Sir, the humanitarian crisis in Syria continues to negatively impact many Syrian refugees' access to quality healthcare in neighbouring countries.1,2 During the crisis, hundreds of dental clinics have been destroyed or closed as a result of the strikes from the different parties involved in the war, and thousands of highly qualified dental professionals from all dental specialties have left Syria. In response, and with help from medical and charity organisations, dentists from various specialities have established several dental clinics in border regions of Turkey (Urfa, Killis, Reyhanli) and Jordan (Zatari Camp) – sometimes just a few kilometres from the Syrian borders – to provide the Syrian refugees with much needed oral health care. To the best of our current knowledge, 19 dental clinics for refugees have been established in the regions bordering Syria, with 13 of them in Turkey: 4 in Urfa, 2 in Killis, 2 in Reyhanli and 5 smaller primitive dental clinics in the refugee camps bordering Syria; and 6 others in Jordan (Zatari Camp). These clinics are lacking in resources, such as radiographic machines, important dental materials, and sterilisation protocols and equipment. They are especially ill-equipped to deal with facial injuries, and this has detrimental physical and emotional effects on their patients. This minimalism equates them with 'field hospitals'.3
Reported adverse consequences of the war among the refugees include decreased oral hygiene and increased periodontal diseases including chronic generalised gingivitis and periodontitis. When they were asked why they do not brush their teeth, most patients reported that they would rather buy food for their children than buying a toothbrush and toothpaste. The rate of dental caries and odontogenic infections, including acute periapical abscesses and even orofacial infections, have increased. Traumatic injuries in the maxillofacial and temporomandibular regions, including both boney and soft-tissue injuries, have immensely increased in incidence and severity. This includes amputations, facial lacerations and fractured bones (temporomandibular joint, maxillary, mandibular and nasal), as well as injuries to the teeth and surrounding dental structures. Some of these problems were the result of poor treatments that were performed inside Syria because of either a lack of proper dental/medical materials and supplies or the unavailability of expert surgeons/specialists or both.
Furthermore, there has been a continuous decrease in financial support from governmental and non-governmental organisations for dental initiatives; this shortage should lead to adjusting the strategies to focus more on preventive procedures and positive psychological support to those who are in dire need. Lastly, as this humanitarian crisis worsens there is a desperate need for action from the dental community to build more awareness and strengthen efforts in mitigating the tragic medical and dental consequences of what is being labelled as the 'greatest humanitarian tragedy of our times'.4
References
Saltaji H . 4 years of the humanitarian tragedy in Syria: who cares? Lancet. 2015; 385: 943.
Hurley R . Who cares for the nine million displaced people of Syria? BMJ 2013; 347: f7374.
Attar S, Aleppo City Medical Council. Field hospitals in Syria. Lancet 2014; 383: 303.
World Food Programme. Aid principals call for action to increase humanitarian access and funding for Syria crisis. 2014. Available online at https://www.wfp.org/news/news-release/aid-principals-calling-decisive-action-increase-humanitarian-access-and-funding-sy (accessed July 2015).
Acknowledgements
HS is supported through a Clinician Fellowship Award by Alberta Innovates - Health Solutions (AIHS), the Honorary Izaak Walton Killam Memorial Scholarship by the University of Alberta, Alpha Omega Foundation of Canada Grant, and the Honorary WCHRI Award by the Women and Children's Health Research Institute (WCHRI). The funders had no role in decision to publish or preparation of this letter. The authors declare no potential conflicts of interest related to this letter.
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Saltaji, H. Oral health consequences of the crisis in Syria. Br Dent J 219, 49 (2015). https://doi.org/10.1038/sj.bdj.2015.586
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DOI: https://doi.org/10.1038/sj.bdj.2015.586
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