A Heart-Wrenching Crisis: Cardiovascular Disease in Syrian Refugees

Cardiovascular diseases (CVDs) refer to a group of disorders that affect the circulatory system, where disease onset is typically attributed to a buildup of plaque in the arteries (Cleveland Clinic, 2022). Common examples of CVDs include heart failure and stroke. While CVDs present a significant health challenge for populations across the world, they are particularly prevalent among Syrian refugees. About 11.1 percent of Syrian refugees over the age of 40 in Jordan suffer from some form of CVD and 29.3 percent suffer from hypertension, which is a significant risk factor for CVD (Hani et al., 2019). Given the substantial health issues that CVDs pose in refugees, it is important to analyze the risk factors that account for this phenomenon. 

Syrians tend to have a high rate of CVD before they even step foot out of their country. CVD and its associated risks are the leading cause of mortality in Syria, accounting for almost half of all adult deaths (Maziak et al., 2007). For comparison, CVD only accounts for 25 percent of all deaths in other developing countries (Maziak et al., 2007). CVD poses a significant public health challenge in Syria due to factors grounded in basic living conditions, such as poor infrastructure and sanitation practices. A possible explanation for Syria’s abnormally high CVD rate is its ongoing civil war. Armed conflict is associated with an increased rate of coronary heart disease, a type of CVD; greater stress levels and the disruption of disease prevention programs, such as anti-smoking campaigns, may explain the greater prevalence of this disorder (Jawad et al., 2019). Thus, a potential factor contributing to the high rate of CVD in Syrian refugees is conflict within Syria. 

Figure 1. CVD causes almost half of all mortality in Syria, which is unusually high for a developing country

Although leaving a war-torn country should be a blessing, it often leads to the exacerbation of CVD for Syrian refugees. In fact, a survey of Syrian refugees in Lebanon found that 10.8 percent of households had at least one member with some form of CVD (Boulle et al., 2019). Chronic illnesses such as CVD are prevalent in Syrian refugee camps due to neglect and poor funding. For example, in one Jordanian hospital serving Syrian refugees, only 65.8 percent of patients requiring further treatment for chronic conditions received follow ups due to low funding (Hani et al., 2019). The lack of follow up appointments is crucial to understanding the CVD crisis among Syrian refugees because untransmissible diseases, such as CVD, tend to increase in severity if left untreated (Daynes, 2016). Therefore, patients with hypertension, a precursor to more severe CVDs, may not receive the treatment that could resolve a less severe precursor to their heart condition. Given that migrant camps and hospitals tend to lack funds and/or have poor organization, they consequently cannot treat patients long term, leading refugees to develop CVD.

Figure 2. This site in Arsal, Lebanon shows the poor and crowded conditions typical of a Syrian refugee camp

Finally, even upon arrival to asylum countries, Syrian refugees continue to face high rates of CVD. A Danish study found that immigrants from the Middle East and North Africa, many of whom include Syrian refugees, had a significantly higher incidence of coronary heart disease than Danish-born individuals (Byberg et al., 2016). The reasons for this higher incidence are still unclear, but it should be noted that non-Western immigrants in Denmark often have lower incomes, higher unemployment rates, and lower educational levels compared to native-born Danes (Hempler et al., 2011). These trends exist across Europe and can be linked to language barriers, cultural differences, and a potentially growing, unconscious stigma against refugees. Unfortunately, the outcome of lower socioeconomic status is clear across Europe; a study of six Western European countries including the United Kingdom and Sweden, which have high refugee populations, found that over time, mortality from CVD decreased faster in upper socioeconomic groups than in lower ones (Mackenbach et al., 2003). Advances in CVD treatment increasingly benefit wealthier groups in European countries, as new treatments tend to be expensive and only accessible for members of higher socioeconomic groups. Therefore, Syrian refugees, who tend to be economically disadvantaged, suffer from higher rates of CVD mortality in their European asylum countries due to poorer access to healthcare and new treatments. 

Figure 3. In European countries, foreign citizens like refugees are at a significantly higher risk of poverty, which is associated with CVD

Understanding the factors contributing to high rates of mortality from CVD in Syrian refugees is crucial to improving the health of this troubled population. However, addressing many of these factors involves vast geopolitical changes beyond the reach of doctors or healthcare systems, such as negotiating an end to the Syrian civil war. While further research on Syrian refugees is necessary to find medically relevant solutions for CVD in this group, the evidence is clear. Once treatment plans and political conflicts are permanently addressed, healthcare systems can bring equity to refugee health, overcoming a major challenge in global health. 

Edited by Luisa Taverna

References

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