title: Communicable disease surveillance and control in the context of conflict and mass displacement in Syria.
abstract: OBJECTIVE
  To describe trends in major communicable diseases in Syria during the ongoing conflict, and the challenges to communicable disease surveillance and control in the context of dynamic, large-scale population displacement, unplanned mass gatherings, and disruption to critical infrastructure.
  
  
  METHODS
  A rapid review of the peer-reviewed and non-peer-reviewed literature from 2005 to 2015 was performed, augmented by secondary analysis of monitoring data from two disease early warning systems currently operational in Syria, focusing mainly on three diseases: tuberculosis (TB), measles, and polio.
  
  
  RESULTS
  Trend data show discrepancies in case report numbers between government and non-government controlled areas, especially for TB, but interpretation is hampered by uncertainties over sentinel surveillance coverage and base population numbers. Communicable disease control has been undermined by a combination of governance fragmentation, direct and indirect damage to facilities and systems, and health worker flight.
  
  
  CONCLUSIONS
  Five years into the crisis, some progress has been made in disease surveillance, but governance and coordination problems, variable immunization coverage, and the dynamic and indiscriminate nature of the conflict continue to pose a serious threat to population health in Syria and surrounding countries. The risk of major cross-border communicable disease outbreaks is high, and challenges for health in a post-conflict Syria are formidable.
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, Reynolds Building, St. Dunstan's Road, London W6 6RP, UK. Electronic address: sharif.ismail15@imperial.ac.uk.
authors.forename: Sharif A
authors.initials: SA
authors.lastname: Ismail
authors.affiliation: Department of Infectious Diseases, Imperial College London, UK.
authors.forename: Aula
authors.initials: A
authors.lastname: Abbara
authors.affiliation: School of Social and Community Medicine, Bristol University, Bristol, UK.
authors.forename: Simon M
authors.initials: SM
authors.lastname: Collin
authors.affiliation: Conflict and Health Research Group, King's College London, London, UK.
authors.forename: Miriam
authors.initials: M
authors.lastname: Orcutt
authors.affiliation: Department of Politics and International Studies, University of Cambridge, Cambridge, UK.
authors.forename: Adam P
authors.initials: AP
authors.lastname: Coutts
authors.affiliation: Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Florida, USA.
authors.forename: Wasim
authors.initials: W
authors.lastname: Maziak
authors.affiliation: University of Illinois, Chicago, Illinois, USA.
authors.forename: Zaher
authors.initials: Z
authors.lastname: Sahloul
authors.affiliation: Public Health England, London, UK.
authors.forename: Osman
authors.initials: O
authors.lastname: Dar
authors.affiliation: Department of Infectious Diseases, London North West NHS Healthcare Trust, London, UK.
authors.forename: Tumena
authors.initials: T
authors.lastname: Corrah
authors.affiliation: Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: Fouad M
authors.initials: FM
authors.lastname: Fouad
mesh_terms: D000328:Adult; D002648:Child; D003140:Communicable Disease Control; D004196:Disease Outbreaks; D006801:Humans; D007114:Immunization; D008457:Measles / Q000453:epidemiology*; D011051:Poliomyelitis / Q000453:epidemiology* / Q000517:prevention & control; D012036:Refugees; D018571:Sentinel Surveillance; D013593:Syria; D014376:Tuberculosis / Q000453:epidemiology*
keywords: Communicable disease; Conflict; Mass gathering; Public health; Syria