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Report RUNOMI Guest Lecture Dr Souha Kanj

Report RUNOMI Guest Lecture Dr Souha Kanj 12 January 2021 (Zoom)

Dr Souha Kanj gave a very enlighten lecture on the risk of infections among refugees and their limited access to public health in times of crisis in Lebanon – a country that was and still is confronted with a multitude of crises from the Middle-East conflict and hosting the largest number of refugees per capita in the world.

Dr Kanj placed this medical issue into its socio-economic context and started out by giving some background information on not only Lebanon, but the Arab world in general. Since 2001, the Arab world has been one of the regions worst affected by wars and there are still ongoing civil wars today. Lebanon’s civil war in the 20th century lasted from 1975-1990. After 15 years of conflict, Lebanon was rebuild and the capital city Beirut regained its nickname “Paris of the Middle-East” in the 90s.

Unfortunately, the nickname did not remain for long, as Lebanon was heavily affected by the Syrian war in 2011, being one of the countries with the largest number of Syrian refugees next to Turkey and Jordan. Lebanon repeatedly became host country, just as during the Palestinian exodus in 1947, when Lebanon hosted Palestinian refugees – and is still doing so until this day. Over half a million Palestinian refugees where registered in camps in Lebanon in 2019.

Although there is a slight difference in infrastructure between Palestinian and Syrian camps, refugees in both types have to endure polluted water – only one of the health issues connected to those camps. The fragmented health care system fortifies these issues, leaving the majority of refugees depended on non-governmental help of NGO’s such as Médecins Sans Frontières.

In 2014, Dr Kanj wrote a review on wars and infectious diseases together with her daughter Sima L. Sharara (see also https://doi.org/10.1371/journal.ppat.1004438). For this lecture, Dr Kanj gave an overview of infectious diseases related to refugee crisis.

Contagious leishmaniasis was one of the examples, a disease heavily reported outside endemic areas of Syria. In Lebanon, this disease was not commonly known prior to the Syrian war, as they have been two cases per year only. During the Syrian war, however, the risk factors (especially among refugees) such as poor housing, weak immune system, population displacement, financial disadvantage and environmental factors grew – and so did the reported cases of contagious leishmaniasis. In 2013, 1033 cases were reported in Lebanon of which 96.6% were among Syrian refugees, the remaining 3.4% involved both Lebanese nationals and Palestinian refugees.

Other diseases have similar narratives, such as poliomyelitis, measles, hepatitis A and tuberculosis, demonstrating the vulnerability of displaced people on the move and the increased health risks during times of war. Another major concern of Dr Kanj is the growing antimicrobial resistant bacteria among (Syrian) refugees in Lebanon, meaning the development of antibodies towards drugs and therefore limiting the options of treating certain diseases.

Dr Kanj then elaborated on recent political and global developments that have added on the precarious situation of Lebanon in general and of refugees in Lebanon specifically:

The Lebanese revolution of 2019 led to a heavy devaluation of the Lebanese currency, turning a middle income country (as it was reported in 2018) into a country where a quarter of the population lives below the World Bank Poverty Line. This financial crisis also hit the refugees, because they are mainly paid in Lebanese lira, but the devaluation makes it worth much less.

In February 2020, the first cases of COVID-19 were reported and although panic and scares helped to enforce social distancing in the beginning of the spread of the virus, there has been a sharp increase by July, heavily affecting refugee camps. When assessing the impact of the economic and COVID-19 in Lebanon, the World Food Program confirms that 75% of Syrian refugees in Lebanon felt worried about not having enough food to eat in June 2020.

The tragic Beirut port blast in August 2020 complicated the situation in the capital, leaving 3000 people homeless, 6000 injured and 200 dead. Three major hospitals reported non-functional and two others substantial damage; 17 containers with essential medical supplies were destroyed – leading to a catastrophic setting where medical equipment was re-used in the emergency rooms. Refugees of all nationalities living in areas surrounding the blast location were severely affected.

Dr Kanj gave a very enlighten overview on the many public health challenges currently in Lebanon imposed by wars, refugee crisis, political unrest, and total economic collapse. She concluded that health consequences are much more than the collateral damage inflicted on civilians, infrastructure, environment and health systems – with refugees being one of the major groups at risk.

Dr Souha Kanj
Souha Kanj is currently a tenured Professor of Medicine at the American University of Beirut Medical Center, Lebanon and Consulting Professor at the Duke University Medical Center (DUMC), NC, USA where she also undertook her training in Internal Medicine and Infectious Diseases (ID). She was an associate at the Howard Hughes Medical Institute. She founded the ID transplant program at DUMC before joining AUBMC where she is currently Head of the ID Division, Chair of the Infection Control and Prevention Program, and Co-Chair of the Antimicrobial Stewardship Program.

She has published more than 200 manuscripts in international journals such as CID, Lancet ID, and JAMA. She has also been an invited author of numerous book chapters and UpTodate cards and is currently Principal Investigator on research projects on Antimicrobial Resistant (AMR) Bacteria. She has contributed greatly to the work of the WHO in various programs, such as the R&D Blueprint Annual Review of Priority Diseases, the Global Infection Prevention and Control Network, and the WHO Priority Pathogens List for AMR Bacteria. She was elected to the Executive board of the International Society of Antimicrobial Chemotherapy (ISAC) and was a co-chair of the Stewardship Study group. She is a member of the Scientific Affairs Subcommittee of The European Society of Clinical Microbiology and Infectious Diseases (ESCMID).

She has a broad range of research interest and more recently has focused her efforts on Antimicrobial Resistance and fungal infections.

Dr Kanj is a fellow of the American College of Physicians (FACP), the Infectious Diseases Society of America (FIDSA), The Royal College of Physicians (FRCP), the European Confederation of Medical Mycology (FECMM) and FESCMID.

In 2014, she was invited as a Visiting Scholar Professor at DUMC, and in 2018 at Radboud University Medical Centre (UMC), Nijmegen, Netherlands where she received the Valkhof professorship award.

She is the recipient of numerous honours and awards throughout her career, including the Lebanese National Council for Scientific Research award in 2014, the Abdul Hameed Shoman award for researchers in the Arab world in 2017. In October 15, 2020 she received an Honorary Doctorate degree from Radboud UMC.