The Impact of Water and Sanitation on Syrian Refugees' Health

This essay delves into the critical issue of water and sanitation challenges faced by internally displaced persons (IDPs) in Syria, particularly focusing on the impact on the health of Syrian refugees. The introduction establishes health as a fundamental human right and highlights the role of social determinants, including water and sanitation, in shaping health outcomes. The essay then focuses on the Syrian civil war, which has significantly reduced access to clean water and sanitation for the population. The essay explores the impacts of poor water and sanitation, including disease outbreaks (such as diarrhea), increased rates of malnutrition, lower school attendance, and poor maternal health. The essay emphasizes how these issues are exacerbated by factors such as inadequate water supplies, electricity disruptions, and damage to infrastructure. The conclusion underscores the urgent need for improved water and sanitation to mitigate the adverse health effects and improve the quality of life for Syrian refugees.

Running head: WATER AND SANITATION AMONG REFUGEES IN SYRIA
Water and Sanitation Among Syria’s Internally Displaced Persons
Student’s Name
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Water and Sanitation Among Syria’s Internally Displaced Persons
Introduction
Health is a universal human right. Every person on the globe is entitled to the highest
attainable physical and mental wellbeing (Abbara et al, 2015). Provision of healthcare
services is largely a function of the government in most countries. Health is a very key area
of interest in any population since it directly determines lots of factors such as productivity. If
the workforce is to be productive, they should enjoy both physical and mental wellbeing
(Almoshmosh, 2015). If this wellbeing is not achieved, the workforce is weak and
unproductive. Ill health also leads to higher costs of healthcare leading to disease burden.
There are several factors that determine health. These could be political, social,
economic etc. For one to fully understand a healthcare system, they must consider all these
factors that play together to influence health. It is very unlikely to find a situation where only
one factor determines health. In most situations, it is an interaction of various factors that
influence health. One category of these are the social determinants. Social determinants of
health imply the conditions that people are born into, grow, live. It also includes the
conditions in which people work and age. These factors are greatly shaped by the how
money, power and resources are distributed. The distribution of resources on the
international, national and local levels inevitably determine the health status of individuals
(Adler et al, 2016). Social determinants of health play the greatest role in shaping health.
According to Braveman and Gottlieb (2014), due to these determinants there exists
inequalities between countries and regions in as far as provision of quality healthcare is
concerned.
Some proportions of the population are more at risk of ill health than others. These
include the children below the age of five years. Another category is the people displaced

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from their homes due to factors such civil wars. These groups face unique challenges that
make them more susceptible to more health. The social determinants of health are also varied
and include colonisation, urbanization, social exclusion and water and sanitation. This essay
is going to discuss water and sanitation as a social determinant of health among internally
displaced persons in Syria. The essay is going to demonstrate that this section of the
population is affected by water and sanitation challenges and show why the selected
population is relevant. In addition, possible solutions to the negative impacts posed by water
and sanitation challenges will be discussed.
Social Determinant of Health and the Population to be Discussed.
As indicated in the introduction, the social determinant of health that will be discussed
is water and sanitation. Around the world, there are great improvements made when it comes
to access of clean water and sanitation (Centre for Disease Control and Prevention, 2014).
However, there is still a lot more to be done to make sure that the largest proportion of the
world’s population has access to clean water and sanitation. Today, there are about 2.4 billion
people in the world who do not utilise sanitation that is improved. It is also saddening that
another 663 million of the world’s population do no have access to the improved sources of
water (Lonergan, 2018). To demonstrate the global importance of improving water and
sanitation, it would be appropriate to note that more than 800 children lose their lives each
day due to poor water and sanitation (Marmot and Allen 2014). Water is an indispensable
component of the human diet. There is therefore great need to improve the water and
sanitation to avoid infections and illnesses.
The chosen population is refugees who are internally displaced in Syria. There has
been a civil war in Syria since 2011. This war has posed great challenges to the people living
in Syria. The war has resulted to at least 6.0 million ordinary people being internally

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displaced (Piper et al, 2017). Another 5.6 million has fled out of the country to seek refuge
elsewhere. Before the war began, the largest proportion of the population (more than 90%) of
Syria had access to clean water and sanitation. In the present day, less than half of the
population has access to clean water and sanitation. Factors such as explosion of the water
pipes and displacement from homes have contributed to this situation. In addition to the
challenge of water and sanitation, healthcare in general has greatly deteriorated. For instance,
the vaccination coverage prior to war was estimated to be 90%. In the current day, the rate
has dropped to below 50% in some regions of the country (Sikder, Daraz, Lantagne and
Saltori, 2018). The internally displaced persons have more challenges when it comes to the
issue of water and sanitation.
Impacts of Poor Water and Sanitation on Internally Displaced Persons in Syria.
As seen in the discussion, water and sanitation has greatly deteriorated due to the civil
war experienced in the last seven years in Syria. Compared to the situation before the crisis,
availability of drinking water has reduced to an average of half. In some regions, such as As
Salamia and Aleppo the conditions are worse with the water availability levels having
reduced to about 80% of the situation prior to crisis (King, 2015). The major causes of the
deterioration of the water and sanitation levels are going to be mentioned next. One is that the
current water supplies are inadequate to supply the large number of people. Certain groups
such as the internally displaced are mainly affected due to their large numbers. The second
major cause is the shutdown of electricity supply systems. The shutdown is largely deliberate
and causes significant disruption of water supply. The third and final major cause is
damaging of the gas-fed power generation system. It goes without saying the densely
populated regions are likely to experience greater challenges. This is the case with internally
displaced people. With this general overview of the situation the impacts of poor water and
sanitation among the internally displaced persons are going to be outlined.

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One of the effects of the reduced water and sanitation levels is disease outbreaks. For
instance, diarrhoea is a common phenomenon among the internally displaced persons. The
most affected are children probably because their immune system is weaker and more prone
to illnesses (Devakumar et al, 2015). The disease outbreak could be happening due to some
of the following factors. There is extensive poor disposal of excreta. The toilet facilities are
not enough to meet the needs of the great number of displaced persons. The sewerage
systems are also poor, non-functional or lacking. Under such circumstances, there is a high
likelihood of taking contaminated water which increases the risk for infections. The largest
proportion of the population has no knowledge of preventive practices such as boiling water.
In addition, water access is limited. As a result, people are more prone to use any form of
water that is available whether it is safe or not due to a lack of otherwise. To make the
matters worse, the situation is still aggravating due to the continuing war. Unlike their
counterparts who have departed the country, humanitarian assistance is more unreachable to
this population group due to the war. The situation is therefore only likely to get worse
considering these combinations of factors. The situation of disease outbreaks is further
aggravated by inadequate healthcare facilities. Most of the health care professionals have
been displaced due to the ongoing war. Water and sanitation challenges such as diarrhoea
could be significantly addressed with access to adequate health care. With the
lack/inadequacy of this, the situation becomes difficult to contain and often has debilitating
effects. Sometimes, it even results to death. In addition, the population is more prone to
infections associated with poor water, sanitation and hygiene such as cholera.
Another impact of poor water and sanitation conditions is increased rates of
malnutrition. These cases are more rampant in the children. Malnutrition refers to a situation
where one is either undernourished or over nourished. In the case of internally displaced
people, the burden of malnutrition manifests mainly as undernutrition. Undernutrition occurs

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in several forms. It may be that a person is dangerously thin for their height (wasting), greatly
short for the age one is in (stunting) and having too little weight for one’s age. According to
Combs and McClung (2016), undernutrition could also occur in a situation where one does
not consume sufficient amounts of micronutrients (vitamins and minerals). Undernutrition
could have devastating effects on the affected individuals. Evidence from extensive research
suggests that undernutrition increases the likelihood of death due to infectious diseases
(Whitney and Rolfes, 2018). Both inadequate consumption of foods and nutrients and
infectious diseases contribute to the malnutrition burden. Poor water and sanitation inevitably
contributes to increased cases of malnutrition (Teague, Johnston and Graham, 2014). More
than half of all cases of malnutrition among the displaced persons has been associated with
environmental factors. Of the environmental factors, inadequate access to safe drinking water
and poor sanitation and hygiene are significant contributors. Studies have repeatedly shown
that improving water and sanitation could greatly prevent undernutrition. The malnutrition
burden in Syria is great and as seen above, sanitation contributes to this.
Another impact is lower rate of school attendance. There exists evidence that
increased missing of school attendance is associates with decreased performance in
academics and an increase in the rate of school dropouts. This applies mainly to high school
and lower levels of education. This could have far reaching negative impacts. A child who
has no education has lower chances of getting employment in future. From a
community/regional point of view, this would mean that the poverty levels are likely to be
high in future. Poor water and sanitation lowers school attendance rate through several ways.
Diarrhoeal disease and/or respiratory infections may cause pupils/students to abstain from
going to school. Improved water and sanitation would significantly change the situation by
lowering these diseases and infections. Another way in which poor water and sanitation leads
to decreased school attendance is through absence of girls from schools due to challenges in

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managing their menstrual health. Without appropriate facilities that are in place, they find it
hard to attend school while menstruating since they will not be able to manage their
menstrual hygiene adequately. Such lack/inadequacy of appropriate facilities makes them not
to go to school in fear of embarrassment that may come with unpleasant stains or odours. The
lower school attendance rates have also been associated with fear of assault. There are many
cases where there is no adequate privacy in the water and sanitation facilities. Some students
do not go to school due to fear that their privacy will be intruded. The great water shortage
also may lead to lower school attendance due to the need to fetch water. In some situations,
students spend the better part of the day fetching water and therefore absent from school.
Failure to attend school is associated with poor health in future. This is because poverty
levels are generally higher among the uneducated.
The final impact that will be discussed is poor maternal health. A strong association
has been found to exist between water, sanitation and hygiene and maternal health (Wash and
Indicators, 2015). It has been known for a long time now that the handwashing of a birth
attendance could result to maternal infection in cases where it is not done at all or done
poorly. Poor water and sanitation increases the risk of soil transmitted helminth (DeJong et al,
2017). These infections have been associated with higher chances of developing listeria and
anaemia. In some situations, it may lead to maternal death. Soil transmitted helminths have
also been known to increase the likelihood of births before term and spontaneous abortion.
Poor water and sanitation also increases the likelihood of schistosomiasis (Grimes et al,
2015). This increases the likelihood of undernutrition, anaemia and ectopic pregnancy. Poor
sanitation and water management systems that are not well managed could encourage
breeding of mosquitoes. This could cause malaria among pregnant mothers which could have
devastating effects. Infections associated with poor water and sanitation have also been
known to cause increased expenditure of calories due to increased basal metabolic rate. This

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is coupled with anorexia (lack of appetite). This leads to undernutrition among pregnant
women which poses a risk not only on their own health but also of their infants. The water
unavailability and poor sanitation has also been associated with a higher chance of
developing urinary tract infections. As it can be seen from the above discussion, poor water
and sanitation has adverse effects on maternal health.
How the Negative Health Impacts Associated with Poor Water and Sanitation
Could be Addressed.
Water and sanitation are important factors for human dignity and survival. As seen
above, when water, hygiene and sanitation are poor, there are numerous negative health
implications. In Syria, these conditions are generally poor in the current day due to the
ongoing civil war (Doocy and Lyles, 2018). Although the challenge may affect many parts of
the country, the internally displaced persons are more at risk than the rest of the population.
The situation in which these people are could be categorized as an emergency. There are
some interventions related to water, sanitation and hygiene that are usually carried out in
emergency situations. These and several others will be discussed in this section. The aim of
this section is to propose/provide possible ways of addressing the negative health impacts
brought about by the poor water and sanitation.
One method could be supplying the affected individuals with water. This strategy
could employ transporting water from regions of plenty to where the displaced people are. To
ensure sustainability repair of the water infrastructure could be done (Doocy and Lyles,
2017). Such intervention could be carried out through the support of international
communities, humanitarian agencies and people/groups of good will. In addition to repairing
the infrastructure, there should also be regular maintenance to ensure that disruptions in water
supplies are minimal. Prior to the crisis, more than 90% of Syria’s region was supplied with

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clean water (Heisler, Baker and McKay, 2015). Due to this, repair of the existing
infrastructure would adequately address the problem without requiring new infrastructure. In
cases where this may be difficult, some boreholes could be drilled to supply water. Most of
the internally displaced people live in camps. It follows that drilling some boreholes may be a
good way of addressing the poor water and sanitation problem.
Treating of water would be another strategy that can potentially reduce the negative
health impacts experienced by the internally displaced persons of Syria. Water treatment kills
the microorganisms that might be present in the water making it safe for drinking, cooking,
bathing and other purposes (Handzel, 2018). The result is improved hygiene. To ensure that
this strategy is sustained, it should go beyond providing the appropriate chemicals for water
treatment. It should involve educating the people of simple ways of treating their drinking
water and the importance of doing that. Providing this knowledge has the potential of shaping
attitudes. As Rayes, Orcutt, Abbara, and Maziak, (2018) observes, when attitudes are shaped,
change in practices could potentially occur. The change of practices in this case would be
treating drinking water. For instance, when a mother is informed that untreated water may
lead to diarrhoea in her child and that treating the water would lower the chances, then they
are likely to treat the water for use by the children and households in general. Water
treatment kills the disease-causing microorganisms that might be present in water. This way,
the negative health impacts discussed in the previous section are greatly minimized/
eliminated.
Promoting proper excretion of excreta would be another great way of reducing the
negative health impacts. This would include establishment of a proper sewerage system too.
When there are not adequate facilities for disposing excreta, the likelihood that there will be
contamination of water and food is high (Hoy, 2017). Consequently, the risk of infections of
poor sanitation such as cholera increases. Establishment of these facilities would come in

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10
handy to solve this problem. Consequently, the negative health impacts such as diarrhoea
would significantly reduce. Educating the people about proper hygiene practices would also
be a great way to promote hygiene practices and reduce the vast negative health impacts
associated with poor water, sanitation and hygiene (Taleb et al, 2015). Provision of hygiene
would also greatly improve health. For instance, providing girls and women of reproductive
age with sanitary towels would greatly improve menstrual health and decrease the rate of
absenteeism from school. To address the issue of undernutrition, intervention strategies for
management of acute malnutrition should be put in place. This include supply of both
therapeutic feed for severe acute malnutrition and supplementary feeds for moderate acute
malnutrition.
Conclusion
In conclusion, health is a universal human right with every person being entitled to
the highest attainable physical and mental wellbeing. There are several factors that influence
the health of individuals. These include social, political and economic factors. Social
determinants of health refer to those situations/environments that people grow and live in.
Some proportions of the population are more at risk of ill health than others. These include
children below the age of five years and displaced populations. Water and sanitation is social
determinant of health. Conditions of water, sanitation and hygiene inevitably affect health. If
the conditions are good, positive health outcomes are likely. On the other hand, if the
conditions are poor the likelihood of ill health is high. There has been an ongoing civil war in
Syria since the year 2011. This has led to decreased access to clean drinking water and
deteriorating conditions. It has also led to extensive displacement of people from their homes.
While the effects of poor water and sanitation are felt by both the displaced and those who
are not, they are more far reaching in the displaced population. The impacts of poor water and
sanitation among the internally displaced persons in Syria include increased cases of

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11
diarrhoea and disease outbreaks, absenteeism from school and undernutrition. Strategies to
address the problems could include establishing excreta disposal facilities, repairing the water
supply system and providing hygiene items.

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