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Ibrahim Hassan is propped up on pillows on a cement floor when a physician comes to check on him. Hassan fled to Jordan from southern Syria after conflict erupted there in 2011. The 65-year-old can no longer walk as a result of multiple strokes, which his doctor blames on high blood pressure — but Hassan blames on fear. One stroke hit just as Hassan (whose name has been changed to protect him) made it to Syria’s border with Jordan, after 18 hours of dodging bullets, bombs and hostile soldiers.

Hassan’s encounter with tragedy is all too common here. Across the Middle East, deaths resulting from violence grew by 850% between 1990 and 2015, according to a series of reports published on 3 August in the International Journal of Public Health1–15. The increase accelerated after 2010, corresponding with the beginning of the Arab Spring movement and wars in Syria and Iraq. At the same time, the authors found, the incidence of many chronic diseases has also risen dramatically; the death rate from diabetes, for instance, grew 216% over the study period.

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