GD01 War, conflict and displacement: a clinical vignette of current dermatological issues in affected nations

Abstract Global wars, conflicts and displacement have created conditions that increase the risk of opportunistic skin infections. Of the 70.8 million displaced people worldwide, 25.9 million are refugees, 41.3 million are internally displaced persons (IDPs) and 3.5 million are asylum seekers. During crises, access to dermatological care declines compared with peace time. The humanitarian crisis in Gaza has internally displaced 1.5 million people. Sixteen of Gaza’s 36 hospitals are partially operational, and 20 have closed, leaving 1822 beds. Consequently, this has resulted in poor sanitation increasing exposure to pests and waste. Of 31 000 people screened for skin diseases, over 4000 were positive. Within a month of the conflict’s onset in October 2023, 8944 cases of scabies and lice, 1005 cases of varicella zoster and 12 635 cases of skin rashes were reported. Dermatology provision is limited, but the Palestine Children’s Relief Fund has previously supported Dr Patricia Senet, a dermatologist, on a medical mission to Gaza. Psychodermatology data is scarce, but exposure to war can lead to post-traumatic stress disorder in up to 50% of adults, with similar data on depression and anxiety, which can exacerbate skin conditions. Médecins Sans Frontières (MSF) have provided over 8800 psychosocial support sessions. Cutaneous leishmaniasis is a neglected tropical disease in occupied Palestinian territory, with no data on prevalence in Gaza. Teledermatology may be a solution, but its feasibility is hindered by the destruction of 50% of the telecommunications infrastructure, damage to 75%, and the deaths of 1057 healthcare workers. Refugee health similarly suffers. Sudan has suffered from internal wars: in rural Sudan, 88.8% of people from orphanages and refugee camps had a skin condition, with fungal infections the most common (32.6%). In Cox’s Bazar, Bangladesh, where Rohingya refugees live, there is a scabies endemic: 730 000 cases were treated in 2021, accounting for 90% of all skin diseases at MSF clinics. An analysis of skin disease and needs among 380 Rohingya refugees found that fungal, particularly dermatophyte, infections were the most common (n = 215), particularly in women of reproductive age. There is scope for point-of-care testing and initiatives to improve the training of healthcare workers, as well as patient education. Globally, there is a rise in recalcitrant and recurrent tinea associated with dermatophyte resistance. Dermatologists have a central role in the promotion of global health. Efforts to help displaced populations are constrained by diagnostic and therapeutic resources, as well as specialist expertise. Telemedicine offers a solution but is constrained by telecom infrastructure and workforce shortages.