Thursday, May 1, 2014

Beyond Counter-Terrorism: Public Health Consequences of Fighters Returning from Conflict Zones

By all estimates Germany and the Netherlands have witnessed disproportionate numbers of fighters returning from conflict zones; mainly Syria. See: While the terror threat is a very real one for Germany, given a number of issues they have struggled with for some time, the Netherlands, has taken a progressive approach to countering the threat posed by would-be terrorists and this approach is likely to result in quite positive consequences to public health security. While Germany and the Netherlands are at an increased risk, compared to other EU states, due to the disproportionate numbers of their populations going off to war zones, of greater concern is the re-introduction of disease into the EU upon return of their citizens.

In contrast to Germany and its various problems with regard to counter-terrorism, the Netherlands, in a landmark case, arrested two would be terrorist fighters, sending one to jail and one to a mental health facility. See:
The Dutch should be applauded for their efforts and the creation of this legislation should be a blueprint for other EU nations struggling to pre-empt travel to war zones.

The study of conflict and disease is not a new one and Syria's civilian populations, like other nations experiencing  internal and protracted conflict, are confronted with various diseases. While I've touched on conflict and disease before (see: game changer in Syria is that more European citizens have returned from this war-zone than any other in recent times. While some are kept under twenty four hour surveillance, their potential exposure to diseases with lengthy incubation periods is an often overlooked concern in the shadow of terrorist threats. Syria is currently facing a Wild Polio Virus 1 (WPV1) outbreak, cholera, hepatitis, typhoid among others. In an article entitled: 'Syrian disease outbreaks 'ineveitable, warns WHO", by James Meikle (see: the author notes:

"More than a third of Syria's public hospitals are out of action, in some areas 70% of health workers have fled and 4.25 million internally displaced Syrians are living in overcrowded, unsanitary condition, it said. Shortages of safe drinking water and disruption to vaccination programs are increasing the risks With thousands of Syrians crossing the boarders each day, diseases already prevalent inside Syria are being transmitted to neighboring countries, according to the WHO's regional office for the eastern Mediterranean , just days ahead of new United Nations appeals for funds to combat the humanitarian crisis." All the risk factors that enhance the transmission of communicable diseases in emergencies are present in the current crisis in Syria and its neighbouring countries," said Jaouad Mahjour, its director for communicable diseases." :

The number of fighters returning from combat, given the above mentioned situation in country, lack of public health infrastructure, interruption in vaccine campaigns, and highly transmissible disease puts global public health security at risk. Member States within the EU may find themselves increasingly faced with outbreaks of disease which are directly attributable to the return of citizens from Syria.  In contrast to others nations such as Pakistan, where Polio is also endemic, the numbers of potentially exposed individuals arriving and spreading disease is relatively low do to immigration controls which are not generally observed with nationals returning to their country of origin for example Germany. As fighters return from Syria and other conflict zones it is important to monitor these individuals, not only in terms of counter-terrorism, but also from a public health standpoint. Health screening is a vital tool. If we consider polio, which is just one of many public health threats facing returning fighters, this statement below puts the threat into context:

"The majority of European countries use inactivated polio vaccine (IPV) instead of oral polio vaccination (OPV), which is a live form of immunization. While IPV is very effective in preventing polio, it only provides partial protection from infection and is less reliable if the virus is circulating. Large numbers of Syrian refugees are leaving Syria for nearby nations and Europe. The potential for polio to be re-introduced into areas that have been free of polio for decades now exists."

"Only 1 in 200 people who are unvaccinated will develop acute flaccid paralysis. People who are infected can spread the polio virus unrecognized. Inactivated polio vaccine (IPV), used across Europe, only partly prevents those vaccinated from infection. It does reduce transmission and is effective in preventing acute flaccid paralysis. IPV reduces the ratio of acute flacid paralysis to infection. Oral polio vaccination (OPV) provides high protection against acquisition and spreading of the infection, but the vaccine was discontinued in Europe due to rare instances of vaccination-related acute flaccid paralysis. Only some of the European Union member states still permit the use of OPV and none of them have a stockpile of OPV. Routine screening of sewage for poliovirus has not been performed in most of Europe, but intensified surveillance measures should be considered for settlements with large numbers of refugees from Syria." See:

We must encourage EU Member States to take a stronger position on preventive jihad and ensure screening of populations entering the EU from war and conflict zones. 

Dragon voice recognition

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