The Syrian civil war’s impact on the health of Syria’s children is far more insidious than has been widely understood, a leading children’s advocacy group reported Sunday, with large numbers dying or at risk from chronic and preventable diseases that have flourished because the country’s public health system has basically collapsed.
In a report timed to coincide with the start of the fourth year of the conflict, the group, Save the Children, said the effects of untreated illnesses on Syrian children were only partly reflected in the documented statistics. They show that at least 1.2 million children have fled to neighboring countries, that 4.3 million in Syria need humanitarian assistance and that more than 10,000 have died in the violence.
“It is not just the bullets and the shells that are killing and maiming children,” said the report, “A Devastating Toll.” The conflict, which began in March 2011, has left a “shattered health system resulting in brutal medical practices that have left millions of children suffering,” the report said.
The report asserted that “several thousands of children” had died because of greatly reduced access to treatment for diseases including cancer, epilepsy, asthma, diabetes, hypertension and kidney failure.
The basic lack of medical care, including routine vaccinations, the report said, means “increasing numbers of children are suffering and dying from diseases that would previously either have been treated or prevented from taking hold in the first place.”
The report is based partly on conclusions drawn from data that has been issued by other organizations, including the United Nations and the World Health Organization, the European Center for Disease Prevention and Control, Doctors Without Borders, and other medical research, as well as from the Syrian government.
But the report also draws on Save the Children’s own research, including interviews with Syrian children, parents and medical providers who painted what amounted to a portrait of medieval health conditions.
It said that in some areas, like the besieged city of Aleppo, where the number of doctors has fallen from 2,500 to only a few dozen, homes are used as makeshift hospitals, “turning living rooms into operating theaters.”
The report said that medical providers often amputated the limbs of children with grievous injuries because they lacked the equipment to treat them and that amputation was the only practical alternative to death from uncontrolled blood loss.
The shortage of painkillers and surgical drugs is so pervasive, the report said, that in some cases, patients opt “to be knocked out with metal bars for lack of anesthesia.”
The report cited examples of newborns dying in incubators because of power cuts, and panicked parents with wounded children who arrive at empty hospitals and attach intravenous tubes to the children themselves.
Because prenatal and maternal health services have been drastically reduced or stopped, the report said, the number of unassisted births has surged. It also cited a study that showed that the percentage of mothers who deliver by means of a cesarean section has more than doubled to 45 percent over the past three years, because women fear going into labor without a secure delivery plan.
In another reflection of the doctor shortage, the report cited examples of doctors barely out of medical school performing hundreds of operations. In one case, the only practitioner to treat children was a dentist.
The report cited some research that is in dispute, notably on the extent of the revival of polio, a crippling virus once thought to have been eradicated in Syria.
The World Health Organization, which has been helping coordinate an emergency polio vaccination campaign in Syria, has challenged the findings of the disputed research, by Dr. Annie Sparrow, deputy director at the Icahn School of Medicine at Mount Sinai in New York. She has asserted that the number of cases and the contagion threat are far higher than what W.H.O. officials have been able to confirm.
Misty Buswell, the regional advocacy director for Save the Children, said in a telephone interview from Jordan on Sunday that Dr. Sparrow’s research was cited because “this is a country that had eradicated polio and it’s come back.”
Ms. Buswell said the purpose of her organization’s report was to help direct attention to the humanitarian disaster in Syria, and to press the Syrian government and insurgent groups to grant unfettered emergency access to Syrian civilians, as called for in a United Nations Security Council resolution passed last month.
“What we’re seeing is that the focus in the public discourse is the fighting and the political situation, but what we see really missing is the human impact,” she said. “So many children are dying and being injured and maimed, so we wanted this report to bring the focus back.”