Publications
110 results found
Tarnas MC, Karah N, Almhawish N, et al., 2023, Politicization of water, humanitarian response, and health in Syria as a contributor to the ongoing cholera outbreak., Int J Infect Dis, Vol: 131, Pages: 115-118
In September 2022, the Syrian Ministry of Health declared a cholera outbreak after a surge of acute watery diarrhea cases. Since then, cases have been reported across Syria, particularly in the northwest. This ongoing outbreak reflects a pattern of politicizing water, humanitarian response, and health throughout the country's protracted conflict. Interference with water, sanitation, and hygiene (WASH) infrastructure has been a key component of this politicization, impeding detection, prevention, case management, and control. Droughts and floods have exacerbated the WASH situation, as have the early 2023 Türkiye-Syria earthquakes. The humanitarian response after the earthquakes has also faced politicization, leading to increased risk of surges in cases of cholera and other waterborne diseases. This has all occurred in a conflict where health care has been weaponized, attacks on health care and related infrastructure are the norm, and syndromic surveillance and outbreak response have been influenced and restricted by politics. Cholera outbreaks are entirely preventable; what we see in Syria is cholera reflecting the myriad ways in which the right to health has been brought under fire in the Syrian conflict. The recent earthquakes are additional assaults, which raise urgent concerns that a surge of cholera cases, particularly in northwest Syria, may now become uncontrolled.
Alkhalil M, Ekzayez A, Rayes D, et al., 2023, Inequitable access to aid after the devastating earthquake in Syria., Lancet Glob Health, Vol: 11, Pages: e653-e654
Rodriguez-Morales AJ, Abbara A, Ntoumi F, et al., 2023, World tuberculosis day 2023 - Reflections on the spread of drug-resistant tuberculosis by travellers and reducing risk in forcibly displaced populations., Travel Med Infect Dis, Vol: 53
Jabbour S, Abbara A, Ekzayez A, et al., 2023, The catastrophic response to the earthquake in Syria: the need for corrective actions and accountability, LANCET, Vol: 401, Pages: 802-805, ISSN: 0140-6736
Cinar EN, Abbara A, Yilmaz E, 2023, Earthquakes in Turkey and Syria-collaboration is needed to mitigate longer terms risks to health, BMJ-BRITISH MEDICAL JOURNAL, Vol: 380, ISSN: 0959-535X
Stafford A, Rimmer S, Gilchrist M, et al., 2023, Use of cidofovir in a patient with severe mpox and uncontrolled HIV infection., Lancet Infect Dis, Vol: 23, Pages: e218-e226
A 48-year-old man with poorly controlled HIV presented with severe human monkeypox virus (hMPXV) infection, having completed 2 weeks of tecovirimat at another hospital. He had painful, ulcerating skin lesions on most of his body and oropharyngeal cavity, with subsequent Ludwig's angina requiring repeated surgical interventions. Despite commencing a second, prolonged course of tecovirimat, he did not objectively improve, and new lesions were still noted at day 24. Discussion at the UK National Health Service England High Consequence Infectious Diseases Network recommended the use of 3% topical and then intravenous cidofovir, which was given at 5 mg/kg; the patient made a noticeable improvement after the first intravenous dose. He received further intravenous doses at 7 days and 21 days after the dose and was discharged at day 52. Cidofovir is not licensed for use in treatment of hMPXV infection. Data for cidofovir use in hMPXV are restricted to studies in animals. Four other documented cases of cidofovir use against hMPXV have been reported in the USA in 2022, but we present its first use in the UK. The scarcity of studies into the use of cidofovir in this condition clearly shows the need for robust studies to assess efficacy, optimum dosage, timing, and route of administration.
Abbara A, Ruby T, Naser A, et al., 2023, Disruption to water supply and waterborne communicable diseases in northeast Syria: a spatiotemporal analysis, Conflict and Health, Vol: 17, Pages: 1-15, ISSN: 1752-1505
BackgroundIn Syria, disruption to water and sanitation systems, together with poor access to vaccination, forced displacement and overcrowding contribute to increases in waterborne diseases (WBDs). The aim of this study is to perform a spatiotemporal analysis to investigate potential associations between interruptions to water, sanitation, and hygiene (WASH) and WBDs in northeast Syria using data collected by the Early Warning Alert and Response Network (EWARN) from Deir-ez-Zor, Raqqa, Hassakeh and parts of Aleppo governorates.MethodsWe reviewed the literature databases of MEDLINE and Google Scholar and the updates of ReliefWeb to obtain information on acute disruptions and attacks against water infrastructure in northeast Syria between January 2015 and June 2021. The EWARN weekly trends of five syndromes representing waterborne diseases were plotted and analysed to identify time trends and the influence of these disruptions. To investigate a potential relationship, the Wilcoxon rank sum test was used to compare districts with and without disruptions. Time series analyses were carried out on major disruptions to analyse their effect on WBD incidence.ResultsThe literature review found several instances where water infrastructure was attacked or disrupted, suggesting that water has been deliberately targeted by both state and non-state actors in northeast Syria throughout the conflict. Over time, there was an overall upwards trend of other acute diarrhoea (OAD, p < 0.001), but downwards trends for acute jaundice syndrome, suspected typhoid fever and acute bloody diarrhoea. For the major disruption of the Alouk water plant, an interrupted time series analysis did not find a strong correlation between the disruption and changes in disease incidence in the weeks following the incident, but long-term increases in WBD were observed.ConclusionsWhile no strong immediate correlation could be established between disruptions to WASH and WBDs in northeast Syria
Aldbis A, Naal H, Kishawi T, et al., 2023, The lived experience of patients with conflict associated injuries whose wounds are affected by antimicrobial resistant organisms: a qualitative study from northwest Syria, CONFLICT AND HEALTH, Vol: 17, ISSN: 1752-1505
Rimmer S, Barnacle J, Gibani M, et al., 2023, The clinical presentation of monkeypox: a retrospective case-control study of patients with possible or probable monkeypox in a West London cohort, International Journal of Infectious Diseases, Vol: 126, Pages: 48-53, ISSN: 1201-9712
Objectives: Since May 2022, cases of human monkeypox virus (hMPXV) with human-to-human cross-transmission have significantly increased in non-endemic countries. Our aim was to characterise diagnostic features of patients with confirmed and possible monkeypox to guide future risk stratification, and to describe a virtual care model.Methods: We performed a retrospective case-control study of 140 patients assessed and screened for suspected monkeypox; on hMPXV PCR testing, 70 were confirmed positive and 70 negative. Data were compared to generate odds ratios of demographic and clinical features.Results: Positive patients were predominantly cis-male (99%) and self-identified as gay, bisexual and other men who have sex with men (GBMSM) (94%). Lymphadenopathy at presentation was associated with a higher likelihood of a positive result (OR 7.69 [95% CI 3.58, 16.51]). Positive patients were more likely to have a rash affecting the genital (OR 5.38 [95% CI 2.57, 11.23]) or buttocks/perianal region (OR 3.79 [1.70, 8.45]) compared with negative controls. 79% of patients engaged with virtual ward follow-up.Conclusions: These data can inform a risk-based approach to management of suspected monkeypox in GBMSM populations. Lymphadenopathy at presentation and the location of the rash were more associated with a positive hMPXV result. Health authorities can consider a virtual ward approach in the hMPXV outbreak.
Carew JW, Hamze M, Atassi B, et al., 2023, Investment in Cancer Prevention and Care for Forcibly Displaced Syrians Is an Urgent Priority., JCO Glob Oncol, Vol: 9
Parkes P, Pillay T, Bdaiwi Y, et al., 2022, Telemedicine interventions in six conflict-affected countries in the WHO Eastern Mediterranean region: a systematic review, Conflict and Health, Vol: 16, ISSN: 1752-1505
Background: The COVID-19 pandemic has escalated the use of telemedicine in both high and low resource settings however its use has preceded this, particularly in conflict-affected settings. Several countries in the WHO Eastern Mediterranean (EMR) region are affected by complex, protracted crises. Though telemedicine has been used in such settings, there has been no comprehensive assessment of what interventions are used, their efficacy, barriers, or current research gaps. Objectives: To perform a systematic review of academic and grey literature, identifying telemedicine interventions in select, EMR conflict-affected settings and relevant enablers and barriers to their implementation.Methods: A systematic search of ten academic databases and 3 grey literature sources from January 1st 2000 to December 31st 2020 was completed. Included articles reported on telemedicine use in six conflict-affected EMR countries (or territories) graded as WHO Health Emergencies: Afghanistan, Gaza, Iraq, Libya, Syria and Yemen. Data were extracted and narratively synthesised due to heterogeneity in study design and outcomes.Results: Of 3419 articles identified, twenty-one peer-reviewed and three grey literature sources met the inclusion criteria. We analysed these by context, intervention, and evaluation. Context: eight related to Afghanistan, eight to Syria and seven to Iraq with one each in Yemen and Gaza. Most were implemented by humanitarian or academic organisations with projects mostly initiated in the United States or Europe and mostly by physicians. The in-country links were mostly health professionals rather than patients seeking specialist inputs for specialities not locally available. Interventions: These included both SAF (store and forward) and RT (real-time) with a range of specialities represented including radiology, histopathology, dermatology, mental health, and intensive care. Evaluation: most papers were observational or descriptive with few describing quality measur
Abbara A, Almhawish N, Aladhan I, et al., 2022, Weaponisation of water, LANCET, Vol: 400, Pages: 1925-1925, ISSN: 0140-6736
Kampalath V, Tarakji A, Hamze M, et al., 2022, The impacts of the Syrian conflict on child and adolescent health: a scoping review, JOURNAL OF PUBLIC HEALTH, ISSN: 1741-3842
Atassi B, Tse G, Mkhallalati H, et al., 2022, Cancer Diagnoses during Active Conflict: Experience from a Cancer Program in Northwest Syria., Avicenna J Med, Vol: 12, Pages: 157-161, ISSN: 2231-0770
Background Protracted conflict has destroyed Syria's health system with severe impacts on the diagnosis and treatment of chronic and high-cost diseases including cancer. Here, we review the type and (where possible) the stage of cancers diagnosed in a pathology laboratory serving Northwest Syria. Methods We retrospectively reviewed all pathology reports which reported a diagnosis of cancer from a pathology department in Northwest Syria from January to December 2020. Results A total of 397 new cancers were diagnosed during 2020 of which 191 were among males (48.1%) and 20 cases were in children aged 17 years or under (5%). The most common cancer in men was bladder cancer (15.7%) and skin cancers (14.7%) followed by cancers in the lymph nodes (includes primary and secondary; 9.9%.) In women, breast cancer (38.3%) followed by skin cancer skin (9.7%) and uterine cancer (8.7%) was the most common. The overall proportion of cancer diagnoses were breast cancer (20.2%), skin cancer (12.1%), cancer affecting lymph nodes (8.8%), and urinary bladder (8.3%) and colorectal cancer (7.3%). Discussion This preliminary analysis is the first report of cancer types and demographics in areas outside of government control in Syria since the onset of the conflict. Despite limitations, it presents some indication of the burden of oncological diagnoses in this area. Further research which aims to describe and address the burden of cancer on populations under ongoing conflict and humanitarian crises remains essential, especially in Northwest Syria given ongoing attacks and severe underfunding. There is a particular need to investigate how best to apply interventions and support health systems and cancer services within conflict settings. More support and resources need to be allocated to cancer centers with long-term health partnership models. The underresourced and understaffed conditions of the hospital are significant limits to a more detailed report.
Tarnas MC, Desai AN, Parker DM, et al., 2022, Syndromic surveillance of respiratory infections during protracted conflict: experiences from northern Syria 2016-2021, INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES, Vol: 122, Pages: 337-344, ISSN: 1201-9712
Abbara A, Sara B, Alex S, et al., 2022, Protracted armed conflict and maternal health: a scoping review of literature and a retrospective analysis of primary data from northwest Syria, BMJ Global Health, Vol: 7, ISSN: 2059-7908
Introduction: Syria’s protracted conflict has devastated the health system reversing progress made on maternal health pre-conflict. Our aim is to understand the state of maternal health in Syria focused on underage pregnancy and caesarean-sections using a scoping review and quantitative analysis; the latter draws on data from the Syrian American Medical Society’s (SAMS) maternal health facilities in northwest Syria. Methods: We performed a scoping review of academic and grey literature on the state of maternal health across Syria since the onset of conflict (taken as March 2011). Identified articles were screened using pre-established criteria and themes identified. We also performed a retrospective quantitative analysis of maternal health data from SAMS’ facilities in a micro-context in north-west Syria between March 2017 and July 2020, analysing the trends in the proportion of births by caesarean-section and age at pregnancy. Results: Scoping review: of 2824 articles, 21 remained after screening. Main themes related to maternal mortality rates, caesarean-sections, maternal age and perinatal care. 12 studies reported caesarean-section rates; these varied from 16 to 64% of all births: northern Syria (19-45%,) Damascus (16-54%,) Lattakia (64%) and Tartous (59%.) Quantitative analysis: Of 77,746 births across 17 facilities, trend data for caesarean-sections showed a decrease from 35% in March 2017 to 23% in July 2020 across SAMS facilities. Girls under 18 years accounted for 10% of births and had a lower proportion of caesarean-section births. There was notable geographical and inter-facility variation in the findings. Conclusion: The quality of available literature was poor with country level generalisations. Research which explores micro-contexts in Syria is important given the different effects of conflict across the country and the fragmented health system. Our quantitative analysis provides some evidence around the changes to caesarean-section
Petersen E, Zumla A, Hui DS, et al., 2022, Vaccination for monkeypox prevention in persons with high-risk sexual behaviours to control on-going outbreak of monkeypox virus clade 3, INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES, Vol: 122, Pages: 569-571, ISSN: 1201-9712
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- Citations: 25
Abbara A, Rao B, Titanji BK, et al., 2022, The monkeypox outbreak must amplify hidden voices in the global discourse (vol 400, pg 23, 2022), LANCET, Vol: 400, Pages: 160-160, ISSN: 0140-6736
Abbara A, Rao B, Titanji BK, et al., 2022, The monkeypox outbreak must amplify hidden voices in the global discourse (vol 400, pg 23, 2022), LANCET, Vol: 400, Pages: 160-160, ISSN: 0140-6736
Zumla A, Traore T, Amao L, et al., 2022, Reducing the threat of epidemic-prone infections at mass gathering religious events, LANCET, Vol: 400, Pages: 80-82, ISSN: 0140-6736
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- Citations: 4
Abbara A, Rao B, Titanji BK, et al., 2022, The monkeypox outbreak must amplify hidden voices in the global discourse, LANCET, Vol: 400, Pages: 23-23, ISSN: 0140-6736
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- Citations: 3
Castro KG, Ditiu L, Sahu S, et al., 2022, Optimising tuberculosis care for refugees affected by armed conflicts Comment, LANCET RESPIRATORY MEDICINE, Vol: 10, Pages: 533-536, ISSN: 2213-2600
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- Citations: 1
Karah N, Antypas K, Al-toutanji A, et al., 2022, An Innovative Approach to Providing Web-Enabled Diagnostic Laboratory Services in Syria, AMERICAN JOURNAL OF CLINICAL PATHOLOGY, Vol: 157, Pages: 554-560, ISSN: 0002-9173
Marzouk M, Alhiraki OA, Aguas R, et al., 2022, SARS-CoV-2 transmission in opposition-controlled Northwest Syria: modeling pandemic responses during political conflict, INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES, Vol: 117, Pages: 103-115, ISSN: 1201-9712
Abbara A, Rayes D, Ekzayez A, et al., 2022, The health of internally displaced people in Syria: are current systems fit for purpose?, JOURNAL OF MIGRATION AND HEALTH, Vol: 6, ISSN: 2666-6235
Desai AN, Mohareb AM, Hauser N, et al., 2022, Antimicrobial Resistance and Human Mobility, INFECTION AND DRUG RESISTANCE, Vol: 15, Pages: 127-133, ISSN: 1178-6973
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- Citations: 1
Sbaiti M, Streule M, Alhaffar M, et al., 2021, Whose voices should shape global health education? Curriculum codesign and codelivery by people with direct expertise and lived experience, BMJ Global Health, Vol: 6, ISSN: 2059-7908
There are contrasting opinions of what Global Health (GH) curricula should contain and limited discussion on whose voices should shape it. In GH education, those with first-hand expertise of living and working in the contexts discussed in GH classrooms are often absent when designing curricula. To address this, we developed a new model of curriculum co-design called Virtual Roundtable for Collaborative Education Design (ViRCoED). This paper describes the rationale and outputs of the ViRCoED approach in designing a new section of the Global Health BSc curriculum at Imperial College London, with a focus on healthcare in the Syrian conflict. The team, importantly, involved partners with lived and/or professional experience of the conflict as well as alumni of the course, and educators in all stages of design and delivery through to marking and project evaluation. The project experimented with disrupting power dynamics and extending ownership of the curriculum beyond traditional faculty by co-designing and co-delivering module contents together with colleagues with direct expertise and experience of the Syrian context. An authentic approach was applied to assessment design using real-time syndromic healthcare data from the Aleppo and Idlib Governorates. We discuss the challenges involved in our collaborative partnership and describe how it may have enhanced the validity of our curriculum with students engaging in a richer representation of key health issues in the conflict. We observed an enhanced self-reflexivity in the students’ approach to quantitative data and its complex interpretation. The dialogic nature of this collaborative design was also a formative process for partners and an opportunity for GH educators to reflect on their own positionality. The project aims to challenge current standards and structures in GH curriculum development and gesture towards a GH education sector eventually led by those with lived experience and expertise to significantly
Naderi H, Abbara A, Viviano A, et al., 2021, Re-emphasising the importance of histopathological diagnosis in suspected bacterial endocarditis, PERFUSION-UK, Vol: 38, Pages: 197-199, ISSN: 0267-6591
Hartley A, El-Sayed A, Abbara A, et al., 2021, Restricted use of echocardiography in suspected endocarditis during COVID-19 lockdown: a multidisciplinary team approach, Cardiology Research and Practice, Vol: 2021, Pages: 1-4, ISSN: 2090-0597
Background:Infective endocarditis (IE) is challenging to manage in the COVID-19 lockdown climate, in part given its reliance on echocardiography for diagnosis and management, and the associated virus transmission risks to patients and healthcare workers. This study assesses utilisation of the endocarditis team (ET) in limiting routine echocardiography, especially transoesophageal echocardiography (TOE), in patients with suspected IE, and explores the effect on clinical outcomes.Methods:All patients discussed at the ET meeting at Imperial College Healthcare NHS Trust during the first lockdown in the UK (23rd March – 8th July 2020) were prospectively included and analysed in this observational study.Results:In total, 38 patients were referred for ET review (71% male, median age 54 [interquartile range 48, 65.5] years). At the time of ET discussion, 21% had no echo imaging, 16% had point-of-care ultrasound only and 63% had formal TTE. In total, only 16% underwent TOE. The ability of echocardiography, in those where it was performed, to affect IE diagnosis according to the Modified Duke Criteria was significant (p=0.0099), however, sensitivity was not affected. All-cause mortality was 17% at 30-days and 25% at 12-months from ET discussion in those with confirmed IE.Conclusion:Limiting echocardiography in patients with a low pre-test probability (not probable or definite IE according to the Modified Duke Criteria) did not affect the diagnostic ability of the Modified Duke Criteria to rule out IE in this small study. Moreover, restricting non-essential echocardiography, and importantly TOE, in patients with suspected IE through use of the ET did not impact all-cause mortality.
Morgan C, Barrett J, Brown A, et al., 2021, Respiratory samples to diagnose tuberculosis in the absence of chest x-ray abnormalities, RESPIRATORY MEDICINE, Vol: 185, ISSN: 0954-6111
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