AMMAN: A “major outbreak” of measles is hitting the encircled, rebel-controlled Damascus suburbs of East Ghouta, with doctors telling Syria Direct that vaccine shortages are to blame for more than 350 cases of the easily preventable disease in under two months.

With up to 80 percent of children unvaccinated inside the 450,000-person opposition pocket, measles is making an alarming resurgence where such incidences were once “very rare” before the war, Amani, a pediatrician at the Kafr Batna hospital who asked to be referred to only by her first name, told Syria Direct.

Doctors began seeing patients with the disease as recently as late December, she said. “By the beginning of February, it became an outbreak,” Amani said. Doctors across East Ghouta now tally more than 350 confirmed cases of the disease, with new patients diagnosed daily.

Measles is a viral disease that disproportionately affects young children, often with a fever, rash and potentially lethal complications that can be prevented by immunization. Vaccines, however, have either been slow or entirely unable to reach East Ghouta amidst the Assad regime’s ongoing blockade and bombardment of the rebel-held territory, 2km east of Damascus. The encirclement, coupled with densely crowded living conditions due to mass internal displacement, are turning the 100 sq. km suburbs into a breeding ground for the highly contagious infection.

As a result, hundreds of East Ghouta children now suffer from dangerously high fevers, severe respiratory issues and, in at least two instances, death.

Dr. Amani, an East Ghouta pediatrician, treats measles patients in Kafr Batna. Photo courtesy of UOSSM.

Even when the Syrian Arab Red Crescent delivered scores of vaccines to East Ghouta on March 9—the first such shipment in months—doctors said the amount was “hardly enough” to treat the area’s unvaccinated population.

Dr. Amani describes the local hospital as “packed with children” waiting to receive one of the limited vaccines, which are often given on a first-come, first-serve basis.

“Inevitably, not all of the children will get the vaccine…what we have just isn’t enough,” she said.

At least two people have died of measles-related complications since the start of the outbreak earlier this month. They include a 23-year-old woman in Kafr Batna and an eight-year-old girl in the town of Hamouriyah, 2km northeast.

Children who are already symptomatic cannot be given a vaccine, and antiviral treatment does not currently exist for the disease. This means that doctors can only resort to palliative measures such as painkillers, antipyretics and IV fluids to ensure that the condition of patients, such two-year-old Mohammad Nour, does not worsen.

Nour spent more than 15 days in the Kafr Batna hospital with upper respiratory problems, a rash characteristic of measles and severe conjunctivitis. His condition deteriorated to such an extent that he was unable to open his eyes for two days, his mother, Umm Mohammad, told Syria Direct.

“I was incredibly worried for my child’s life,” she said.

“Even though he’s doing relatively better now, I don’t deny that I’m still afraid for his health. I'm also afraid that he may infect another child,” said Umm Mohammad.

Families with multiple, unvaccinated children living in one room such as Umm Mohammad’s often see more than one child contract the virus.

Syrians sit at a shop selling firewood in Kafr Batna, January 27, 2017. Photo courtesy of AMER ALMOHIBANY/AFP/Getty Images

In patients with access to quality health care, measles can be managed. But for populations with malnutrition and inadequate health care, “mortality can be as high as 10 percent,” the France-based Union of Medical Care and Relief Organizations (UOSSM) reported earlier this month. Children affected by measles within East Ghouta face an added risk of serious health complications given the dire food and medical shortages resulting from the opposition-held area’s five-year encirclement.

Fears of measles-related complications stemming from severe malnutrition drastically increased last month after regime forces launched a campaign to cut East Ghouta’s vital food and medical supply routes via underground tunnels, Syria Direct reported. The ongoing campaign is largely stalemated with little ground changing hands but has claimed dozens of lives.

While disproportionately affecting the young, “it’s important to note that measles does not just affect children,” said Dr. Ahmed al-Baqai, the director of the Save a Soul center, East Ghouta’s only medical center specialized in infectious diseases and epidemics, which is in Kafr Batna.

“There are even confirmed cases with people over the age of 40,” he added.

The United Nations has been unable to transport vaccines to encircled towns within East Ghouta for several months because of “fighting in the area and road closures due to security issues, lack of administrative permissions and facilitations and/or agreement between parties to the conflict,” Linda Tom, a spokeswoman with the UN Office for the Coordination of Humanitarian Affairs (UNOCHA), told Syria Direct from Damascus.

With doctors recording new cases of measles every day, “time is running out for the people of East Ghouta,” Elizabeth Hoff, the World Health Organization (WHO) Representative in Syria, said in a press statement on Monday. “As health needs increase, available resources are being depleted day by day.”

Measles is one of the leading causes of vaccine-preventable deaths, with more than 134,200 deaths attributed worldwide to the disease in 2015, the World Health Organization reported in November.

That figure is down from an estimated 2.6 million annual measles-related deaths prior to widespread vaccination campaigns beginning in 1980.