Early in my education as a flu blogger, I asked a naive question: In a pandemic, what happens to the routinely ill?
I never really got an answer, though I've learned a bit about hospital surge capacity (mostly the lack of it) when serious outbreaks occur. And, mercifully, the H1N1 pandemic wasn't as universal as a proper zombies-in-the-streets catastrophe.
But events in Syria and now in Egypt keep reminding me of my original question. When hospitals and their staff are busy dealing with gunshot and shrapnel wounds, who's free to look after the dialysis patients and the new babies? Egypt hasn't reported a new H5N1 case since April, but is anyone even looking at this point?
Syria's public health system, meanwhile, appears to have collapsed altogether. Syrian refugees in Turkey, Iraq, and Jordan are testing the surge capacity of their hosts' hospitals. Could MERS have broken out in Syria? How would we know?
What's really disturbing is that this aspect of a political disaster goes unnoticed. Everyone's snapping photos of the corpses in the square and the funeral processions following children's coffins, but we hear nothing about how the vaccination campaigns are going, or whether waterborne diseases are on the rise.
Egypt's Ministry of Health and Population website, when Google translated, offers nothing but the blandest reports on investment plans agreements with Bahrain. The link to the Media Centre news page takes you to a blank page with no news at all.
The English page of the Syrian Ministry of Health looks more informative, until you see that the "Epidemical Bulletin" dates to last autumn (a 2011 bulletin is also available, but the avian influenza preparedness page gets an error message).
So the Syrian civil war goes unmentioned in the government's website (and health statistics seem no more recent than 2009). Egypt, after weeks of civil unrest and a week of carnage, has nothing to say about how delivery of health services might be a bit complicated for a while.
And the international media have no more to say about the problem than the ministries do.