The neglected refugee crisis
BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i484 (Published 01 February 2016) Cite this as: BMJ 2016;352:i484All rapid responses
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We commend the effort made by Murphy and Colleagues in genuinely advocating for better access to healthcare for Syrian refugees scattered all over the neighboring frontline Countries (1).
In particular they suggest financially supporting and medically upgrading the classic health response provided to refugees coming from poor Sub-Saharan countries, by adapting it to the different disease profile of the Syrian population, characterized by the dominance of non-communicable diseases in adult people.
Their advice needs to be complemented by a strong call for providing primary and secondary preventive care for Rheumatic heart Disease (RHD), a neglected non-communicable disease in children and young adults(2).
The conservative estimate of the global mortality of RHD has been established at more than 233,000–468,164 deaths every year(5).
Following the seminal work of Marjon et Colleagues(3), a metanalysis by Rothenbuler(4) showed that, in children from 37 pooled countries, the prevalence of clinically silent RHD detected by ultrasound (21•1/1000) was eight times higher than that of clinically manifest disease(2•7/1000).
The timely use of echocardiography to detect and treat sub-clinically affected children early (through benzathine-penicillin) has proved to be promising(5). Based on these facts, the World Heart Federation is calling for a 25% reduction in premature mortality from RHD by 2025 (5).
The Syrian children, suffering from years of displacement, poverty and lack of proper healthcare, hold the classic risky profile for developing Acute Rheumatic Fever (ARF) and RHD.
Decentralised diagnostic services for ARF/RHD, framed as routine screening through point-of-care technologies (echocardiography and rapid diagnosis of group-A streptococcal pharyngitis), should be considered at migrant/refugee pediatric community level.
Severe RHD is lethal without surgical treatment. The international community has the moral obligation to care for the silent population of refugee children, often arriving unaccompanied and defenseless. It must not turn a blind eye to them.
References
1. Murphy A, Woodman M, Roberts B, McKee M. The neglected refugee crisis. BMJ 2016; 352: i484
2. Marijon E, Mirabel M, Celermajer DS, Jouven X. Rheumatic heart disease. Lancet 2012;379,953–964
3. Marijon E, Ou P, Celermajer DS, et al. Prevalence of rheumatic heart disease detected by echocardiographic screening. N. Engl. J. Med 2007; 357, 470–476 (2007)
4. Rothenbuler, M., O’Sullivan, C.J., Stortecky, S., et al. Active surveillance for rheumatic heart disease in endemic regions: a systematic review and meta-analysis of prevalence among children and adolescents. Lancet Glob Health 2014; 2, e717-26
5. World Heart Federation. World Heart Federation RF and RHD goals: 25x25<25. http://www.world-heart-federation.org/heart-facts/resources/scientific-s...
Competing interests: No competing interests
Re: The neglected refugee crisis
Greek Immigration Minister Mouzalas admits that 70% of incomers arriving in Greece by sea were adult men who traveled alone, filling the profile for illegal economic migrants, not refugees. [3][4][5][6][7][8][9]
European Frontex has accused NGOs of collusion with people smugglers who bring immigrants into Europe, after an extensive classified investigation. [1][2]
References
[1] http://www.statewatch.org/news/2016/dec/eu-vs-ngos.html
[2] https://www.ft.com/content/3e6b6450-c1f7-11e6-9bca-2b93a6856354
[3] http://www.foxnews.com/world/2017/01/05/greek-minister-says-most-migrant...
[4] https://www.yahoo.com/news/greek-minister-says-most-migrants-no-longer-r...
[5] http://www.dailystar.com.lb/News/World/2017/Jan-05/388033-greek-minister...
[6] http://www.whio.com/news/world/greek-minister-says-most-migrants-longer-...
[7] http://www.business-standard.com/article/pti-stories/greek-minister-says...
[8] http://www.timesdaily.com/news/nation/greek-minister-says-most-migrants-...
[9] https://www.youtube.com/watch?v=pmxRQga1YqM
Competing interests: No competing interests