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Background

Armed conflict began in the Syrian Arab Republic (Syria) in March 2011, rapidly escalating to civil war () and a prolonged conflict situation (see and ). The crisis lasted 14 years, with profound economic and humanitarian impact. More than 14 million people were forcibly displaced (refugees and internally displaced people - IDP). On 8 Dec 2024, military forces including��Hayat Tahrir Al-Sham (HTS) took back Damascus in a period of days, ending the civil war. Since then, to their country, and 500,000 IDP returned to north-west Syria.��

• Syrians make up one of the largest refugee populations globally, with���������ǰ��پ��Բ� 3.74M��registered Syrian refugees (Jan 2026, a 1M decrease over 12m); 51.4%��are children <18 years. Syrian refugee populations are predominantly in Turkiye (2.33M), Lebanon (532K),�� Jordan (413K), Iraq (308K) and Egypt (114K). Large numbers of Syrian refugees�� reached - with an influx of around 700K Syrian asylum seekers in 2015-16 and ongoing flows (more than 100k asylum applications each year - see ).
• As of end 2025 - more than 16.7M��Syrians need humanitarian assistance (see �����Ի���), and 9.1M��people are food insecure (), and the humanitarian situation remains difficult, with the need to rebuild health services and infrastructure.
  
• In June 2022, the with 350K documented deaths, including 143K��documented civilian deaths and a further estimated 164K civilian deaths. Earlier (2016) estimates from the �����ܲ�������ٱ�� 11.5% population had been killed or injured, with 1.9M people wounded.�� �� �� ��
  

Demography

• Population - Syria’s pre-conflict population was 22.8M (World Bank 2013) and current is 24.7M (). Approximately 90% Syrians are Arab descent, the largest minority is Kurdish (~9%).��
• Languages - official language is Arabic; Kurdish, Armenian, Aramaic, and Syriac are also spoken. French and English may be additional languages in educated groups.��
• Religion - predominantly Sunni Muslim (70-75%), minority Christian (~10%), Alawite Shi'a (<10%) and other populations
• Education -��prior to conflict, Syria had almost 100% primary school enrolment and literacy rates over 90%, although a of pregnant Syrian women in Lebanon found 75% had no or primary level education. A�� of Syrian refugees in Jordan (outside camps) found <25% had completed secondary school and a of Syrian refugees in Jordan found 15% adults had completed secondary/post-school education, and 21% of 17-year olds were attending secondary school.

Other

• Living conditions for Syrian refugees in other countries have been difficult, with overcrowding, poor sanitation, food scarcity, and variable availability of shelter. Conditions are often more difficult outside of established camps and settlements. The large volume of Syrian refugees over many years has placed significant strain on host countries’ health systems, public finance and security; and created tension between refugee and host populations (, 2022 Oxfam summary , of conditions in/outside camps in Jordan).
• Health - The conflict decimated Syrian health systems, with a dramatic drop in life expectancy, especially for males, loss of health services, health staff, pharmaceutical production capacity and immunisation programs (see ), also with implications for . There were significant communicable diseases outbreaks, including polio in 2013, measles in 2014, 2017 and 2018, typhoid in 2018, and leishmaniasis (>78,000 cases by 2021), with subsequent impact from the Covid pandemic. High prevalence of disability (25% in 2021), mental health problems and exposure to violence and traumatic experiences are reported.
  
• Economy - currency - Syrian pound - in 2022, inflation in Syria was 85% (see ), and .
• Education - school attendance was <30% by 2013, and by 2015��there were 2.6 - 2.8 million children out of school. UNICEF reported thousands of schools were damaged, or turned into shelters/storage/military bases. In 2023, there were still 2M Syrian children out of school and a further 1.6M at risk of stopping school ().
• Earthquakes -��on 6 Feb 2023, a 7.8 magnitude earthquake struck central/south Turkiye and north/western Syria, causing damage over an area of 350,000 km2, killing more than 59,000 people, injuring more than 121,000 people and displacing 15.7M people in Turkiye and 5.4M in Syria (see ).

Australian response

Australia has provided more than $600M in humanitarian support for Syria since 2011, including a $249M Syria Crisis Humanitarian and Resilience Package (2017-20) - see . On 9 Sep 2015, Australia announced an��intake of 12,000 Syrian and Iraqi refugees (in addition to the existing humanitarian intake - see ���Ի���), with priority to those: i) assessed to be most vulnerable – women, children, and families with the least prospect of ever returning safely and ii) located in Lebanon, Jordan, and Turkey. This group arrived in Australia in late 2016/early 2017.��

Pre-arrival health screening

All permanent migrants to Australia, including humanitarian entrants, undergo an Immigration Medical Examination (IME) 3-12 months before travel. Humanitarian entrants are offered an additional Departure Health Check (DHC), see summary on Initial assessment guideline, and also����(Nov 2025) ���Ի�����(Aug 2024).

• From 2015, the additional intake of Syrian and Iraqi refugees underwent enhanced pre-migration screening, combining the IME and DHC, with additional screening tests.��Additional screening included hepatitis B sAg (all ages), tuberculosis (TB) screening (TST or IGRA) in children 2-10 years, mental health screening for children and adults, and extended immunisation (polio, MMR and DT-containing vaccines for all ages, using hexa- or pentavalent vaccines in children <10 years). These changes have since incorporated been into the IME on a permanent basis.
  

Health screening

All Syrian arrivals should have an��initial health assessment��and catch-up immunisation. Immediate health triage (for all ages) should assess for acute physical health issues (including malnutrition and injuries), acute mental health issues, disability, frailty/mobility issues in elders, pregnancy and medication type and supply.��

Recommended health assessment Syrian arrivals

Recommended investigations are based on the , updated based on prevalence (including HCV screening for adults). Malaria screening is not required.

Screening tests children��

• All:��FBE/film, ferritin, vit D/ALP, IGRA or TST, HBsAg, cAb, sAb,��Strongyloides, Schistosoma, faecal COP��
• Age/risk based: nutrition, including B12/folate,��HCV, HIV (15y+/clinical/UHM), STI screening, syphilis (clinical/UHM),��, H pylori (symptoms)

Screening tests adults

• All:��FBE/film, IGRA, HBsAg, cAb, sAb, HCV, HIV,��Strongyloides, Schistosoma, , faecal COP
• Age/risk based:��ferritin (women, men with RF), vit D, nutrition, including B12/folate/nutrition (especially for breastfeeding women), rubella (women), STI screening, syphilis, H pylori (Sx)
  
• Catch-up primary care:��
  • ��- 45-79 years, each 5 years, BP 18y+ opportunistically each 2 years;��lipids��- 45 years+, frequency varies with risk,��
  • ��– general risk: >40y using��, each 3 years; high risk: BSL or HbA1C, each 3 years, more often (+extra tests) if abnormal results;��
  • ��- based on risk, Albumin:creatinine & eGFR, each 1-2 years (CKD handbook)
  • ��- FOBT 45-74 years, each 2 years, extra screening high risk
  • ��- Mammogram women 50-74y, each 2 years; ≥40y if moderately increased risk
  • ��- HPV test women 25-74y, each 5 years (clinician or self-collected)

Catch-up immunisation

Prior to the conflict, Syria had a strong immunisation program and high compliance with vaccinations (coverage >95%). The����includes: BCG, DTwP-Hib-HepB, OPV/IPV, MMR and influenza vaccine, in the following schedule:

Missing compared to Australian schedule:��rotavirus, pneumococcal, meningococcal ACWY, (meningococcal B - risk groups only), varicella, zoster, and HPV. Also consider both covid and influenza vaccines.

• Catch-up immunisation��is required for all new arrivals,��including full catch-up for anyone without a written vaccination record.��
  
• Note��- RCH/MVEC protocols for catch-up vaccination after chemotherapy use infanrix-hexa and MMR-V up to age 18y, this reduces needles required, and we use this in practice. AIR will accept these vaccines for adolescents, **AIR data entry - use��other, and enter by��antigen, and then accept queries.��
• Translated catch-up information:����,��,��.

Prevalence data for Syria

Immunisation

• Immunisation coverage fell from , leaving large numbers of children unimmunised or under-immunised
  • Polio - after eradication in 1999, polio re-emerged in Syria in 2013 and 2014 (). Cases were reported in Syrian refugees in Iraq (see ��and ); , and there was an outbreak of vaccine derived polio in 2017 ().�� continued, and after an 18-month intensive vaccination campaign, the outbreak was closed in .��
  • Measles - outbreaks were reported in Syria and surrounding countries from the start of the conflict, with ��in 2013, and large scale outbreaks in (with ~18,000 cases), and subsequent mass vaccination campaigns.
    

Hepatitis and HIV

• Hepatitis A outbreaks were reported in Syria, with , and , notably in adolescents. Further outbreaks occurred in , ���Ի���.
• Hepatitis B��virus (HBV) - prevalence of ��- medium endemic. HBV immunisation coverage was high in children born <2011, so children aged over 15 years (in 2026) are likely to be immune to HBV.�� 2015 IOM screening data in Syrian refugees found HBV prevalence of 1.5%, and a of 488 unaccompanied Syrian minors in Germany found��0% had HBV.
• Hepatitis C virus (HCV) - prevalence of . 2015 IOM screening data in Syrian cohorts found HCV prevalence of 0.5%.
• HIV - prevalence of HIV in Syria is��.�� in 26,166 Syrian arrivals found 0% prevalence and 2015 IOM screening data in Syrian cohorts found HIV prevalence of 0.11%.
  • ��of 128 Syrian and Iraqi refugee children found no cases of HBV, HCV or HIV infection, 70.3% children were immune to HBV (HBsAb+).

Tuberculosis

• Tuberculosis��- showed incidence of 22.7/100,000 population, and 1.0% new cases as MDR/RR-TB.�� of 69,000 Syrian refugees in Jordan found only 3 smear positive cases and a total of 33 culture confirmed cases. 45% of those screened were children, and children <15 years had significantly lower disease prevalence than the general screened population. in Syrian cohorts found 0% prevalence TB disease in 26,166 arrivals. 2015 IOM screening data in Syrian cohorts found prevalence of CXR consistent with TB disease was 1.6%. ����
  • of 128 Syrian and Iraqi refugee children found 11.8% had positive post arrival TB screening results (all LTBI).
    

Parasites

• Cutaneous leishmaniasis (CL) is a parasitic disease caused by approximately 20 species of the Leishmania parasite, with L. tropica and L. major being most prevalent in the Middle East. ��- with Leishmania tropica in 85% and L. major in 15%. CL is transmitted by sandflies, with peak incidence in the summertime (May – Oct).��CL presents with ulcerated skin lesion and local lymphadenopathy��See����and .��, >89,000 cases were reported in Syria in��, and >78,000 in . �� �� ����
• Schistosomiasis (primarily S. haematobium) was endemic in Syria and surrounding countries. is considered to be eliminated in Iran, Lebanon, Morocco and Tunisia, and low endemnicity achieved in Syria, Jordan, Libya, Oman and Saudi Arabia. A on 488 unaccompanied Syrian minors in Germany found positive Schistosoma serology in 1.4%.��
• Strongyloides infection - a documented a general prevalence of 0.03% in Jordan, 0.6% in Turkey, 0.6% in Iran, but 24.2% prevalence in a hospital-based survey in Iraq.
• Other - a of 488 unaccompanied Syrian minors in Germany found Giardia in 7%.
  • ��of 128 Syrian and Iraqi refugee children found 3.2% prevalence of Strongyloides, but no cases of Schistosoma or faecal parasites (noting Albendazole used offshore).

Other infections

• Skin infections - Increased rates and outbreaks of scabies, lice, and bacterial skin infections were common and reported by ��and others.
• Syphilis - in Syrian cohorts found 0% prevalence in 26,166 arrivals. 2015 IOM screening data found prevalence of 0.26%. ��

Nutrition

• Syrian children remain at risk for poor nutrition, with high risk of both macronutrient (energy intake/protein) and micronutrient (vitamins and trace elements) deficiencies. reported more than 609,900 children <5 years were stunted.����
• Low vitamin D is common, especially in veiled women and girls. Studies of vitamin D deficiency in refugees to Australia from the Middle East show a prevalence of 20-66%, a of 128 Syrian and Iraqi refugee children found 63.6% had low vitamin D.
  

Non communicable diseases (NCD)

• A of 1550 Syrian refugees outside refugee camps in Jordan reported prevalence for NCD in adults: hypertension 9.7%, arthritis 6.7%, diabetes 5.3%, chronic respiratory diseases 3.1%, cardiovascular disease 3.7%. The prevalence was higher in people aged >40 years. In this study, people with tertiary education and those with primary level education had markedly lower rates of seeking care than those with no education.
• A of 210 older (>= 60 years) Syrian and Palestinian refugees in Lebanon found 2/3 described their health as poor/very poor, and reported the prevalence of NCD was: hypertension 60%, diabetes 47%, and heart disease 30%. Functional impairment was common: difficulty walking 47%, visual impairment 24%, hearing impairment 18%, 10% were unable to leave their homes due to disability, and 4% were bedridden; 64% were independent in activities of daily living.
  

Mental health, trauma

• High rates of post-traumatic stress disorder (PTSD), depression, and anxiety are reported in Syrian refugees arising from mass displacement, exposure to conflict and violence, including sexual violence, and with many people experiencing death or loss of family members.��The conflict produced a high proportion of female-headed households – the loss of fathers and of family integrity creating acute and ongoing stress for mothers and children. In addition, millions of children lost the physical, mental, and social protective environment provided by schools and education.
  • A ��of 6357 Syrian IDPs and refugees in Lebanon, Jordan, and Turkey receiving mental health services found: adults:��54% severe emotional disorders, including depression and anxiety, and 11% had psychotic disorders; and in children 27% had developmental disorders and 3.6% had severe emotional disorders.
  • A of 765 Syrian refugees in Jordan (86% aged 18-49 years) found one third had significant depression, and that 35-40% had comorbidities
  • The ) reports a 2020 WHO nationwide survey found prevalence of 44% severe mental disorders, 27% both severe mental disorders and PTSD and 37% PTSD; >60% of people were traumatised by war experiences, >40% had experienced direct military attack, >33% had experienced disappearance/killing of relatives, 20% had been tortured, and >6% had been raped.��

Gender based violence, early marriage

• The Syrian crisis included systematic gender-based violence against women and girls (). Women and girls may have been subject to sexual violence or early marriage, which may be seen as a means to .��
  • A of 452 Syrian refugee women aged 18-45 years in Lebanon found 30.8% had experienced conflict-related violence, and 3.1% had experienced non-partner sexual violence. Most women (64.6%) who had experienced violence did not seek medical care.
  • A in Syrian refugee women and girls in Lebanon found >1/3 had married before 18 years and 24% of 15-17 year old girls were married; with increasing prevalence of child marriage over the conflict.
  • A of Syrian refugees in Jordan found 14% of 15-year olds were married.
• Rates of family violence were high in the Syrian population pre-conflict - a reported 67% of women experienced “punishment” by their husbands, and a ��found that one-third of women in Syria experienced family violence.
  

Sexual and reproductive health (SRH)

• The adolescent fertility rate for girls 15-19 years was 39/1000 () compared to 7/1000 in Australia.��
• A of 452 Syrian refugee women aged 18-45 years in Lebanon found more than half had gynaecologic problems, pregnancy/delivery complications were common, and 34.5% were using contraception/family planning, compared to 58.5% pre-conflict.
• A of 420 pregnant Syrian women in Lebanon found 83% received some form of antenatal care, although only 15.7% had the expected 4 antenatal visits. Care was more likely in UNHCR refugees, and less likely in older women and women with less education. Nearly 60% had inadequate dietary intake of folate, and vitamins, 90% had not received the recommended tetanus prophylaxis. Rates of smoking were low (9.5%).
  
• A on Toxoplasma serology in pregnant women found rates of nearly 5% toxoplasma IgM positive in pregnant Syrian refugees in Turkey, which was more than double the rates for the local population.
• A described barriers to SRH for Syrian refugees in Jordan, noting a higher total fertility rate (4.7 children per woman vs 2.6 in Jordan), and high rates of IPV, sexual violence, forced marriage, unintended pregnancy and unsafe births.
• A on pregnancy outcomes for 1065 Syrian refugee women in Lebanon found increased rates of caesarean deliveries, spontaneous abortions and maternal complications, reduced pregnancy spacing and decreased breastfeeding rates.

Disability

• In 2015, reported��more 1M people had been wounded in the conflict, with many injuries resulting in longer-term disability. In 2016, the�� reported 1.9M people have been wounded.��
• A found 19% of children 2-17 years had a disability.

Resources

• (2021)
• ASID-RHEANA Refugee Guidelines��(2016)
  
  • ASID guidelines country-based screening
• Syrian Centre for Policy Research - ��(2023)
• UNHCR ��and ,

_{RCH Immigrant Health - additional information. Authors: Karen Kiang and Georgie Paxton. Initial Sep 2015, updated Feb 2026. Contact: georgia.paxton@rch.org.au}