Article Text

Download PDFPDF

Reproductive, maternal, neonatal and child health in conflict: a case study on Syria using Countdown indicators
  1. Jocelyn DeJong1,
  2. Hala Ghattas1,2,
  3. Hyam Bashour3,
  4. Rima Mourtada1,
  5. Chaza Akik2,
  6. Amelia Reese-Masterson4
  1. 1 Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
  2. 2 Faculty of Health Sciences, Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
  3. 3 Department of Family and Community Medicine, Damascus University, Damascus, Syrian Arab Republic
  4. 4 Research Adviser in Nutrition, Food Security and Livelihoods, International Medical Corps, Beirut, Lebanon
  1. Correspondence to Professor Jocelyn DeJong; jd16{at}


Introduction Women and children account for a disproportionate morbidity burden among conflict-affected populations, and yet they are not included in global accountability frameworks for women’s and children’s health. We use Countdown to 2015 (Millennium Development Goals) health indicators to provide an up-to-date review and analysis of the best available data on Syrian refugees in Jordan, Lebanon and Turkey and internally displaced within Syria and explore data challenges in this conflict setting.

Methods We searched Medline, PubMed, Scopus, Popline and Index Medicus for WHO Eastern Mediterranean Region Office and relevant development/humanitarian databases in all languages from January 2011 until December 2015. We met in person or emailed relevant key stakeholders in Lebanon, Jordan, Syria and Turkey to obtain any unpublished or missing data. We convened a meeting of experts working with these populations to discuss the results.

Results The following trends were found based on available data for these populations as compared with preconflict Syria. Birth registration in Syria and in host neighbouring countries decreased and was very low in Lebanon. In Syria, the infant mortality rate and under-five mortality rate increased, and coverage of antenatal care (one visit with a skilled attendant), skilled birth attendance and vaccination (except for DTP3 vaccine) declined. The number of Syrian refugee women attending more than four antenatal care visits was low in Lebanon and in non-camp settings in Jordan. Few data were available on these indicators among the internally displaced. In conflict settings such as that of Syria, coverage rates of interventions are often unknown or difficult to ascertain because of measurement challenges in accessing conflict-affected populations or to the inability to determine relevant denominators in this dynamic setting.

Conclusion Research, monitoring and evaluation in humanitarian settings could better inform public health interventions if findings were more widely shared, methodologies were more explicit and globally agreed definitions and indicators were used consistently.

  • public health
  • maternal health
  • child health

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

View Full Text

Statistics from


  • Contributors JD initiated and led the overall research project and the writing of this manuscript, had full access to all data collected and took the final decision to publish. HG supervised the data extraction and oversaw the quality control on the data collected. HB took the lead in providing the Syrian public health perspective and data sources particularly on the internally displaced within Syria. RM served as study coordinator and travelled to Turkey to meet with stakeholders. RM, CA and AR conducted the literature search and data extraction and contributed sections of the text. All authors had access to the full data, contributed to the conceptualisation and execution of the project and to the literature review and writing, and approved the final draft.

  • Funding US Fund for UNICEF (as part of the Gates Foundation grant to Countdown to 2015: Maternal, Newborn and Child Survival).

  • Competing interests The authors declare no conflict of interests. Jocelyn DeJong is a member of the Countdown to 2030 Coverage Working Group and has argued for the inclusion of conflict countries in the Countdown to 2030 process, and is currently contributing to a strategy for so doing.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.