New Generation of Syrians Were Born in Exile

Syrian women wait at a clinic in the Zaatari camp - AFP
Syrian women wait at a clinic in the Zaatari camp - AFP
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New Generation of Syrians Were Born in Exile

Syrian women wait at a clinic in the Zaatari camp - AFP
Syrian women wait at a clinic in the Zaatari camp - AFP

Ten years after fleeing war in her native Syria, Hadeel is expecting a third child, brought into a life of poverty and uncertainty at the Zaatari refugee camp in Jordan.

The camp, 50 kilometers (30 miles) north of the capital Amman, is home to some 80,000 Syrian refugees, according to the United Nations.

Half of the camp's residents are children, and many have no memory of Syria.

"I was hoping to be at home, in my country," Hadeel said, asking to use a pseudonym for safety concerns.

"Fate decided I would be here, get married and give birth to my children here."

Like most refugees in the camp, she and her family arrived from Syria's southern Daraa province, the cradle of the 2011 uprising against the regime of President Bashar al-Assad.

The ensuing war has killed nearly half a million people and displaced around half of the country's pre-war population.

Hadeel, who is six months pregnant, married a Syrian refugee who also lives in Zaatari, and the couple have two children, aged six and seven.

At least 168,500 Syrian babies have been born in Jordan since 2014, according to the UN, part of an estimated one million children born to Syrians in exile across the world over the same period.

Many are born in overcrowded refugee camps, with limited access to education and the threat of child labor and forced marriage hanging over them.

Sat on a red plastic chair in a large hall, Hadeel awaited a checkup at the only clinic in the camp that delivers babies.

"My children grew up here. When they hear me talking to other women about Syria, they ask me, 'Mama, where is Syria? Why do we live in this?'" said Hadeel.

"I try to explain to them that this is not our country. We are refugees. It's difficult for them to understand".

Some 675,000 Syrian refugees are registered with the UN in Jordan, but Amman estimates the real figure to be about twice that and says the cost of hosting them has exceeded $12 billion.

While fighting in southern Syria has abated, Hadeel said it still is not safe enough to return.

Her cousin, "fed up" with the camp, returned to Syria earlier this year.

He was killed less than a month later, and his widow and five children still in Zaatari do not know how he died.

"The bad security situation makes us think a thousand times before returning," Hadeel said.

The maternity ward at the UN-run clinic -- the camp's biggest health facility with 60 staff including 21 midwives -- has 10 beds.

The clinic's director Ghada al-Saad said the facility "works 24/7, offering everything for free, including medicines, treatments, tests and vaccinations" up to the age of two.

Midwife Amon Mustafa, 58, who has worked there since the camp opened in 2012, checks on the new mothers.

"We deliver between five and 10 babies every day, with the five today, the total number of births in the camp has reached 15,963," Mustafa said.

"I know most of the women and children in the camp," she added with a smile.

Nagham Shagran, 20, holding her newborn son, has spent nine years in the camp, where she and her cousin married.

"At first we hesitated to have our first child," she said. "Every human... has the right to be born and live in his or her country, but what can we do?"

Mustafa said staff "are trying" to educate women on family planning and the use of contraceptives, but uptake is limited.

"Children are a blessing, but I hope this will be my last pregnancy,"said Eman Rabie, 28, expecting her fourth child. "My husband loves children; he says they are a blessing from God."

Rabie's home in Daraa was destroyed during the war.

"If we are asked to leave the camp and go back to Syria," she said, "I will be the last to leave".



New Mpox Strain Is Changing Fast; African Scientists Are ‘Working Blind’ to Respond 

Dr. Robert Musole, medical director of the Kavumu hospital (R) consults an infant suffering from a severe form of mpox at the Kavumu hospital, 30 km north of Bukavu in eastern Democratic Republic of Congo, August 24, 2024. (AFP)
Dr. Robert Musole, medical director of the Kavumu hospital (R) consults an infant suffering from a severe form of mpox at the Kavumu hospital, 30 km north of Bukavu in eastern Democratic Republic of Congo, August 24, 2024. (AFP)
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New Mpox Strain Is Changing Fast; African Scientists Are ‘Working Blind’ to Respond 

Dr. Robert Musole, medical director of the Kavumu hospital (R) consults an infant suffering from a severe form of mpox at the Kavumu hospital, 30 km north of Bukavu in eastern Democratic Republic of Congo, August 24, 2024. (AFP)
Dr. Robert Musole, medical director of the Kavumu hospital (R) consults an infant suffering from a severe form of mpox at the Kavumu hospital, 30 km north of Bukavu in eastern Democratic Republic of Congo, August 24, 2024. (AFP)

Scientists studying the new mpox strain that has spread out of Democratic Republic of Congo say the virus is changing faster than expected, and often in areas where experts lack the funding and equipment to properly track it.

That means there are numerous unknowns about the virus itself, its severity and how it is transmitting, complicating the response, half a dozen scientists in Africa, Europe and the United States told Reuters.

Mpox, formerly known as monkeypox, has been a public health problem in parts of Africa since 1970, but received little global attention until it surged internationally in 2022, prompting the World Health Organization to declare a global health emergency. That declaration ended 10 months later.

A new strain of the virus, known as clade Ib, has the world's attention again after the WHO declared a new health emergency.

The strain is a mutated version of clade I, a form of mpox spread by contact with infected animals that has been endemic in Congo for decades. Mpox typically causes flu-like symptoms and pus-filled lesions and can kill.

Congo has had more than 18,000 suspected clade I and clade Ib mpox cases and 615 deaths this year, according to the WHO. There have also been 222 confirmed clade Ib cases in four African countries in the last month, plus a case each in Sweden and Thailand in people with a travel history in Africa.

"I worry that in Africa, we are working blindly," said Dr. Dimie Ogoina, an infectious diseases expert at Niger Delta University Hospital in Nigeria who chairs the WHO's mpox emergency committee. He first raised the alarm about potential sexual transmission of mpox in 2017, now an accepted route of spread for the virus.

"We don’t understand our outbreak very well, and if we don't understand our outbreak very well, we will have difficulty addressing the problem in terms of transmission dynamics, the severity of the disease, risk factors of the disease," Ogoina said. "And I worry about the fact that the virus seems to be mutating and producing new strains."

He said it took clade IIb in Nigeria five years or more to evolve enough for sustained spread among humans, sparking the 2022 global outbreak. Clade Ib has done the same thing in less than a year.

MUTATING 'MORE RAPIDLY'

Mpox is an orthopoxvirus, from the family that causes smallpox. Population-wide protection from a global smallpox vaccine campaign 50 years ago has waned, as the vaccinating stopped when the disease was eradicated.

Genetic sequencing of clade Ib infections, which the WHO estimates emerged mid-September 2023, show they carry a mutation known as APOBEC3, a signature of adaptation in humans.

The virus that causes mpox has typically been fairly stable and slow to mutate, but APOBEC-driven mutations can accelerate viral evolution, said Dr. Miguel Paredes, who is studying the evolution of mpox and other viruses at Fred Hutchison Cancer Center in Seattle.

"All the human-to-human cases of mpox have this APOBEC signature of mutations, which means that it's mutating a little bit more rapidly than we would expect," he said.

Paredes and other scientists said a response was complicated by several mpox outbreaks happening at once.

In the past, mpox was predominantly acquired through human contact with infected animals. That is still driving a rise in Congo in clade I cases – also known as clade Ia - likely due in part to deforestation and increased consumption of bushmeat, scientists said.

The mutated versions, clade Ib and IIb, can now essentially be considered a sexually transmitted disease, said Dr. Salim Abdool Karim, a South African epidemiologist and chair of the Africa CDC’s mpox advisory committee. Most of the mutated clade Ib cases are among adults, driven at first by an epidemic among female sex workers in South Kivu, Congo.

The virus also can spread through close contact with an infected person, which is likely how clusters of children have been infected with clade Ib, particularly in Burundi and in eastern Congo’s displacement camps, where crowded living conditions may be contributing.

Children, pregnant women and people with weakened immune systems or other illnesses may be at greater risk of serious mpox disease and death, say the WHO and mpox scientists.

Clade I has typically caused more severe disease, with fatality rates of 4%-11%, compared to around 1% for clade II. Ogoina said data from Congo suggests few have died of the new Ib version, but he feared some data is being mixed up.

More research is urgently needed, but three teams tracking mpox outbreaks in Africa say they cannot even access chemicals needed for diagnostic tests. Clade Ib can also be missed by some diagnostic tests.

Planning a response, including vaccination strategies, without this is difficult, the scientists said.

Karim said around half of cases in eastern Congo, where Ib is particularly prevalent, are only being diagnosed by doctors, with no laboratory confirmation.

Getting samples to labs is difficult because the healthcare system is already under pressure, he said. And around 750,000 people have been displaced amid fighting between the M23 rebel group and the government.

Many African laboratories cannot get the supplies they need, said Dr. Emmanuel Nakoune, an mpox expert at the Institut Pasteur in Bangui, Central African Republic, which also has clade Ia cases.

"This is not a luxury," he said, but necessary to track deadly outbreaks.