have been documented and have been treated on time, though consolidated data is missing. The EWARN (Early Warning System, reporting to the health authorities) reports cases of infections throughout the country (in the provinces of Raqqa, Idlib, Aleppo, rural areas of Damascus ...). At the moment they are limited but do occur. The risk we face is that factors such as a generalized lack of immunization and mass population displacements are brought together. Some of these infections are transmitted through the air, so we may find ourselves in a situation where infections spread as an epidemic that we cannot control. During the winter people choose not to move much because of the cold. With the arrival of good weather it is expected that people will try to return to their places of origin, where the conflict has ceased, as in the city of Aleppo, or areas such as Al Bab that are changing control in the framework of offensives.
What is MSF doing?
On the one hand, in our Al Salamah hospital (Azaz district, Aleppo governorate) we have been carrying out an expanded program of immunization (EPI) for several years, once a week. In July of last year we also started sending teams to the displaced camps in the northern part to curb the risk of outbreaks of infections. We concentrate on an area with an estimated population of 200,000 people, of which 17% are under the age of five (about 34,000). It is a process that includes three rounds and we are still working in collaboration with other humanitarian actors responsible for implementing vaccination, while MSF provides the vaccines, ensures the maintenance of the cold chain through a monitoring process and trains the vaccinating teams. On the other hand, in the last year we have launched two specific campaigns of vaccination of measles, the last one of them in January after seven cases were confirmed in the displaced camp of Shamareek. The vaccination was led by MSF and the campaign was also joined by the World Health Organization (WHO) along with local medical organizations. In 12 days, 6,540 children under the age of 15 were vaccinated, 93% of the target. At the moment we are studying the possibility of expanding our actions to other places. In the three districts of the northern part of Aleppo governorate where we are working we estimate that there are about 143,000 children under the age of five.
What problems do our teams have when it comes to vaccination?
Sometimes we have met some resistance from the population. The work of health promotion teams to talk to mothers to understand the benefits of these preventive measures in their children is critical. Usually the acceptance is good and those families that have several children and have already gone through this add up quickly and understand the need.
Why are there not many other organizations vaccinating in Syria?
These are programs that cost a lot in terms of human resources and are expensive. It is also not easy to get the vaccines or keep the cold chain, for them not to spoil. This happened to us, for example, in the city of Aleppo. It was impossible to introduce vaccines there because of the siege between July and December 2016. We did not have a specialized supervisor to offer guarantees that the cold chain was maintained and, therefore, the quality of the vaccines.
What should be done?
We believe that WHO, other UN agencies and other medical actors should press for increased population coverage in vaccinations. Small steps are being taken, such as an immunization program for children under one year old in the provinces of Hama and Idlib. But it's not enough. Syrian children deserve greater protection against a complicated future.
Between July 2016 and February 2017, MSF has vaccinated a total of 35,907 children under the age of five in four districts in the northern governorate of Aleppo in the framework of an expanded immunization program (EPI). 5,733 women of childbearing age (between 15 and 45 years of age) have also been vaccinated for tetanus. In addition, MSF conducts vaccination initiatives in several other governorates of Syria.