4224Conflict-driven risk factors faced by displaced populations and deterioration of health: Review of Syrian conflict as an example

Abstract

Abstract Purpose Conflict yields adverse health effects for those living in afflicted regions. It dramatically exacerbates poverty and creates large numbers of vulnerable refugees. In addition to food scarcity, healthcare disparity, and overwhelming inequality, refugees face extreme emotional trauma and cumulative stress. This could lead to lifestyle modifications – including unhealthy diets, low activity levels, and smoking – that contribute to cardiovascular disease (CVD). The issue of refugees and displaced persons has never been more apparent than in the last decade. There are currently 68.5 million refugees worldwide, including those due to violent conflict in Syria. [i] Methods To conceptualize the magnitude of cardiovascular risk refugees face during periods of conflict and resettlement, we reviewed the published literature for the prevalence of behavioral modification in Syrian refugees, including altered diets, smoking, stress, and overall mental health. Results Literature review suggests refugees are 10 times more likely to experience post-traumatic stress disorder (PTSD), with lifetime incidence as high as 38.5% as seen in a study of Syrian Kurdish refugees in Iraq.[ii] Syrian refugees in Sweden were found to experience high levels of both depression and anxiety, 40% and 32%, respectively. [iii] The INTERHEART study showed a causal link between elevated levels of stress and CVD. [iv] In addition to serving as a risk factor for CVD, stress cultivates unhealthy lifestyles. A study of Syrian refugees found an increase of 7.6 cigarettes per day following the war; this data also followed a trend of increasing levels of PTSD, suggesting that the stress of migration and the conflict led to increased cigarette use.[v] In Syrian resettlement areas, Palestinian refugees were found to consume almost twice as many cigarettes as the local population, a trend also true in Lebanon.[vi] Heart-healthy nutrition and diets are often not available to refugees, and a study of Syrian refugees in Lebanon found diets that consisted almost exclusively of carbohydrates with little to no vegetables, fruits, or proteins. Stress, poor diets, and smoking in displaced people may translate into a higher incidence of noncommunicable diseases. In the Lebanese study, hypertension, diabetes, and CVD were reported in refugees at 60%, 47%, and 30%, respectively. [vii] Conclusions Improving the health of war-affected displaced subjects is an issue worthy of concern. Conflict results in unhealthy lifestyles and behaviors and must end to restore emotional health and physical well-being.